@article{Rysava_Mancero_Caldas_Carvalho_Gutierrez_Haydon_Johnson_Mancy_Gonzalez Roldan_Vilas_et al._2017, title={Management tool to guide rabies elimination programmes}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7669}, DOI={10.5210/ojphi.v9i1.7669}, abstractNote={<div style="left: 100.8px; top: 407.782px; font-size: 15.8667px; font-family: sans-serif; transform: scaleX(1.08121);" data-canvas-width="71.43173333333333">Objective</div><div style="left: 117.6px; top: 424.528px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.0609);" data-canvas-width="428.63799999999986">To provide surveillance tools to support policymakers and</div><div style="left: 100.8px; top: 443.194px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.977836);" data-canvas-width="442.5197466666668">practitioners to identify epidemiological situations and inform the</div><div style="left: 100.8px; top: 461.861px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.00097);" data-canvas-width="399.2687999999998">progressive implementation of rabies elimination programmes.</div><div style="left: 100.8px; top: 497.382px; font-size: 15.8667px; font-family: sans-serif; transform: scaleX(1.11731);" data-canvas-width="92.55026666666666">Introduction</div><div style="left: 117.6px; top: 514.128px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.02777);" data-canvas-width="425.08704">Global targets for elimination of human rabies mediated by dogs</div><div style="left: 100.8px; top: 532.794px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.954156);" data-canvas-width="442.4102666666668">have been set for 2030. In the Americas countries are progressing</div><div style="left: 100.8px; top: 551.461px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.04388);" data-canvas-width="444.93465333333256">towards interruption of transmission and declaration of rabies</div><div style="left: 100.8px; top: 570.128px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.0469);" data-canvas-width="55.311199999999985">freedom</div><div style="left: 156.106px; top: 570.547px; font-size: 9.52px; font-family: serif;">1</div><div style="left: 161.076px; top: 570.128px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.05542);" data-canvas-width="385.2109333333333">. Guidance for managing elimination programmes to</div><div style="left: 100.8px; top: 588.794px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.03753);" data-canvas-width="441.743866666667">ensure continued progress during the endgame is critical, yet often</div><div style="left: 100.8px; top: 607.461px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.01993);" data-canvas-width="444.04294666666624">limited and lacking in specific recommendations. Characteristic</div><div style="left: 100.8px; top: 626.128px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.998318);" data-canvas-width="443.4193866666665">spatiotemporal incidence patterns are indicative of progress, and</div><div style="left: 100.8px; top: 644.794px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.00324);" data-canvas-width="397.92013333333324">through their identification, tailored guidance can be provided.</div><div style="left: 100.8px; top: 680.316px; font-size: 15.8667px; font-family: sans-serif; transform: scaleX(1.07283);" data-canvas-width="65.22786666666666">Methods</div><div style="left: 117.6px; top: 697.061px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.0552);" data-canvas-width="428.4126933333333">Using SIRVERA, a surveillance database for rabies in the</div><div style="left: 100.8px; top: 715.728px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.994845);" data-canvas-width="60.42026666666665">Americas</div><div style="left: 161.183px; top: 716.147px; font-size: 9.52px; font-family: serif;">2</div><div style="left: 165.912px; top: 715.728px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.985467);" data-canvas-width="375.21651999999983">, we developed a classification framework for identification</div><div style="left: 100.8px; top: 734.394px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.995598);" data-canvas-width="443.1242666666665">of epidemiological situations at subnational level. Each situation</div><div style="left: 100.8px; top: 753.061px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.979813);" data-canvas-width="440.2952399999998">exhibits a characteristic pattern identified via a set of objective criteria</div><div style="left: 100.8px; top: 771.728px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.01024);" data-canvas-width="441.2059866666667">including trends in case detection, assessment of virus variants, case</div><div style="left: 100.8px; top: 790.394px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.00104);" data-canvas-width="259.11853333333335">locations and measures of incursion risk.</div><div style="left: 117.6px; top: 809.061px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.01786);" data-canvas-width="427.1465333333332">We refined our framework through application to Mexico in</div><div style="left: 100.8px; top: 827.728px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.01242);" data-canvas-width="443.35592000000014">consultation with stakeholders. To understand factors predicting</div><div style="left: 100.8px; top: 846.394px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.972359);" data-canvas-width="442.1801999999999">incursions we analysed state-level data on vaccination campaigns,</div><div style="left: 100.8px; top: 865.061px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.991691);" data-canvas-width="442.74029333333306">populations and socioeconomic indicators employing multivariate</div><div style="left: 100.8px; top: 883.728px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.00099);" data-canvas-width="118.98413333333333">regression models.