RITM, GARC, LGU intensifies rabies prevention and control with new community-based surveillance system

Muntinlupa is set to see heightened rabies prevention and control with the Community-Based Rabies Surveillance (CBRS) Project collaboratively launched by the Global Alliance for Rabies Control (GARC), the Research Institute for Tropical Medicine (RITM), and the City Government of Muntinlupa.

Through CBRS, hospitals and local health facilities will adapt an early warning and rapid response system for rabies to prevent human deaths among bite victims through timely provision of rabies post-exposure prophylaxis (PEP) and prevent further transmission of rabies virus within the animal population.

The study will use a One Health approach, directly linking human and animal cases, while automatically sharing surveillance data between key sectors through a system called ‘District Health Information System-2 (DHIS-2) data management software’.

The DHIS 2 is an all-inclusive system that tracks and links suspect animals and humans identified in the community, as well as the samples received in the laboratory. The collected data will create a comprehensive, grassroots-level rabies database.

Overview of the Community-Based Rabies Surveillance software module. Diagram: Terrence Scott, GARC

“The involvement of RITM is mainly in its role as an animal bite treatment center. Our ABTC staff will identify and treat bite patients from the involved barangays in Muntinlupa city. They will report this to the Surveillance nurse who will, in turn, identify and report high risk bites to the Muntinlupa CESU,” explains Dr. Beatriz Quiambao, head of the RITM rabies research group, when asked about the responsibility of RITM in the project.

According to Dr. Sarah Jaime, GARC Asia representative, RITM also provided support in training veterinarians from the City Veterinarian Office and private practitioners from veterinary clinics/hospitals in the new animal rabies sample collection technique called the ‘straw technique’. RITM will also support rabies laboratory diagnosis for animals and humans.

RITM currently houses the only laboratory in the country that performs human rabies diagnosis through polymerase chain reaction (PCR) and fluorescent antibody test (FAT), as well as antibody analysis through enzyme-linked immunosorbent assay (ELISA) test, optimized with the fluorescent antibody virus neutralization (FAVN) test.

With its animal bite treatment center and diagnostic laboratory for animal rabies suspects, RITM manages around 12,000 to 13,000 animal bite patients per year, and about two to three human rabies cases per month. In 2017, around 4,800 of the animal bite consultations were from Muntinlupa City.

The project is set to contribute to the national commitment to eliminate dog-mediated rabies in the Philippines by 2030.

“A robust surveillance system is integral to any disease elimination effort, the community based surveillance system developed in this study can serve as a model for other communities, to help identify and investigate rabies cases early, thus preventing its spread,” explained Dr. Quiambao.

Apart from reporting of possible and existing cases in the community, Dr. Jaime highlighted that the project may also provide evidence of rabies absence. “CBRS include negative reporting system that can support eventual proof of freedom from rabies. This is crucial to support the global goal of eliminating canine-mediated human rabies by 2030,” says Dr. Jaime.

Formed in 1992, the RITM Rabies Research Group aims to provide support to the National Rabies Prevention and Control Program of the Departments of Health and Agriculture through its multi-disciplinary research activities, laboratory capabilities, rabies referral center and animal bite clinic, training programs, advocacy and as technical advisers to the program. Composed of physicians, veterinarians, medical technologists, nurses and technical staff, the RITM Rabies Research Group conducts One Health research on human and animal rabies, including clinical trials on human biological products, epidemiology of human rabies, analysis of treatment failures, dog ecology studies, molecular epidemiology, and development/evaluation of diagnostic tests/reagents.

“The Rabies Research group is currently focusing on improving surveillance systems through development and testing of novel diagnostic tests in collaboration with Oita University and evaluation of the Integrated Bite Case Management (IBCM) approach and judicious use of post-exposure prophylaxis with the University of Glasgow,” said Dr. Quiambao. The group continues to conduct clinical trials on rabies biologicals, exploring cost effective vaccination regimens.

RITM is set to finalize and sign the memorandum of agreement with GARC by end of February 2019. Large-scale training for widespread implementation of the CBRS at the national level in the Philippines will begin in January 2019, after which DHIS 2 will go live.

by JA Quinto, Communication and Engagement Office