Browsing by Author "Hampson, K."

Now showing 1 - 5 of 5

Elucidating the phylodynamics of endemic rabies virus in eastern Africa using whole-genome sequencing
(Virus Evolution, 2015) Brunker, K.; Marston, D. A.; Horton, D. L.; Cleaveland, S.; Fooks, A. R.; Kazwala, R. R.; Ngeleja, C.; Lembo, T.; Sambo, M; Mtema, Z. J.; Sikana, L.; Wilkie, G.; Biek, R.; Hampson, K.
Many of the pathogens perceived to pose the greatest risk to humans are viral zoonoses, responsible for a range of emerging and endemic infectious diseases. Phylogeography is a useful tool to understand the processes that give rise to spatial patterns and drive dynamics in virus populations. Increasingly, whole-genome information is being used to uncover these patterns, but the limits of phylogenetic resolution that can be achieved with this are unclear. Here, whole-genome variation was used to uncover fine-scale population structure in endemic canine rabies virus circulating in Tanzania. This is the first whole-genome population study of rabies virus and the first comprehensive phylogenetic analysis of rabies virus in East Africa, providing important insights into rabies transmission in an endemic system. In addition, sub-continental scale patterns of population structure were identified using partial gene data and used to determine population structure at larger spatial scales in Africa. While rabies virus has a defined spatial structure at large scales, increasingly frequent levels of admixture were observed at regional and local levels. Discrete phylogeographic analysis revealed long-distance dispersal within Tanzania, which could be attributed to human-mediated movement, and we found evidence of multiple persistent, co-circulating lineages at a very local scale in a single district, despite on-going mass dog vaccination campaigns. This may reflect the wider endemic circulation of these lineages over several decades alongside increased admixture due to humanmediated introductions. These data indicate that successful rabies control in Tanzania could be established at a national level, since most dispersal appears to be restricted within the confines of country borders but some coordination with neighbouring countries may be required to limit transboundary movements. Evidence of complex patterns of rabies circulation within Tanzania necessitates the use of whole-genome sequencing to delineate finer scale population structure that can that can guide interventions, such as the spatial scale and design of dog vaccination campaigns and dog movement controls to achieve and maintain freedom from disease.
The feasibility of canine rabies elimination in Africa: Dispelling doubts with data
(2010-02-23) Lembo, T.; Hampson, K.; Kaare, M. T.; Ernest, E.; Knobel, D.; Kazwala, R. R.; Haydon, D. T.; Cleaveland, S.
Background: Canine rabies causes many thousands of human deaths every year in Africa, and continues to increase throughout much of the continent. Methodology/Principal Findings: This paper identifies four common reasons given for the lack of effective canine rabies control in Africa: (a) a low priority given for disease control as a result of lack of awareness of the rabies burden; (b) epidemiological constraints such as uncertainties about the required levels of vaccination coverage and the possibility of sustained cycles of infection in wildlife; (c) operational constraints including accessibility of dogs for vaccination and insufficient knowledge of dog population sizes for planning of vaccination campaigns; and (d) limited resources for implementation of rabies surveillance and control. We address each of these issues in turn, presenting data from field studies and modelling approaches used in Tanzania, including burden of disease evaluations, detailed epidemiological studies, operational data from vaccination campaigns in different demographic and ecological settings, and economic analyses of the cost-effectiveness of dog vaccination for human rabies prevention. Conclusions/Significance: We conclude that there are no insurmountable problems to canine rabies control in most of Africa; that elimination of canine rabies is epidemiologically and practically feasible through mass vaccination of domestic dogs; and that domestic dog vaccination provides a cost-effective approach to the prevention and elimination of human rabies deaths.
Mobile phones as surveillance tools: Implementing and evaluating a large-scale intersectoral surveillance system for rabies in Tanzania
(PLOS Medicine, 2016-04-12) Mtema, Z.; Changalucha, J.; Cleaveland, S.; Elias, M.; Ferguson, M. H.; Halliday, J. E. B.; Haydon, D.T.; Jaswant, G.; Kazwala, R. R.; Killeen, G. F.; Lembo, T; Lushasi, K.; Malishee, A. D.; Mancy, R.; Maziku, M.; Mbunda, E. M.; Mchau, G. J. M.; Murray-Smith, R.; Rysava, K.; Said, K.; Sambo, M.; Shayo, E.; Sikana, L.; Townsend, S. E.; Urassa, H.; Hampson, K.
