Rabies Control in N'djamena, Chad
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Rabies control in N’Djamena, Chad INAUGURALDISSERTATION zur Erlangung der Würde eines Doktors der Philosophie vorgelegt der Philosophisch-Naturwissenschaftlichen Fakultät der Universität Basel von Monique Sarah Léchenne Aus Sceut/Glovelier JU, Schweiz Basel, 2017 Original document stored on the publication server of the University of Basel edoc.unibas.ch This work is licensed under a Creative Commons Attribution 4.0 International License. Genehmigt von der Philosphisch-Naturwissenschaftlichen Fakultät auf Antrag von Prof. Dr. Jakob Zinsstag und Prof. Dr. Louis Nel Basel, den 10. November 2015 Prof. Dr. J. Schibler Dekan der Philosophisch-Naturwissenschaftlichen Fakultät « Ce n’est pas une vie que de ne pas bouger !» Alexandre Yersin <What was life, if you don’t commit to something?> <Das ist doch kein Leben, wenn man nichts unternimmt> To the anonymous children with the puppy on my desktop picture - my daily motivation (Plate 1) Table of contents TABLE OF CONTENTS Table of Contents ...................................................................................................................... i Index of Tables ........................................................................................................................ iii Index of Figures ....................................................................................................................... v Table of Acronyms ................................................................................................................ viii I. Acknowledgements ............................................................................................................... x II. Summary ............................................................................................................................. xi III. Résumé ............................................................................................................................ xiii IV. General introduction........................................................................................................... 1 IV.1 Research subject ............................................................................................................... 1 IV.1.1 Rabies: invariably fatal but entirely preventable ............................................... 1 IV.1.2 The destructive dynamics of neglect ................................................................ 4 IV.1.3 Prospects and tools for rabies elimination ........................................................ 8 IV.1.4 The potential for One Health ambassadorship ............................................... 10 IV.2 Research approach ....................................................................................................... 11 IV.2.1 From desk to field: Translational Research .................................................... 11 IV.2.2 The common goal: Transdisciplinary research .............................................. 13 IV.2.3 The path to sustainability: Community Participation ..................................... 15 IV.3 Research Context ......................................................................................................... 17 IV.3.1 N’Djamena: Split between dearth and boom ................................................ 17 IV.3.2 Program foundation: A decade of rabies research in N’Djamena .................. 18 IV.3.3 From research to action back to research: The present elimination program ........................................................................................................... 21 V. Aim and Objectives ........................................................................................................... 23 CHAPTER 1: Operational performance and analysis of two rabies vaccination campaigns in N’Djamena, Chad .................................................................................. 24 i CHAPTER 2: The importance of a participatory and integrated One Health approach for rabies control: the case of N’Djamena, Chad ......................................................... 43 CHAPTER 3: Validation of a rapid rabies diagnostic tool for field surveillance in developing countries .................................................................................................... 61 CHAPTER 4: Mass dog vaccination rapidly interrupts rabies transmission and human exposure in an African city .......................................................................................... 86 CHAPTER 5: Rabies awareness and dog ownership among rural northern and southern Chadian communities - Analysis of a community-based, cross- sectional household survey ........................................................................................ 110 CHAPTER 6: Cost estimate of canine rabies elimination by parenteral mass vaccination in Chad .................................................................................................... 134 CHAPTER 7: A mixed methods approach to assess animal vaccination programmes: the case of rabies control in Bamako, Mali ................................................................ 151 VI. WORKING PAPER: Molecular dynamics of classical rabies virus during a mass dog vaccination campaign .......................................................................................... 174 VII. Book Chapters .............................................................................................................. 181 VII.1 Integrated Rabies Control ....................................................................................... 181 VII.2 Rabies in East and Southeast Asia - a mirror of the global situation .................. 196 VIII. Discussion ................................................................................................................... 211 V.III.1 Did we turn the wheels? ........................................................................................... 211 VIII.2 Have we met our ideals? ............................................................................................ 218 VIII.3 Short and long term prospects for rabies control in Chad ......................................... 224 IX. Conclusion ..................................................................................................................... 229 X. References ....................................................................................................................... 230 XI. Plates .............................................................................................................................. 252 ii Index INDEX OF TABLES Table IV.1 The Ladder of Pretty derived from Jacobs 2010 15 Table 1.1 Coverage estimates, number of owned dogs, percentage of ownerless dogs and total dog population by district and vaccination sequence . 29 Table 1.2 Summary of animals vaccinated by district in 2012 and 2013 31 Table 1.3 Data from the household survey 39 Table 2.1 Number of responding health facilities and questionnaires collected. 47 Table 2.2 Summary of results of samples received for rabies diagnosis at IRED, by species 49 Table 2.3 Number of questionnaires and participating health facilities per district compared to the population census of 2009 51 Table 3.1 Description of samples tested in Chad and results obtained after FAT, RIDT and RT-qPCR on FTA papers. 65 Table 3.2 Limit of detection of the RIDT using 8 different titrated rabies virus suspensions 71 Table 3.3 Intrinsic parameters of the RIDT after laboratory evaluation (NRC-R), under field conditions (IRED) and when combining both conditions (all) 72 Table 3.4 Detection of viral RNA with RT-qPCR on Anigen test strip used in field conditions (IRED), in laboratory conditions (NRC-R) or combined. 73 Table 3.5 Comparison results of the detection of viral RNA with RT-qPCR performed on FTA Whatman cards and Anigen test strips 73 Table 3.6 Evaluation of the RIDT Anigen test in NRC-R in an inter-laboratory trial 74 Table S3.1 Description of samples tested at NRC-R, Paris, France 77 Table S3.2 Oligonucleotide sequences of primers and probes used in the combo RT- qPCR (combination of pan-RABV and pan-lyssa RT-qPCR assays) and in the internal control eGFP-based RT-qPCR assay 80 Table S3.3 Comparison results obtained with samples from NRC-R for the post-mortem diagnosis of rabies using FAT and RIDT, and for the detection of rabies virus RNA using Anigen test strip as support material 82 Table S3.4 Comparison results obtained with samples from IRED for the post-mortem diagnosis of rabies using FAT and RIDT, and for the detection of rabies virus RNA using Anigen test strip and FTA Whatman card as support material 84 Table 4.1 Number of dogs vaccinated in each week of the vaccination campaigns 97 Table 4.2 State variables of dog rabies transmission model 99 Table 4.3 Parameters of the rabies transmission model with estimated values and sources 99 Table 5.1 Key characteristics of the regions sampled 116 Table 5.2 Knowledge parameters and scores assigned to correct answers 118 iii Index Table 5.3 Socio-demographic characteristics of the 963 surveyed households by geographical area 120 Table 5.4 Estimated dog:human ratio in the study population and different subpopulations 121 Table 5.5 Linear extrapolation of the rural owned dog population and dog density on region level 121 Table 5.6 Univariable and multivariable generalized estimating equation models for binomial outcome variables to determine factors associated with rabies awareness 124 Table 5.7 Univariable and multivariable