Rabies Free Africa | Newsletters

June 2021

Jun 10, 2021
Tanzania Update & Employee Spotlight: Kennedy Lushasi
Vaccination team talking to group of boys with two golden brown and white dogs

Update from Tanzania

The work in Tanzania that focuses on leveraging community partners continues. The program continues to measure the proportion of dogs that are vaccinated in each segment of the randomized controlled trial. Additionally, one of the primary outcomes is measuring how the rolling out of mass dog vaccination across the Mara region impacts human health in terms of reduction of human rabies cases and dog bite injuries from suspect rabid dogs. 

To do this we have a team (led by PhD student Kennedy Lushasi who you can read more about below) who have set up an Integrated Case Bite Management network across the Mara region.  This enhanced surveillance network comprises health facility-based risk assessments that trigger animal health investigations and enhances the identification of dog rabies cases. 

The primary outcome of the network is that it allows bite victims to be identified and to receive proper care. The secondary outcome is that it allows the team to collect data from district hospitals and health clinics on the number of cases of dog bite injuries and rabies that occur.  This network was established before the randomized controlled trial and will allow us to see how the rolling out of mass dog vaccination impacts the incidence of dog bite injuries and cases of human rabies. 

Going forward, we will use the outputs from the randomized controlled trial and the human health surveillance to model the impact that delivery strategy (team-led and community-led) has on public health outcomes, including lives saved, rabies exposures prevented, and changes in post-exposure prophylaxis use as well as the time to elimination of dog-mediated rabies. The hypothesis is that community-led delivery of mass dog vaccination results in improved public health outcomes and achieves elimination more rapidly.

As we will also be collecting cost-data for each mass dog vaccination strategy. The data generated will allow estimation of the public health impacts, the cost-effectiveness and the net benefits in terms of public health outcomes that can be achieved under the different vaccination delivery strategies.

With mass dog vaccination programs in rabies endemic countries typically funded and implemented by external agencies, national policy makers are often unaware of the public health and economic benefits of mass dog vaccination. In quantifying the reduction in the burden of human rabies that mass dog vaccination provides and the comparative effectiveness and cost effectiveness of the different delivery strategies, our program will provide much needed data that will inform decision makers on the best approaches to eliminate human rabies at regional and national levels. With governments of rabies endemic countries developing national elimination plans in response to the Zero by 30 target, the program outputs will be extremely timely.

Employee Spotlight: Kennedy Lushasi

Kennedy in communities investigating cases with LFOs.

Meet Kennedy Lushasi, a member of the Rabies Free Tanzania team. Kennedy is an epidemiologist who works on the Integrated Bite Case Management program. Kennedy is a PhD student with the Nelson Mandela African Institution of Technology (one of our partners) and the Ifakara Health Institute. 

How long have you been working with Rabies Free Tanzania?

I have been working with Rabies Free Tanzania since October 2017.

What is your role in the program?
I work with Rabies Free Africa as a field epidemiologist coordinating field operations on rabies surveillance and other rabies control programmes through the implementation of Integrated Bite Case Management (IBCM). I coordinate, oversee, and implement training programmes to health workers and livestock field workers/veterinarians on IBCM. Specifically, I train health workers on how to differentiate between a suspected rabid animal following the standardized WHO guidelines for probable/suspected animals and veterinarians or livestock field officers on how to carry out animal/epidemiological investigations. I also train them on how to report bite and animal rabies cases through the enhanced electronic IBCM surveillance system we have established across the study sites. I am actively involved in carrying out surveillance activities including collection of tissue samples from dead animals reported at community level for laboratory diagnosis and confirmation. I work very closely with community members in conducting and identifying rabies cases through contact tracing.
 
Why is it important to you to work toward eliminating rabies?

It’s important to me, and I think all of us, to work towards eliminating rabies. This is a disease of poverty. The costs of preventing rabies in humans is very high as few people can afford the treatment, but very cheap and easy to eliminate in dog populations which have been identified as the main source of infection to humans. In addition, rabies has no treatment once someone develops the symptoms. He/she eventually dies in a short period. I am not interested in seeing people die due to rabies or someone spend a lot of money buying costly post exposure prophylaxes. Rabies also causes psychological and mental issues to the affected families. To end these issues, we need to get rid of rabies the same way polio was eliminated.

Can you see the program having an impact?
Yes, this programme has brought very positive impacts to the societies and even to the nation of Tanzania at large. Through the ongoing mass dog vaccinations, there has been a reduction in the number of suspected animal rabies cases and human bite victims. The costs of treating bite victims has also gone down because bite victims are receiving post exposures prophylaxes based on the suspected criteria for rabid animals. IBCM has increased the level awareness among human health workers on rabies and on how to perform the risk assessments, but also improved the animal investigations of suspected cases among veterinarians. This has resulted to an increase in the number of cases and human exposures being reported from each sector, increasing the accuracy of the assessment of the disease burden in the communities. The other notable impact of this programme is how it has helped to strengthen the collaboration and linkage between health and veterinary workers. These two sectors are now working in a very collaborative way for any case related to rabies and at times joint decisions are reached before someone is administered anti-rabies vaccines.
 
What do you do when you aren’t fighting rabies?
I love to spend free time with my family. Playing and laughing with the two little kids is something I miss when I am in the field. Staying with them, exchanging ideas, teaching each other new things, and enjoying the little moment together strengthens our ties, bonds and multiplies the love we have for each other and this is what makes happy all the time!