Surveillance is critical to manage preventative health services and control infectious diseases. Integrated surveillance involving public health, veterinary, and environmental sectors is urgently needed to effectively manage zoonoses and vector-borne diseases. However, most surveillance in low-income countries is paper-based, provides negligible timely feedback, is poorly incentivised, and results in delays, limited reporting, inaccurate data, and costly processing. • The potential of mobile technologies for improving health system surveillance has been demonstrated through small-scale pilots, but large-scale evaluations under programmatic implementation remain rare. • An intersectoral mobile-phone–based system was developed and implemented for rabies surveillance across southern Tanzania. Since 2011, the system has facilitated near realtime reporting of animal bites and human and animal vaccine use (almost 30,000 reports) by over 300 frontline health and veterinary workers across a catchment area of 150,000 km2 with >10 million inhabitants, improving data quality, timeliness, and completeness while reducing costs. • The surveillance system infrastructure is a platform that can be further developed to improve services and deliver health interventions; for example, generating automated personalized text messages (SMS) to alert patients to their vaccination schedules improved their compliance with regimens. Other interventions targeting patients and health workers can now be implemented easily. • The system has become an integrated, popular, and valuable tool across sectors, used routinely throughout southern Tanzania to evaluate the impacts of rabies control and prevention activities and to improve their management, directly informed by the experiences of frontline users. • We discuss challenges encountered during development and deployment, how we overcame these, and our recommendations for scaling up mobile-phone–based health (mHealth) interventions in low-income countries.
Progress towards rabies elimination from Pemba Island, Southern Tanzania.
(Online Journal of Public Health Informatics ., 2017) Lushasi, K. S.; Cleaveland, S.; Changalucha, J. J.; Haydon, D.; Kazwala, R.; Lembo, T.; Masoud, M.; Maziku, M.; Mchau, G.; Mtema, Z.; Omar, K.; Maganga, S.; Rysava, K.; Hampson, K.
Using active surveillance approaches to investigate the transmission dynamics of rabies on Pemba Island and across Southern Tanzania, whilst a large-scale dog vaccination program was underway1 , to gain a greater understanding of the dynamics of infection as the disease is driven towards elimination
Toward Elimination of Dog-Mediated Human Rabies: Experiences from Implementing a Large-scale Demonstration Project in Southern Tanzania
(Original research article., 2017) Mpolya, E. A; Lembo, T.; Lushasi, K.; Mancy, R.; Mbunda, E. M.; Makungu, S.; Maziku, M.; Sikana, L.; Jaswant, G.; Townsend, S.; Meslin, F. X.; Abela, B.; Ngeleja, C.; Changalucha, J.; Mtema, Z.; Sambo, M.; Mchau, G.; Rysava, K.; Nanai, A.; Kazwala, R.; Cleaveland, S.; Hampson, K.
A Rabies Elimination Demonstration Project was implemented in Tanzania from 2010 through to 2015, bringing together government ministries from the health and veterinary sectors, the World Health Organization, and national and international research institutions. Detailed data on mass dog vaccination campaigns, bite exposures, use of post-exposure prophylaxis (PEP), and human rabies deaths were collected throughout the project duration and project areas. Despite no previous experience in dog vaccination within the project areas, district veterinary officers were able to implement district-wide vaccination campaigns that, for most part, progressively increased the numbers of dogs vaccinated with each phase of the project. Bite exposures declined, particularly in the southernmost districts with the smallest dog populations, and health workers successfully transitioned from primarily intramuscular administration of PEP to intradermal administration, resulting in major cost savings. However, even with improved PEP provision, vaccine shortages still occurred in some districts. In laboratory diagnosis, there were several logistical challenges in sample handling and submission but compared to the situation before the project started, there was a moderate increase in the number of laboratory samples submitted and tested for rabies in the project areas with a decrease in the proportion of rabies-positive samples over time. The project had a major impact on public health policy and practice with the formation of a One Health Coordination Unit at the Prime Minister’s Office and development of the Tanzania National Rabies Control Strategy, which lays a roadmap for elimination of rabies in Tanzania by 2030 by following the Stepwise Approach towards Rabies Elimination (SARE). Overall, the project generated many important lessons relevant to rabies prevention and control in particular and disease surveillance in general. Lessons include the need for (1) a specific unit in the government for managing disease surveillance; (2) application of innovative data collection and management approaches such as the use of mobile phones; (3) close cooperation and effective communication among all key sectors and stakeholders; and (4) flexible and adaptive programs that can incorporate new information to improve their delivery, and overcome challenges of logistics and procurement.