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The Importance of a Participatory and Integrated One Health Approach for Rabies Control: The Case of N’Djaména, Chad

Swiss Tropical and Public Health Institute, P.O.Box, Socinstrasse 57, CH-4002 Basel, Switzerland
University of Basel, Petersplatz 1, CH-4051 Basel, Switzerland
Centre de Support en Santé International, BP: 972, Moursal, N’Djaména, Chad
Institut de Recherché en Elevage pour le Développement, BP: 433, Farcha, N’Djaména, Chad
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2017, 2(3), 43;
Received: 31 May 2017 / Revised: 27 July 2017 / Accepted: 3 August 2017 / Published: 23 August 2017
(This article belongs to the Special Issue Rabies Symptoms, Diagnosis, Prophylaxis and Treatment)
PDF [1907 KB, uploaded 23 August 2017]


This study compares data on animal rabies cases from the Chadian national rabies laboratory, hosted at the Insitut de Recherche en Elevage pour le Developpement (IRED), with bite case reporting from health facilities. The data collection accompanied a mass dog vaccination intervention over two years in N’Djaména, Chad. This allowed for a comparison of the dynamics of the incidence of animal rabies cases, human bite exposure incidence and post-exposure prophylaxis (PEP) demand during a dog rabies elimination attempt. Following the mass vaccination, the monthly animal rabies incidence dropped from 1.1/10,000 dogs, as observed prior to the campaign in 2012, to 0.061/10,000 dogs in 2014. However, the PEP demand was found to be largely unaffected. The suspicion of the rabies exposure as reported by health personnel in most cases did not reflect the status of the biting animal but rather the severity of the bite wound, resulting in inappropriate PEP recommendations. In addition, the levels of reporting dead or killed animals to the rabies laboratory was found to be very low. These results reveal a profound lack of communication between health facilities and veterinary structures and the absence of an integrated bite case management (IBCM) approach. Improved communication between human health and veterinary workers is imperative to prevent human rabies deaths through the appropriate use of PEP and to further translate success in animal rabies control into cost savings for the public health sector through a lower PEP demand. Improved training of health and veterinary personnel and the sensitisation of the public are needed to achieve good IBCM practice, to increase the rate of diagnostic testing, to provide adequate and timely PEP, and to reduce the wastage of scarce vaccine resources. View Full-Text
Keywords: rabies incidence; post-exposure prophylaxis; integrated bite case management (IBCM); One Health rabies incidence; post-exposure prophylaxis; integrated bite case management (IBCM); One Health

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Lechenne, M.; Mindekem, R.; Madjadinan, S.; Oussiguéré, A.; Moto, D.D.; Naissengar, K.; Zinsstag, J. The Importance of a Participatory and Integrated One Health Approach for Rabies Control: The Case of N’Djaména, Chad. Trop. Med. Infect. Dis. 2017, 2, 43.

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