Toward Elimination of Dog-Mediated Human Rabies: Experiences from Implementing a Large-scale Demonstration Project in Southern Tanzania
Toward Elimination of Dog-Mediated Human Rabies: Experiences from Implementing a Large-scale Demonstration Project in Southern Tanzania
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DOI：
10.3389/fvets.2017.00021
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发表时间：
2017-03-06
影响因子：
3.2
通讯作者：
Hampson, Katie
中科院分区：
文献类型：
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作者：
Mpolya, Emmanuel Abraham;Lembo, Tiziana;Hampson, Katie
2010年至2015年，坦桑尼亚实施了一项消灭狂犬病示范项目，汇集了卫生和兽医部门的政府部委、世界卫生组织以及国家和国际研究机构。在整个项目期间和项目地区收集了关于大规模犬只疫苗接种活动、咬伤暴露、暴露后预防（PEP）的使用和人类狂犬病死亡的详细数据。尽管在项目地区内以前没有狗接种疫苗的经验，但地区兽医官员能够实施全区范围的疫苗接种运动，在大多数情况下，逐步增加了项目每个阶段接种疫苗的狗的数量。咬伤暴露量下降，特别是在最南端的地区，狗的人口最少，和卫生工作者成功地从主要的PEP肌内给药过渡到皮内给药，从而节省了大量的成本。然而，即使改进了PEP的供应，一些地区仍然出现疫苗短缺。在实验室诊断中，样本处理和提交方面存在一些后勤挑战，但与项目开始前的情况相比，项目地区提交和检测狂犬病的实验室样本数量略有增加，狂犬病阳性样本的比例随着时间的推移而下降。该项目对公共卫生政策和实践产生了重大影响，在总理办公室成立了一个卫生协调股，并制定了坦桑尼亚国家狂犬病控制战略，该战略为坦桑尼亚按照“消除狂犬病逐步方法”（萨雷）到2030年消除狂犬病制定了路线图。总的来说，该项目产生了许多重要的经验教训，特别是狂犬病预防和控制，以及一般的疾病监测。经验教训包括：需要（1）在政府中设立一个专门的单位来管理疾病监测;（2）采用创新的数据收集和管理办法，如使用移动的电话;（3）所有关键部门和利益攸关方之间密切合作和有效沟通;以及（4）灵活和适应性强的计划，可以纳入新信息以改善其交付，并克服物流和采购方面的挑战。
A Rabies Elimination Demonstration Project was implemented in Tanzania from 2010 through to 2015, bringing together government ministries from the health and veterinary sectors, the World Health Organization, and national and international research institutions. Detailed data on mass dog vaccination campaigns, bite exposures, use of post-exposure prophylaxis (PEP), and human rabies deaths were collected throughout the project duration and project areas. Despite no previous experience in dog vaccination within the project areas, district veterinary officers were able to implement district-wide vaccination campaigns that, for most part, progressively increased the numbers of dogs vaccinated with each phase of the project. Bite exposures declined, particularly in the southernmost districts with the smallest dog populations, and health workers successfully transitioned from primarily intramuscular administration of PEP to intradermal administration, resulting in major cost savings. However, even with improved PEP provision, vaccine shortages still occurred in some districts. In laboratory diagnosis, there were several logistical challenges in sample handling and submission but compared to the situation before the project started, there was a moderate increase in the number of laboratory samples submitted and tested for rabies in the project areas with a decrease in the proportion of rabies-positive samples over time. The project had a major impact on public health policy and practice with the formation of a One Health Coordination Unit at the Prime Minister's Office and development of the Tanzania National Rabies Control Strategy, which lays a roadmap for elimination of rabies in Tanzania by 2030 by following the Stepwise Approach towards Rabies Elimination (SARE). Overall, the project generated many important lessons relevant to rabies prevention and control in particular and disease surveillance in general. Lessons include the need for (1) a specific unit in the government for managing disease surveillance; (2) application of innovative data collection and management approaches such as the use of mobile phones; (3) close cooperation and effective communication among all key sectors and stakeholders; and (4) flexible and adaptive programs that can incorporate new information to improve their delivery, and overcome challenges of logistics and procurement.