28 September 2018
The results of two years of research (2016–2018) on the assessment of the burden of rabies have enabled Côte d’Ivoire to make an important step in the disease control strategy. Based on the content of the data generated by the research, Côte d’Ivoire embarks now in the strategic planning of rabies control according to the Stepwise Approach towards Rabies Elimination (SARE) tool in the rabies elimination process. The two-year research was conducted by the Centre Suisse de Recherches Scientifiques en Côte d’Ivoire (CSRS), and its partners (Swiss Tropical Public Health Institute, Direction des Services Vétérinaires de Côte d’Ivoire, Laboratoire National d’Appui au Développement Agricole, Institut National d’Hygiène Publique), thanks to the support of GAVI foundation and the research consortium Afrique One-ASPIRE.
Côte d’Ivoire has an estimated number of 2 million dogs
The dog population in Côte d’Ivoire is estimated at 2 million where 10% are ‘ownerless’, 79% are in rural areas and only 9% are vaccinated against rabies. According to Prof. Bassirou Bonfoh, Director of Afrique One-ASPIRE and principal investigator of the Rabies-GAVI project, ‘obtaining this information is a positive step forward in rabies control. You can plan effectively with vaccines doses if you know the exact population to cover’
Unfortunately, 18 lives are lost per year in Côte d’Ivoire
While evitable, one could not understand why in Côte d’Ivoire, 18 people die of rabies every year. The rural population records more than 60% of deaths. South-West Côte d’Ivoire is the most affected by the disease. Children from 9 to 14 are the main victims and account for half (50%) of the victims annually. Moreover, the number of dog bites is 2 per 1000 people exposing more than 50’000 people to death, as the real threat is that 97% of biting dogs are not vaccinated.
The population must be aware of the shared responsibilities
Even though rabies is incurable and 100% fatal, a large part of the population is unaware of it. An important work of sensitization on the factors of rabies and the health-seeking behavior when exposed. Reporting all dog bites for urgent care is crucial. Half of those who report bites are not completing their treatment because of the high cost of the Post—Exposure Prophylaxis package.
Free dog vaccination and post-exposure treatment will increase compliance
Two protocols (Essen, Zagreb) are used in Côte d’Ivoire for the post-exposure treatment. Each dose costs 8,000 CFA francs (11 US$). Depending on the protocol chosen, the patient will totally pay a fee ranging from 32,000 CFA Francs (44US$) to 40,000 FCFA (54 US$) depending on the type of protocol. In the frame of Rabies-GAVI project, the Thai Red Cross protocol has been tested and validated prior to its recommendation by WHO in addition to the two others. The main reasons are that it is cheaper, less painful and applied for a shorter time.
The next step is for Côte d’Ivoire to introduce this 3rd protocol in his health system. The experts are calling on the Ivorian health authorities to ensure that the new strategy adoption takes place as soon as possible to save lives by reducing the number of people lost to sight.
More than 70% dog vaccination only can lead to rabies elimination, no other way!
Vaccinating dogs is the most cost-effective and only way to eliminate rabies. For, according to the experts as, ‘there is no human rabies without canine rabies’. The current canine population estimates in Côte d’Ivoire provides information to plan for financial resources mobilization. The scenario of the cost of rabies elimination strategy is 25 billion FCFA which is affordable for an emerging country with a priority to eliminate the disease by 2030. This remains possible if Côte d’Ivoire adopts the new memorandum of understanding recommended by WHO”, says Prof Bonfoh.