Integrated rabies epidemiology in remote inuit communities in qu bec canada a one health approach
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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

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Integrated rabies epidemiology in remote inuit communities in qu bec canada a one health approach

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, Québec

NunavikRegionalBoard of Health and Social Services, Kuujjuaq, Nunavik

Centre of Expertise for Rabies, Canadian Food Inspection Agency (CFIA), Ottawa

Ministère de l’Agriculture des Pêcheries et de l’Alimentation du Québec (MAPAQ), Québec

Canadian Public Health Association Annual Meeting

Toronto - May 27, 2014


Background

Background

  • Arctic variant rabies virus (AVRV) in northern Canada

  • Arctic fox main reservoir

  • Epidemiology not fully understood

  • Exposure of human beings


Background rabies in nunavik

Background: rabies in Nunavik

  • Rabiesdiagnosed in animalssince1947

  • No humancases reported

  • Potentialexposurethroughdog bites and contact withwildlife

  • Regular post-exposureprophylaxis

  • Annual dog vaccination campaign by MAPAQ (once a year) since 1983

  • Increased animal cases in late 2011


Objective and rationale

Objective and Rationale

OBJECTIVE:

  • To perform an integrateddescriptive overview of Arcticrabiesepidemiology in Nunavik (wildlife – domesticanimals– humans) in line with the emerging ‘‘One Health’’ paradigm

    RATIONALE:

  • To betterunderstandrabiesrisk and to providebaseline data for the improvement of the regionalrabiespreventionprogram at all levels:

    • human populations (education and health care services)

    • domesticanimal populations (dog vaccination and population control)

    • wildlife (vaccination)


Materia ls methods

Materials & Methods

  • Retrospectivestudy 1999-2012

  • Comprehensive data sets:

    • CFIA: labresults of suspect rabidanimalsthatpotentiallyexposedhumans or domesticanimals(fluorescent antibody test + tissue culture inoculation test, if potentialhumanexposure)

    • MAPAQ: dog vaccination campaign (annual data)

    • NunavikRegionalBoardof Healthand Social Services: data of human cases withpotentialrabiesexposure

  • Descriptive data analysis


Rabies testing in animals

Rabiestesting in animals

112 submissions, mostlydogs

44 positive (39%), mostlywildlife

100%

Proportion of

positive samples

Number of animals

0%


Dog vaccination and animal tests over time

Dog vaccination and animal tests over time

  • Dog vaccination: total 6,243 dogs, annualmedian 517

  • Variation over time and betweenregions

Ungava

Hudson


Human cases of potential exposure to a rabid animal

Human cases of potentialexposureto arabid animal

  • 112 cases investigated, mostlychildren

  • For 41 cases (37%), animal wastested for rabies

  • For 24 cases (59% of 41), the animalstested positive, mostlychildrenwereexposed

  • Most investigations due to dog bites, but mostlab-confirmedexposures due to mucous membrane contact (one event)

Number of people

Number of people


Delay between potential exposure and consultation

Delay betweenpotentialexposure and consultation

  • 62 people started post-exposureprophylaxis

  • 46 completed PEP, including the 24 cases of confirmedexposure

  • Delay varied, mostconfirmed cases started PEP 2 weeks post- exposure

Number of people


Discussion

Discussion

  • Comprehensiveoverviewbased on available data

  • Confirmsregularhumanexposure(children) to rabies virus in Nunavik

  • Highlightsgreaterrequirement for PEP compared to southernQuebec

    • Rabiesstill a public healthissue of concern in Nunavik

    • Needfor prevention and control action:

      • Potential case management

      • Education on rabiesprevention

      • Education on dog bite prevention


Discussion1

Discussion

  • Confirmsrabies in dogs and wildlife (underestimation)

    • Surveillance of rabies in wildlife

    • Potential for wildlife vaccination

  • Actual dog vaccination coveragestillunknown

  • Dog vaccination effect on humanexposureunknown

    • Maintain and reinforce dog vaccination

    • Improvedog population estimates

    • Implementperennial dog population control program

    • Thankto a greatercommunity participation


Conclusion

Conclusion

  • Residents of Nunavikatrisk of exposure to rabies

  • Prevention and control shouldfollow the ‘’One Health‘’approach

  • Requiresintegrated actions toward public health, animal health and ecosystemhealth


Acknowledgments

Acknowledgments

  • NunavikResearchCenter

  • NunavikRegionalBoard of Health and Social Services

  • VeterinarianswithoutBordersCanada

  • World Society for the Protection of Animals

    for supportingthisresearch


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