bioRxiv preprint doi: https://doi.org/10.1101/2020.06.08.140517; this version posted June 9, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license. 1 Baseline epidemiology and associated dog ecology study towards stepwise elimination of 2 rabies in Kwara state, Nigeria 3 Al-Mustapha, Ahmad Ibrahim a,b*, Abubakar Ahmed Tijani b,c, Oyewo Muftau b,c, Folashade 4 Onatola Bamidele b,c, Ahmed Ibrahim b,c, Muhammad Shuaib Osu d, Babasola Olugasa e, 5 Muhammad Shakir Balogun f, Grace Kia g,h, Stella Mazeri i, Annamari Heikinheimo a 6 a Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, 7 University of Helsinki, Finland. 8 b Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural 9 Development, Ilorin, Nigeria. 10 c Nigerian Field Epidemiology and Laboratory Training Program, Asokoro, Abuja-Nigeria. 11 d Federal Department of Veterinary and Pest Control Services, Federal Ministry of 12 Agriculture and Rural Development, Abuja -Nigeria. 13 e Department of Veterinary Public Health and Preventive Medicine, Centre for Control and 14 Prevention of Zoonoses (CCPZ), Faculty of Veterinary medicine, University of Ibadan, 15 Nigeria. 16 f African Field Epidemiology Network, Abuja – Nigeria. 17 g Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary 18 Medicine, Ahmadu Bello University, Zaria-Kaduna State, Nigeria. 19 h War Against Rabies Foundation, Abuja- Nigeria. 20 i Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of 21 Edinburgh, Edinburgh – UK. 22 23 *Correspondence: 24 Al-Mustapha, Ahmad Ibrahim 25 [email protected] 26 27 28 29 30 31 32 33 34 1 bioRxiv preprint doi: https://doi.org/10.1101/2020.06.08.140517; this version posted June 9, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license. 35 Abstract 36 Understanding domestic dog population dynamics and ecology is necessary for any effective 37 rabies control program. This study was conducted as part of the baseline epidemiological 38 studies necessary for the establishment of the Kwara Rabies Rapid Alert System “KRRAS”. 39 The aim of this study was to determine the dog population structure of Kwara State by assessing 40 the dog ownership, vaccination status, and prevalence of dog bites. 41 A total of 1,460 questionnaires were administered to respondents in the three senatorial zones 42 of the state using Open Data Kit (ODK) between June 2019 to January 2020. 43 Of the 1460 households surveyed, 293 (20.1%) owned at least one dog with an average of 2.25 44 dogs per household. The male to female ratio was 2.2:1 and 85% (n=250/293) of the owned 45 dogs were local breeds. A total of 785 dogs was enumerated (659 dogs from 293 households 46 and 126 free-roaming dogs) and 7811 persons which resulted in a dog-human ratio of 1:9.95. 47 The estimated dog population is 376,789 (95% CI: 343,700 – 379,878). The dog anti-rabies 48 vaccination coverage was 31% (n=92/293). The prevalence of dog-bite was 13% (n=193/1460) 49 of which only 27% of the victims (n=61/225) received post-exposure prophylaxis (PEP). The 50 ethnicity of respondents had a significant impact on dog ownership. Yoruba’s more often (OR: 51 2.2-5; 95% CI: 1.2 - 12.4; p < 0.001) owned dogs than other tribes. The vaccination status of 52 owned dogs was greatly impacted by the level of education of the respondents (OR: 5.03; 95% 53 CI: 1.5073 - 16.8324; p < 0.001); the breed of the dog with exotic dogs being more vaccinated 54 (OR: 2.8; 95% CI: 0.7150 - 10.857; p < 0.001) and the confinement of the dog (OR: 2.07; 95% 55 CI: 1.1592 – 3.7037; p < 0.001). Always confined dogs were twice more vaccinated than non- 56 confined dogs. The results of the study showed that the vaccination coverage needs to be 57 increased, the number of dog bites needs to be reduced, the number of non-confined dogs needs 58 to be reduced and stray dog control strategies need to be implemented. The findings of this 2 bioRxiv preprint doi: https://doi.org/10.1101/2020.06.08.140517; this version posted June 9, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license. 59 study showed very low vaccination coverage for dogs which is below the 70-80% target 60 recommended for herd immunity by the world health organization. 