U.S. Centers for Disease Control and Prevention in Haiti: A National Rabies Prevention and Control Program Strategy Open Access

Abstract

Introduction: An estimated 60,000 persons die of infection with the rabies virus annually, and dog bites are responsible for 95 percent of these deaths. Haiti is estimated to have a high incidence of canine and human rabies, and the Centers for Disease Control and Prevention (CDC) is assisting the Haitian government with prevention and control efforts. In order to reduce the burden of disease associated with rabies, a comprehensive strategy for prevention and control must be developed and implemented throughout the country.

Objective: This study aims to assess and describe animal welfare, animal vaccination, animal bite treatment among humans, and canine morbidity and mortality in Haiti in order to develop effective and efficient program recommendations for rabies prevention and control in Haiti.

Methods: A Knowledge, Attitudes and Practices (KAP) survey was used for data collection among dog owners during government-sponsored vaccination clinics at eight different randomly selected sites. 1,448 surveys were collected and analyzed using statistical analysis software.

Results: The majority of owned dogs (58 %) spend all or part of their time in the street. Thirteen percent of owned dogs received veterinary care. Lack of access to a rabies vaccine was the largest barrier to animal vaccination. Sixty-seven percent of respondents provided some sort of care to community animals. Nearly a third of the dog population dies annually and five percent of the total dog population died of a canine rabies-like-illness in the past year. Four percent of our study population experienced a dog bite in the past year, a third of whom were children. One percent of respondents reported knowing someone who had died of rabies or a dog bite.

Discussion: The incidence of canine and human rabies in Haiti is high and the risk of infection is exacerbated by infrastructural barriers, the roaming nature of owned dogs, and poor animal welfare. Knowledge of prevention and treatment of human rabies is low and education of the public and healthcare providers is needed to address gaps in knowledge. Community-based initiatives endorsed and supported by the Haitian government are needed to tackle the burden of disease among animals and humans.

Table of Contents

I Introduction 1
1.1 Epidemiology and Transmission of Rabies 1
1.2 Disease Prevalence and Strategic Elimination Goals in the Americas 2
1.3 Haiti Background 4
1.4 CDC Presence and Ongoing Activities in Haiti 4
1.5 Problem Statement 5
1.6 Significance of Project 8
II Literature Review 9
2.1 Introduction 9
2.2 Peer-Reviewed Literature on Rabies Control 10
2.3 Experience in Different Countries and Current Strategies 24
2.4 Research Areas 27
III Methodology 28
3.1 Introduction 28
3.2 Population Sample and Research Design 29
3.3 Procedures and Instruments 31
3.4 Data Analysis 32
3.5 Ethical Considerations 32
3.6 Limitations 33
IV Results 34
4.1 Introduction 34
4.2 Dog and Household Population Overview 35
4.3 Animal Welfare 40
4.4 Animal Vaccination 44
4.5 Exposures and Need for Post-Exposure Prophylaxis 46
V Discussion 48
5.1 Introduction 48
5.2 Animal Welfare and Population Management 49
5.3 Animal Vaccination 52
5.4 Exposures and Need for Post-Exposure Prophylaxis 54
5.5 Canine Morbidity and Mortality 56
5.6 Canine Rabies-Like-Illness 57
5.7 Community-Based Solutions 58
5.8 Summary 59
VI Conclusions and Recommendations 60
References 69
Appendices 74

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	post-exposure prophylaxis exposure disease bite canine sustainability zoonotic strategy vaccine welfare prevention rabies control laboratory diagnostics animal vaccination surveillance education communication
Committee Chair / Thesis Advisor	McFarland, Deborah A, Emory University
Committee Members	Wallace, Ryan, Centers for Disease Control and Prevention
Partnering Agencies	CDC

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