Rabies in the Americas: 1998-2014

Abstract

Through national efforts and regional cooperation under the umbrella of the Regional Program for the Elimination of Rabies, dog and human rabies have decreased significantly in Latin America and Caribbean (LAC) countries over the last three decades. To achieve this decline, LAC countries had to develop national plans, and consolidate capabilities such as regular mass dog vaccination, opportune post-exposure prophylaxis and sensitive surveillance. This paper presents longitudinal data for 21 LAC countries on dog vaccination, PEP and rabies surveillance collected from the biannual regional meeting for rabies directors from 1998–2014 and from the Regional Epidemiologic Surveillance System for Rabies (SIRVERA). Differences in human and dog rabies incidence rates and dog vaccination rates were shown between low, middle and high-income countries. At the peak, over 50 million dogs were vaccinated annually in national campaigns in the countries represented. The reported number of animal exposures remained fairly stable during the study period with an incidence rate ranging from 123 to 191 reported exposures per 100,000 people. On average, over 2 million doses of human vaccine were applied annually. In the most recent survey, only 37% of countries reported that they had sufficient financial resources to meet the program objectives. The data show a sufficient and sustained effort of the LAC countries in the area of dog vaccination and provide understanding of the baseline effort required to reduce dog-mediated rabies incidence. Globally, dog-mediated rabies kills over 55,000 people on an annual basis and disproportionally affects socio-economically disadvantaged populations. For over 4 decades, the Latin America and Caribbean (LAC) region have worked towards the elimination of dog-mediated rabies succeeding in a substantial reduction of both human and dog rabies cases. This paper summarizes the last 15 years of the national and regional rabies elimination efforts, through a series of performance indicators, including government mass dog vaccination campaigns and post-exposure prophylaxis for humans. The most important message from the tail of the rabies epidemic in the LAC Region is one of endurance by the countries and the region to achieve rabies control and elimination. The performance indicators shown in this paper are tools for the LAC region to evaluate its progress and refine its approach, and for other regions to understand the scope of the effort required to reach elimination.