Rabies2.pptx

Designing a Community Based Rabies Surveillance (CBRS) System for Muntinlupa City By: Global Alliance for Rabies Control

PROJECT DETAILS: 

DURATION: June 2108-November 2019

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SITE: Muntinlupa City

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PROJECT ACTIVITIES:

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Community Based Rabies Surveillance System Development ( June –December 2018)

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Field Application : January –December 2019

Objectives of CBRS: •Early detection of suspect rabid animals and humans with high risk of rabies exposure for rapid response

•Track progress of rabies elimination efforts to guide program implementation

The Philippines has a strong national rabies control program, but children are still at risk 

THE PROBLEM:

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The Philippines has over 500 bite treatment clinics providing free rabies vaccination

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But 200-250 human deaths occur per year because rabies is not yet controlled in dogs

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The Philippines has a strong network of voluntary community health workers

THE SOLUTION IN THIS SETTING: 

DHIS 2 can link a widely distributed health network to the resource limited veterinary services to identify the high risk area quickly and support faster responses and better dog vaccination control program.



GARC wants to use DHIS 2 to allow Community Health Workers to improve rabies control and save lives

Use of DHIS2 for Community-Based Rabies Surveillance (CBRS) 

Good surveillance is essential to controlling and eliminating rabies

 Good surveillance can assist in:

• Guiding strategic dog vaccination • Identifying new cases rapidly • Ensuring exposed individuals receive adequate PEP

Integrated Bite Case Management (IBCM)  

is integral in an effective, active surveillance system Helps to identify new cases

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Identifies suspect animals

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Ensures more cases are detected and reported

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Facilitates investigations and follow-up Improves suspect sample submission Can result in reduced PEP usage

IBCM  IBCM

relies on people on the ground within communities reporting suspect animals and bite incidents •

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 

These reports trigger a cascade of responses

Ideally, every bite patient is identified Risk assessment undertaken to determine risk of rabies and need for PEP

 Veterinary

investigations to identify suspect animal and act accordingly  Results in samples being obtained for laboratory confirmation  Potential for rapid vaccination responses to area where positive cases identified to stem further spread of the disease

ConceptThe idea of the Community-Based Rabies Surveillance (CBRS) is to:  For

animals

• Rapidly identify suspect animals in communities

• Trigger a rapid veterinary investigation response in that Barangay • Quarantine or sample the animal for lab testing • Track sample to the lab with diagnostic outcome being available immediately

 For

humans: • Identify potentially exposed individuals in the Barangay • Link these individuals to the suspect animal • Base PEP on laboratory result (negative result, patient can stop PEP)

DHIS 2 Enabled Active Surveillance by Healthcare workers in the Community can:  Empower

healthcare workers to better serve their communities  Enable coordination between medical and veterinary sectors and local and national government  Ensure that bite victims get full vaccination to protect them from fatal rabies

 Contribute

data vital for longer term and vaccination campaigns to eliminate rabies  Contribute data that will enable WHO to monitor the global goal of an end to rabies by 2030  Demonstrate the power of tools that can easily replicated in all rabies endemic countries

CBRS in DHIS2 – automation and realtime reporting  Automated and immediate email and system

messages • More rapid responses and raised awareness 

Automated alerts for overdue investigations and follow ups

• Ensure that cases are being investigated and patients treated • Enables rapid vaccination to prevent spread of disease • Improves PEP compliance

Making connections

• Identified suspect animals can be linked to potentially exposed individuals • Outcomes of veterinary quarantine or lab diagnosis can influence exposed individuals’ PEP requirements • Samples received at the lab can be linked with other exposed individuals

System directionality 

The system can be used in almost any ‘direction’

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The system can be used in any of the situations when:

• Identifying a suspect animal in a Barangay • Identifying a bite victim in the Barangay • Receiving a laboratory sample and linking exposed individuals to the sample

This means that any of the scenarios can be used as the starting point within the system  Reduces limitations of some systems that have to start with identifying a bite victim 

COLLABORATION 

ABTCs and ABCs

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City Vet

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CHO

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BHWs

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Epidemiology Bureau

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GARC

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RITM

Event-based Reporting and Response Events for Reporting

Joint Response

(BHWs and ABTCs)

Investigations

(CVO & CHO )

and dog owners

Program Monitoring

• PEP for bite Check vaccination victims

( ABTC and CVO )

•

Interview bite victims

Monthly and Quarterly Reports

status of biting animal • Dog

Suspect Rabid Animal •

•

Quarantine and vaccination observation of animal

Collection and testing • Impounding of of samples •

campaigns

stray animals

Contact tracing (bite

Human with high-risk victims) and referral Rabies Exposure for PEP and follow-up

Focal Points for DHIS data input, analysis and monitoring Computer City Vet Office/City Health Office (CESU?) RITM (Animal Lab)/ BAI Lab? GARC (for monitoring & trouble shooting)

ABTCs ?

Mobile Phone BHWs

Events to be Reported

A. Suspect Rabid Animal (without known biting incident)

◦ Dog or cat with signs & symptoms of rabies – for quarantine and observation (14 days), sample to be collected if animal dies within 14 days ◦ Dog

or cat that died of unknown cause – sample to be collected for testing

Events to be Reported B. High Risk Bite Incident or Event BITING ANIMAL (DOG OR CAT)

* With Signs & Symptoms of Rabies

 stray dog

 with multiple severe or deep bite wounds

 bites multiple persons

 bite wounds in head, neck, hands, toes and genital areas (highly innervated)

 bite is unprovoked  dies within 14 days of bite incident  unvaccinated  unknown status (lost)

AND Bitten by suspect rabid animal OR Anyone bitten by confirmed rabid animal OR

HUMAN BITE VICTIM

Rabies Death

May rule out Rabies if … •animal is alive after 14 days from bite incident •animal sample is negative for rabies

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biting animal has verifiable adequate vaccination history

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other cause of human or animal death is known

Data to be entered in DHIS ANIMAL 

type of animal

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owner’s name, address, contact info

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date and location of biting incident

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age and sex

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address and contact information date & location of bite incident

vaccination status circumstances surrounding bite incident

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outcome after 14 days

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lab result

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HUMAN  name

FINAL DIAGNOSIS

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vaccination status

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patient status

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FINAL DIAGNOSIS

Indicators for Monitoring Program Indicators (by time and place) 

No. of Bite Incidents

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No. (%) of suspect animals tested & no. (%) positive for rabies

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No. (%) of suspect animals found vaccinated

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No. (%) of suspect animals alive after 14 days

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No. (%) of biting animals with probable or confirmed rabies

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No. (%) of humans bitten by highly suspect animals with complete PEP

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No. of Human rabies cases by age and sex

Surveillance and Response Indicators 

Data accuracy

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Completeness and timeliness of reporting & response

Tools to be developed  Guidelines (Manual) for CBRS  Unique ID for linking investigation form, lab form, patient record  Customized DHIS Software

 Report template – frequency, users  Tracking logbook – Event ID, Animal Owner, Bite Victim/Patient

THANK YOU