Boosting Rabies Surveillance: Zanzibar’s Success Story with Rapid Diagnostic Kits

While striving for rabies elimination, robust surveillance systems are required to determine the number of rabies cases. Monitoring the prevalence of rabies cases and subsequent laboratory diagnosis in humans and animals guides the implementation of effective control measures. However, these passive surveillance systems through which rabies cases are reported are often severely constrained in resource-limited settings, and no clear idea of the actual disease burden is given. As such, no political or financial investments are made towards rabies elimination efforts. Therefore, new and innovative methods are required to boost surveillance networks that will allow for timely intervention where rabies outbreaks are seen.

The recent advancements in rapid diagnostic test kits, such as lateral flow devices (LFDs), promise a solution to alleviate the surveillance burden and allow for rapid in-field testing of suspected rabies cases. These LFDs are easy to use, cost-effective, and allow for prompt disease intervention strategies to be put in place.

To test the efficacy of these LFDs in a field setting for rabies diagnosis, the ‘Rapid In-Field Diagnosis and Epidemiology of Rabies’ (RAIDER) toolkit was developed by GARC. The RAIDER toolkit consists of a series of steps to guide users through the brain sample collection procedure, using the LFD, capturing the sample information (including the GPS coordinates) using the GARC Rabies Case Surveillance (RCS) tool, and how to submit a field sample for confirmation to the nearest diagnostic laboratory capable of performing a WOAH-accredited assay (Figure 1). Whether the sample tested positive or negative, the toolkit is written in such a way that each sample is still submitted for diagnostic confirmation using a WOAH-approved and recommended diagnostic assay.

 

In a first study of its kind that was recently published, the RAIDER toolkit was tested on the island of Zanzibar between 2022 and 2023 to determine how the use of the LFDs affected the rabies surveillance network on the island. From the initial implementation of the RAIDER toolkit, a four-fold increase in the number of submitted samples could be seen, and samples were submitted from regions where surveillance data had previously been lacking.

The LFD devices provided two additional advantages that contributed to their continued use across the island: 1) implementing targeted dog vaccinations in regions where samples had tested positive, and 2) the ability to provide community members with information in real-time. As the LFD allows for a positive result to be seen within 10 – 15 minutes, the government of Zanzibar implemented an immediate and targeted dog vaccination campaign where positive rabies samples were seen.

This study not only highlighted that LFD devices were highly specific and sensitive in diagnostically screening rabies cases but also showed that their implementation significantly boosted the surveillance network on the island, leading to a more active surveillance approach. This, coupled with the real-time reporting on the GARC App enabled a significant increase in both active and passive surveillance across the island of Zanzibar, facilitating rapid outbreak responses, such as targeted and strategic vaccinations to rapidly break cycles of transmission before rabies can spread and affect more animals and people.

This study highlighted the importance of the RAIDER toolkit which improved overall surveillance and facilitated rapid outbreak response to facilitate efforts of progress towards achieving rabies elimination.  

If you want to learn more about the RAIDER toolkit or are looking to implement it in your own area or country, contact us.

Article contributed by: Ayla Malan, Technical support, GARC.