61 Keyword: Rabies; KRRAS; Vaccination; Baseline dog ecology; Nigeria 62 63 64 Background 65 Rabies is one of the oldest and most terrifying diseases known to man (Horton et al., 2015). It 66 is a fatal viral disease caused by one of the seven lineages of lyssavirus with a distinct “bullet” 67 shape belonging to the family Rhabdoviridae (Badrane et al., 2001). Domestic dogs account 68 for over 99% of human death from rabies (WHO, 2013). 69 It causes approximately 59,000 (95% CI: 25 - 159,000) human deaths annually mainly in Asia 70 and Africa with 40% of people bitten by suspect rabid animals are children under 15 years of 71 age (OIE, 2017a). Annually, it is responsible for 3.7 million (95% CI: 1.6 - 10.4 million) 72 disability-adjusted life years (DALYs) and 8.6 billion USD (95% CI: 2.9 - 23.5 billion) 73 economic losses (Hampson et al., 2015). 74 Rabies is endemic in Nigeria and has remained one of the most important neglected diseases 75 of public health concern in the country. Despite the under-reporting of dog-bites incidents, 76 about 10,000 cases of dog-bites are reported annually (NCDC, 2018). The rabies viral antigen 77 has been detected in the brain tissues of apparently healthy dogs slaughtered for human 78 consumption (Suleiman et al., 2020; Mohammed et al., 2019; Kia et al., 2018; Hambolu et al., 79 2014; Garba et al., 2010). 80 Several factors such as poor vaccination strategy, lack of sufficient vaccines, presence of stray 81 (community) dogs and illegal trade of dogs within and across countries are major contributory 82 factors to the endemicity and transboundary movement of rabies in Nigeria (Kia et al., 2018; 83 Ogo et al., 2011; Ogunkoya et al., 2008). The epidemiology of rabies has been described in 3 bioRxiv preprint doi: https://doi.org/10.1101/2020.06.08.140517; this version posted June 9, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license. 84 Nigeria with dogs as the main reservoir of the disease (Kia et al., 2018; Garba et al., 2011; 85 Ameh et al., 2014). Most industrialized countries have eliminated rabies from domestic dog 86 populations. However, in the majority of developing countries, rabies remains endemic in 87 domestic dog populations and poorly controlled (Coleman et al., 2004). The presence of 88 unvaccinated free-roaming dogs (FRD) amidst human settlements is a major contributor to the high 89 incidence and maintenance of rabies in Nigeria. 90 Mass dog vaccination is the most cost-effective strategy for preventing human rabies (OIE, 91 2017b). Vaccinations can be by parenteral administration of inactivated vaccines or by the use 92 of baits for oral vaccination of dogs (Maki et al., 2017). Dog vaccination reduces deaths 93 attributable to rabies and the need for post-exposure prophylaxis (PEP) as a part of dog bite 94 patient care (Cliquet et al., 2018). 95 Through the implementation of the Global strategic plan to end human deaths from dog- 96 mediated rabies by 2030 (WHO, 2017), the importance of projects such as KRRAS cannot be 97 over-emphasized. The project is divided into three phases: Baseline epidemiological 98 assessment studies; Mass dog vaccinations; Surveillance of dog-bite cases in the state using 99 the existing disease surveillance and notification officers (DSNOs) in the state. This study, as 100 well as three others, are the epidemiological basis for the proposed Kwara Rabies Rapid Alert 101 System (KRRAS)- a one health system designed to improve reporting of dog-bite cases and 102 enhance diagnosis of rabies. 103 Our baseline data aims to generate evidence-based data that can be used for the dog leash law 104 (in Kwara State). Estimation of the dog population and ecology in the state is important in 105 vaccine procurement and prioritizing intervention plans. 106 107 4 bioRxiv preprint doi: https://doi.org/10.1101/2020.06.08.140517; this version posted June 9, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-NC-ND 4.0 International license. 108 Methods 109 Study area 110 Kwara State, located in the southern guinea savannah zone of Nigeria between latitude 8.9669° 111 N, and longitude 4.3874° E.