A Blueprint for Rabies Surveillance

Almost every rabies-related document stresses the importance of surveillance. Rabies surveillance is vital for any rabies elimination program and helps to put and maintain the disease on the agenda of public and veterinary health authorities as well as policy makers. In regions of the world where rabies is still a neglected disease surveillance is the key link in a chain what is called the “circle of neglect”. Unfortunately, many countries in Africa and Asia are confronted with this situation. Breaking the ‘circle of neglect’ will stop underreporting of rabies cases both in humans and animals, enable assessment of the true burden of disease in a given country and hence, result in policy changes required to tackle rabies at the source.

So far so good. However, have you ever asked yourself what rabies surveillance actually means? Are you aware of the components rabies surveillance comprises of? Do you know what is required and needed to make rabies surveillance in humans and animals adequate and efficient? Is rabies surveillance the same as monitoring? Do you know which form of surveillance is best suited for rabies, who is responsible for implementing rabies surveillance and what you can do to make the system work?

Why all these questions? Because sometimes the answers are not obvious. Although there exist general guidelines from WHO, OIE and FAO on adequate disease surveillance, there is no detailed rabies tailored approach covering both human and animal related aspects of surveillance yet. Also, experience has shown that responsible authorities and people across the world often have different perceptions on the issue, different states of knowledge, and sometimes even misconceptions.

Hence, there was a desire in the global rabies community to make such relevant information easily available to make a difference in the global fight against rabies.  Now a small group of experts from the ‘Partners for Rabies Prevention’ (PRP), an informal group of stakeholders, under coordination of the Global Alliance for Rabies Control has developed a new third module using the successful simple Q&A format and integrating it into the existing Rabies Blueprint website. Their effort is greatly acknowledged.

The first version of the new information and learning module, the Rabies Surveillance Blueprint is now complete. It brings together relevant information from specific international health organizations, published data from the field, as well as expert knowledge on the topic in an easily accessible format. It is not meant to replace existing material or national guidelines but rather is meant to serve as an easy to use guide to assist countries in understanding how to conduct adequate rabies surveillance, as well as how to report and use the data generated to improve rabies control in any species.

The Surveillance Blueprint is divided into six main sections: (I) Introduction, (II) Rabies Surveillance, (III) Minimum requirements for adequate rabies surveillance, (IV) Laboratory rabies diagnosis, (V) Epidemiological analyses and (VI) Reporting, dissemination and communication. Like with the canine and fox rabies blueprints answers to 78 rabies surveillance related questions are provided in clear and concise key messages, including links to specific documents and websites for more information if so required. One of the big advantages over traditional printed guidelines is that the Blueprint will be regularly updated by PRP experts and new or modified recommendations can be immediately included as they become available. Based upon an initiative of WHO, this living document will further evolve by incorporating approved standard operating procedures (SOP) for standard laboratory techniques in rabies diagnosis.  Also, it is being contemplated to provide exemplary organizational flow charts that can be used as templates for countries in need in Africa or Asia by giving them ideas how other countries in the world implemented structures, work flows and chain of commands to make rabies surveillance efficient.

Written by Dr Thomas Müller of the WHO Collaborating Centre for Rabies Surveillance and Research at the Freidrich Loeffler Institut in Germany. Dr Müller and Dr Dennis Slate of the United States Department of Agriculture lead the team who wrote the Rabies Surveillance Blueprint. Suggestions and useful information for further elaboration of this information tool are encouraged and should be sent to [email protected].