Designing a Community Based

Rabies Surveillance (CBRS)

System for Muntinlupa City

By: Global Alliance for Rabies

Control
PROJECT DETAILS:
 DURATION: June 2108-November 2019
 SITE: Muntinlupa City
 PROJECT ACTIVITIES:
 Community Based Rabies Surveillance System Development
( June –December 2018)
 Field Application : January –December 2019
 Objectives of CBRS:

•Early detection of suspect rabid animals and humans

with high risk of rabies exposure for rapid response
•Track progress of rabies elimination
efforts to guide program
implementation
 The Philippines has a strong national rabies
control program, but children are still at risk

 THE PROBLEM:
 The Philippines has over 500 bite treatment clinics providing free
rabies vaccination
 But 200-250 human deaths occur per year because rabies is not yet
controlled in dogs
 The Philippines has a strong network of voluntary community health
workers
THE SOLUTION IN THIS SETTING:

 DHIS 2 can link a widely distributed health network to the resource

limited veterinary services to identify the high risk area quickly and
support faster responses and better dog vaccination control program.
 GARC wants to use DHIS 2 to allow Community Health Workers to
improve rabies control and save lives
Use of DHIS2 for Community-Based Rabies
Surveillance (CBRS)

 Good surveillance is essential to controlling and

eliminating rabies
 Good surveillance can assist in:
• Guiding strategic dog vaccination
• Identifying new cases rapidly
• Ensuring exposed individuals receive adequate
PEP
 Integrated Bite Case Management
(IBCM)
 is integral in an effective, active surveillance system
 Helps to identify new cases
 Identifies suspect animals
 Ensures more cases are detected and reported
 Facilitates investigations and follow-up
 Improves suspect sample submission
 Can result in reduced PEP usage
IBCM
 IBCM relies on people on the ground within
communities reporting suspect animals and
bite incidents •
 These reports trigger a cascade of
responses
 Ideally, every bite patient is identified
 Risk assessment undertaken to determine
risk of rabies and need for PEP
 Veterinary investigations to identify
suspect animal and act accordingly
 Results in samples being obtained for
laboratory confirmation
 Potential for rapid vaccination
responses to area where positive cases
identified to stem further spread of
the disease
ConceptThe idea of the Community-Based
Rabies Surveillance (CBRS) is to:
 For animals
• Rapidly identify suspect animals in
communities
• Trigger a rapid veterinary investigation
response in that Barangay
• Quarantine or sample the animal for lab
testing
• Track sample to the lab with diagnostic
outcome being available immediately
 For humans:
• Identify potentially exposed
individuals in the Barangay
• Link these individuals to the suspect
animal
• Base PEP on laboratory result
(negative result, patient can stop PEP)
DHIS 2 Enabled Active Surveillance by
Healthcare workers in the Community can:

 Empower healthcare workers to better

serve their communities
 Enable coordination between medical
and veterinary sectors and local and
national government
 Ensure that bite victims get full
vaccination to protect them from fatal
rabies
 Contribute data vital for longer term and
vaccination campaigns to eliminate rabies
 Contribute data that will enable WHO to
monitor the global goal of an end to
rabies by 2030
 Demonstrate the power of tools that can
easily replicated in all rabies endemic
countries
CBRS in DHIS2 – automation and real-
time reporting
 Automated and immediate email and system
messages
• More rapid responses and raised awareness
 Automated alerts for overdue investigations
and follow ups
• Ensure that cases are being investigated and
patients treated
• Enables rapid vaccination to prevent spread of
disease
• Improves PEP compliance
Making connections
• Identified suspect animals can be
linked to potentially exposed individuals
• Outcomes of veterinary quarantine or
lab diagnosis can influence exposed
individuals’ PEP requirements
• Samples received at the lab can be
linked with other exposed individuals
System directionality
 The system can be used in almost any
‘direction’
 The system can be used in any of the
situations when:
• Identifying a suspect animal in a Barangay
• Identifying a bite victim in the Barangay
• Receiving a laboratory sample and linking
exposed individuals to the sample
 This means that any of the scenarios
can be used as the starting point
within the system
 Reduces limitations of some systems
that have to start with identifying a
bite victim
 COLLABORATION

 ABTCs and ABCs

 City Vet
 CHO
 BHWs
 Epidemiology Bureau
 GARC
 RITM
Event-based Reporting and Response

Events for Reporting Joint

Response Program
Monitoring
(BHWs and ABTCs) Investigations

(CVO & CHO ) ( ABTC and CVO )

Monthly
and
and dog owners • PEP for bite • Interview bite victims Quarterly
Reports
Check vaccination victims
 status of biting animal • Dog
Suspect Rabid Animal
• Quarantine and vaccination observation of animal campaigns

• Collection and testing • Impounding of of samples stray animals

• Contact tracing (bite

Human with high-risk victims) and referral

Rabies Exposure for PEP and follow-up

Focal Points for DHIS data input, analysis and monitoring

Computer City Vet Office/City Health Office (CESU?)

RITM (Animal Lab)/ BAI Lab?

GARC (for monitoring & trouble shooting)

 ABTCs ?

Mobile Phone BHWs

Events to be Reported

A. Suspect Rabid Animal (without known biting incident)

◦ Dog or cat with signs & symptoms of rabies – for quarantine and
observation (14 days), sample to be collected if animal dies within 14 days

◦ Dog or cat that died of unknown cause – sample to be collected for testing

Events to be Reported

B. High Risk Bite Incident or Event

BITING ANIMAL (DOG OR CAT) * With Signs & Symptoms of Rabies

 stray dog  with multiple severe or deep bite wounds

 bites multiple persons
 bite is unprovoked
 dies within 14 days of bite incident
 unvaccinated
 bite wounds in head, neck, hands, toes and
genital areas (highly innervated)
AND
Bitten by suspect rabid animal
OR

 unknown status (lost) Anyone bitten by confirmed rabid animal

OR
HUMAN BITE VICTIM
Rabies Death
May rule out Rabies if …
•animal is alive after 14 days from bite incident
•animal sample is negative for rabies
 biting animal has verifiable adequate
vaccination history
 other cause of human or animal death is
known
Data to be entered in DHIS
ANIMAL
 type of animal
 owner’s name, address,
contact info
 date and location of biting
incident
 vaccination status
 circumstances surrounding
bite incident
 outcome after 14 days
 lab result
 FINAL DIAGNOSIS
HUMAN
 name
 age and sex
 address and contact
information date &
location of bite incident
 vaccination status
 patient status
 FINAL DIAGNOSIS
Indicators for Monitoring
Program Indicators (by time and place)
 No. of Bite Incidents
 No. (%) of suspect animals tested & no. (%) positive for rabies
 No. (%) of suspect animals found vaccinated
 No. (%) of suspect animals alive after 14 days
 No. (%) of biting animals with probable or confirmed rabies
 No. (%) of humans bitten by highly suspect animals with complete PEP
 No. of Human rabies cases by age and sex
 Surveillance and Response Indicators

 Data accuracy
 Completeness and timeliness of reporting & response
Tools to be developed
 Guidelines (Manual) for CBRS
 Unique ID for linking investigation form, lab
form, patient record
 Customized DHIS Software
 Report template – frequency, users
 Tracking logbook – Event ID, Animal
Owner, Bite Victim/Patient
THANK YOU