</div><div style="left: 100.8px; top: 919.249px; font-size: 15.8667px; font-family: sans-serif; transform: scaleX(1.08406);" data-canvas-width="57.3104">Results</div><div style="left: 117.6px; top: 935.994px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.04742);" data-canvas-width="428.42856">We were able to classify all states in Mexico and provide</div><div style="left: 100.8px; top: 954.661px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.01412);" data-canvas-width="443.9969333333331">correspondingly tailored guidance. Control efforts have resulted</div><div style="left: 100.8px; top: 973.328px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.02508);" data-canvas-width="444.04612000000026">in progress towards elimination; however rabies still circulates</div><div style="left: 100.8px; top: 991.994px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.955805);" data-canvas-width="442.3626666666668">endemically in one state Chiapas, putting its neighbours at risk of</div><div style="left: 100.8px; top: 1010.66px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.00423);" data-canvas-width="90.29719999999999">re-emergence.</div><div style="left: 117.6px; top: 1029.33px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.05388);" data-canvas-width="428.7363733333333">Epidemiological and socioeconomic factors associated with</div><div style="left: 100.8px; top: 1047.99px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.987783);" data-canvas-width="436.6824">incursions were primarily geographic proximity to endemic and high-</div><div style="left: 100.8px; top: 1066.66px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.00156);" data-canvas-width="440.8204266666666">prevalence states, and inconsistent vaccination campaigns associated</div><div style="left: 100.8px; top: 1085.33px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.0009);" data-canvas-width="243.26773333333335">with a low human development index.</div><div style="left: 100.8px; top: 1120.85px; font-size: 15.8667px; font-family: sans-serif; transform: scaleX(1.10289);" data-canvas-width="95.21586666666667">Conclusions</div><div style="left: 117.6px; top: 1137.59px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.979287);" data-canvas-width="425.98985333333314">Our management tool can support rabies programme managers</div><div style="left: 100.8px; top: 1156.26px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.01827);" data-canvas-width="444.2190666666665">at subnational levels to identify their epidemiological situation,</div><div style="left: 100.8px; top: 1174.93px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.00335);" data-canvas-width="443.6478666666667">develop tailored plans to meet targets, and sustainably maintain</div><div style="left: 100.8px; top: 1193.59px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.02715);" data-canvas-width="441.9310933333331">rabies freedom, as demonstrated for Mexico. Effective surveillance</div><div style="left: 100.8px; top: 1212.26px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.0356);" data-canvas-width="441.9422000000001">is critical for disease elimination. Control options differ depending</div><div style="left: 100.8px; top: 1230.93px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.02127);" data-canvas-width="441.93743999999975">on whether disease circulates intermittently through reintroductions</div><div style="left: 100.8px; top: 1249.59px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.976968);" data-canvas-width="442.53402666666653">or persists focally, but with poor detection these situations might</div><div style="left: 100.8px; top: 1268.26px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.980408);" data-canvas-width="442.44200000000006">be indistinguishable. Our analysis enables identification of at-risk</div><div style="left: 100.8px; top: 1286.93px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.02289);" data-canvas-width="441.75021333333325">areas and methods to reduce risk. Investment in remaining endemic</div><div style="left: 100.8px; top: 1305.59px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.992109);" data-canvas-width="440.3476">areas, through improved implementation and monitoring of mass dog</div><div style="left: 100.8px; top: 1324.26px; font-size: 15.8667px; font-family: serif; transform: scaleX(0.99989);" data-canvas-width="440.70142666666663">vaccinations, is expected to provide the most cost-effective approach</div><div style="left: 100.8px; top: 1342.93px; font-size: 15.8667px; font-family: serif; transform: scaleX(1.00203);" data-canvas-width="364.8539999999999">to elimination whilst preventing re-emergence elsewhere.</div><div style="left: 571.2px; top: 648.638px; font-size: 14px; font-family: serif; transform: scaleX(1.00153);" data-canvas-width="143.83599999999998">Decision-tree framework.</div><div style="left: 571.2px; top: 938.121px; font-size: 14px; font-family: serif; transform: scaleX(1.00933);" data-canvas-width="443.0468">Rabies incursions in Mexico, 2005-2015. Blue circles indicate incursion</div><div style="left: 571.2px; top: 953.054px; font-size: 14px; font-family: serif; transform: scaleX(1.03985);" data-canvas-width="441.36259999999993">locations, and resulting outbreak sizes, with darker shading for more recent</div><div style="left: 571.2px; top: 967.987px; font-size: 14px; font-family: serif; transform: scaleX(1.00149);" data-canvas-width="440.30559999999974">incursions. Red shading indicates the duration of endemic circulation over the</div>ten-year period.}, number={1}, journal={Online Journal of Public Health Informatics}, author={Rysava, Kristyna and Mancero, Tamara and Caldas, Eduardo and Carvalho, Mary and Gutierrez, Veronica and Haydon, Daniel and Johnson, Paul and Mancy, Rebecca and Gonzalez Roldan, Jesus F. and Vilas, Victor D. and et al.}, year={2017}, month={May} }