integrated rabies epidemiology in remote inuit communities in quÉbec, canada: a “one health”...
TRANSCRIPT
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INTEGRATED RABIES EPIDEMIOLOGY IN REMOTE INUIT COMMUNITIES IN QUÉBEC,
CANADA: A “ONE HEALTH” APPROACH C. Aenishaenslin, A. Simon, T. Forde, A. Ravel, J-F Proulx,
C. Fehlner-Gardiner, I. Picard, and D. Bélanger
Groupe international vétérinaire et Groupe de recherche en épidémiologie des zoonoses et santé publique, Faculté de médecine vétérinaire, Université de Montréal,
St-Hyacinthe, QuébecNunavik Regional Board of Health and Social Services, Kuujjuaq, Nunavik
Centre of Expertise for Rabies, Canadian Food Inspection Agency (CFIA), OttawaMinistère de l’Agriculture des Pêcheries et de l’Alimentation du Québec (MAPAQ),
Québec
Canadian Public Health Association Annual MeetingToronto - May 27, 2014
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Background
Arctic variant rabies virus (AVRV) in northern Canada Arctic fox main reservoir Epidemiology not fully understood Exposure of human beings
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Background: rabies in Nunavik
Rabies diagnosed in animals since 1947
No human cases reported Potential exposure through dog
bites and contact with wildlife Regular post-exposure prophylaxis Annual dog vaccination campaign by
MAPAQ (once a year) since 1983 Increased animal cases in late 2011
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Objective and Rationale
OBJECTIVE: To perform an integrated descriptive overview of Arctic rabies
epidemiology in Nunavik (wildlife – domestic animals – humans) in line with the emerging ‘‘One Health’’ paradigm
RATIONALE:
To better understand rabies risk and to provide baseline data for the improvement of the regional rabies prevention program at all levels:– human populations (education and health care services) – domestic animal populations (dog vaccination and population control) – wildlife (vaccination)
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Materials & Methods Retrospective study 1999-2012 Comprehensive data sets:– CFIA: lab results of suspect rabid animals that
potentially exposed humans or domestic animals (fluorescent antibody test + tissue culture inoculation test, if potential human exposure)
– MAPAQ: dog vaccination campaign (annual data)– Nunavik Regional Board of Health and Social Services:
data of human cases with potential rabies exposure Descriptive data analysis
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Rabies testing in animals
Dogs Red foxes Artic foxes Wolves Total0
20
40
60
80
100
120
1018 12
4
44
58
26
2
68
Negative
Positive
Proportion of positive samples
100%
0%
112 submissions, mostly dogs44 positive (39%), mostly wildlife
Num
ber o
f ani
mal
s
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Dog vaccination and animal tests over time
Dog vaccination: total 6,243 dogs, annual median 517 Variation over time and between regions
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
2
4
6
8
10
12
0
20
40
60
80
100
120
Year
Nb
of te
sts =
bar
s
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
2
4
6
8
10
12
0
20
40
60
80
100
120
Year
Nb
of d
ogs v
accin
ated
/100
0 in
habi
tant
s = --
---
Hudson Ungava
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Human cases of potential exposure to a rabid animal
112 cases investigated, mostly children For 41 cases (37%), animal was tested for rabies For 24 cases (59% of 41), the animals tested positive, mostly children
were exposed Most investigations due to dog bites, but most lab-confirmed
exposures due to mucous membrane contact (one event)
0-910-19
20-2930-39
40-4950-59
60 +
unspecifi
ed05
1015202530354045
112 3 2 3 1 0 2
Negative exposure Confirmed exposure
Dog bites
Fox bite
s
Other bite
s
Per skin co
ntacts
Mucous m
embrane
Unspecifi
ed0
10
20
30
40
50
60
70
80
6 1 0 4 121
Negative exposure Confirmed exposure
Num
ber o
f peo
ple
Num
ber o
f peo
ple
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Delay between potential exposure and consultation
62 people started post-exposure prophylaxis 46 completed PEP, including the 24 cases of confirmed exposure Delay varied, most confirmed cases started PEP 2 weeks post-
exposure
<24h
24-48h
48-72h3 day
s
4-7 days
8-14 days
> 14 day
s
unspec
ified0
5
10
15
20
25
30
35
2 0 0 16
1
13
1
Negative exposure Confirmed exposure
Num
ber o
f peo
ple
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Discussion
Comprehensive overview based on available data Confirms regular human exposure (children) to rabies virus in
Nunavik Highlights greater requirement for PEP compared to southern
QuebecRabies still a public health issue of concern in NunavikNeed for prevention and control action:
• Potential case management• Education on rabies prevention• Education on dog bite prevention
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Discussion
Confirms rabies in dogs and wildlife (underestimation) Surveillance of rabies in wildlifePotential for wildlife vaccination
Actual dog vaccination coverage still unknown Dog vaccination effect on human exposure unknown
Maintain and reinforce dog vaccination Improve dog population estimates Implement perennial dog population control programThank to a greater community participation
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Conclusion
Residents of Nunavik at risk of exposure to rabies Prevention and control should follow the ‘’One
Health‘’ approach Requires integrated actions toward public health,
animal health and ecosystem health