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Rabies in sub-Sahara Africa: One Health-based surveillance strategy in the Kongo Central province (Democratic Republic of the Congo) and disease transmission in N'Djamena (Chad)

Mbilo, Céline. Rabies in sub-Sahara Africa: One Health-based surveillance strategy in the Kongo Central province (Democratic Republic of the Congo) and disease transmission in N'Djamena (Chad). 2021, Doctoral Thesis, University of Basel, Associated Institution, Faculty of Science.

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Abstract

Rabies is a viral zoonotic disease transmitted to humans in more than 99% of cas-es through the bite or scratch of an infected dog (dog-mediated rabies).To date all countries on the sub-Saharan African mainland are considered endemic for dog-mediated rabies. Estimates on the worldwide burden suggest that more than a third of the annual 59’000 human rabies deaths occur in Africa, predominately in impoverished rural communities with limited access to health care. Against this background, and in view of the global goal of eliminating human deaths from dog-mediated rabies by 2030, this PhD thesis aimed to provide new insights into the epidemiology of rabies in the DRC and rabies transmission dynamics in Chad.
The PhD work applied a One Health approach to foster intersectoral collaboration and combined desk-based work with extensive field and laboratory work in a challenging research environment.
Most countries in West and Central Africa are still far from meeting the global goal of zero human rabies deaths by 2030 due to lack of govern-ment commitment and financial constraints. Surveillance of rabies in a province of the DRC re-vealed that rabies is a significant public health problem largely underestimated by official health statistics. The data generated through this study provide a sound evidence base to reflect the vet-erinary and public health implications of rabies and advocate for greater political commitment and policy support in rabies prevention and control. Results obtained through the cross-sectional household survey showed that the owned dog population was almost ten times larger than that assumed by local veterinary officials, with a large proportion of free-roaming unvaccinated dogs. Rabies awareness among the community was low, with knowledge gaps that result in poor prac-tices and unnecessary rabies deaths. The rapid immunodiagnostic test validated is a promising tool for decentralized rabies surveillance in endemic settings but requires further thorough valida-tion. In Chad, we demonstrated that the WHO-recommended dog vaccination coverage of 70% prevents major but not minor rabies outbreaks and that highly connected dogs play a critical role in transmission. Minor outbreaks may be explained by import of rabid dogs into N’Djamena from outside the city.
Both innovation and applied research are needed to reach the global goal of zero human rabies death by 2030, both of which were applied in this PhD thesis. We contributed vital information for rabies control in the sub-Saharan African region. Findings on the burden of rabies in humans and animals, dog ecology and community awareness in the DRC are directly relevant for veterinary and public health authorities and support planning of future rabies interventions. Applying new technologies to disease modeling helped generate new ideas on how dog vaccina-tion could become more effective in future and be useful to set new research targets.
Advisors:Zinsstag, Jakob Z and Cleaveland, Sarah
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Human and Animal Health > One Health (Zinsstag)
Item Type:Thesis
Thesis Subtype:Doctoral Thesis
Thesis no:14095
Thesis status:Complete
Number of Pages:XVIII, 280
Language:English
Identification Number:
  • urn: urn:nbn:ch:bel-bau-diss140953
edoc DOI:
Last Modified:07 Jun 2021 10:44
Deposited On:07 Jun 2021 10:44

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