Report prepared by Dr. Janine Seetahal

In light of the lack of surveillance data in many Caribbean countries, the rabies status of bat populations in non-endemic rabies countries can be challenged. As such rabies surveillance guidelines for bat populations need to be developed particularly for countries that are non-endemic for the rabies virus. Therefore, PAHO/PANAFTOSA and the CaribVET Veterinary Public Health working group (Rabies Subgroup) proposed to partner with the Center for Disease Control and Prevention (CDC) to conduct a workshop to develop rabies surveillance guidelines for bat populations in the Caribbean region.

The fundamental objectives of this workshop are:

• To provide information on the recently developed WHO rabies risk classification system and the SIRVERA* platform for the reporting of rabies cases
• To develop surveillance guidelines for sylvatic (bat) rabies in non-endemic countries in the Caribbean
• To train attendees on rabies surveillance methods including passive surveillance models
• To present, discuss and validate a bat rabies ecological risk map for the Caribbean
• To identify rabies diagnostic laboratories that can provide diagnostic support for surveillance in countries that currently do not have the capacity to conduct rabies laboratory testing.
• To develop a road-map towards the establishment of a regional rabies reference laboratory for the Caribbean.

The expected outcomes of this workshop were:

Short-term:

• Documented surveillance guidelines for rabies surveillance in bat populations within non-endemic rabies countries.
• Improved rabies surveillance in bat populations within the Caribbean.

Long-term:

• The establishment of the bat rabies status for Caribbean countries and eventual removal of “rabies-free” countries from the CDC’s travel health recommendations.
• The establishment of at least one Regional Rabies Reference Laboratory in the Caribbean.

 Facilitators will be provided by US Centers for Disease Control and Prevention (CDC), PAHO/PANAFTOSA and the Wistar Institute, a WHO Collaborating Centre on rabies.

Agenda

Check the presentations delivered during the workshop. Presentations and materials are available upon request

Main results of the workshop

Participants

There were 26 participants in the workshop from 10 countries in the Caribbean, one in South America (El Salvador) and the United States. Participants were included from governmental organizations (e.g. representatives from Ministries of Health and Agriculture) and non-governmental organizations (representatives from Conservation Groups) within the Caribbean and international organizations (PAHO) and institutions (representatives from CDC). The workshop provided a forum for the dissemination of knowledge in various areas of bat rabies surveillance, sharing of information on rabies surveillance and control measures within the Caribbean and brain storming of ideas for rabies surveillance within the individual countries.

Description

The opening ceremony for the workshop was chaired by Dr. Alexandra Vokaty with Dr. Bernadette Theodore-Gandi, PAHO/WHO Representative in Trinidad and Tobago and Dr. Saed Rahaman, Director, Veterinary Public Health Unit, Trinidad and Tobago giving comments from the PAHO and Ministry of Health, Trinidad and Tobago respectively.

The first session provided an overview of rabies in the Caribbean with Dr. Janine Seetahal presenting the results of the CaribVET Regional Rabies Survey and literature review as background information to appraise participants on the rabies situation within each Caribbean country. This was followed by presentations from Dr. Marco Vigilato, who covered the WHO country risk classification system for rabies and Dr. Ryan Wallace who outlined the CDC rabies travel advisories listed for Caribbean countries. Dr. Wallace mentioned that there currently was no clear definition for rabies-free status nor is it clear to which reservoir this pertains. He indicated that travel advisories were also provided by WHO and ACIP and that they may differ by source. He emphasized the importance of surveillance using examples of countries in which indigenous rabies cases were discovered in wildlife after years of self-declared rabies-free status.  

The next session outlined rabies surveillance and control in the Americas, with Dr. Vigilato presenting on the measures employed in Latin America and Dr. Wallace on those in the United States. Country representatives from the 10 Caribbean countries (Barbados, Belize, Cuba, DR, Grenada, Guyana, Haiti, Jamaica, Suriname and Trinidad and Tobago) in attendance each gave brief presentations on the measures in place within their respective countries. Also included in this session, Dr. Janine Seetahal gave an overview of bat research techniques including bat handling, trapping and sampling. She also presented on diagnostic test considerations and sample shipment guidelines. Due to time constraints the last two presentations listed for day 1 of the workshop were postponed to the morning of day 2.

Dr. Maurice Frank began the proceedings on day 2 with his presentation of the bat species distribution within the Caribbean. His presentation lay the foundation for the introduction of the recently developed Eco-health risk map specific to bat-transmitted rabies, which was put forward to the plenary by Dr. Clint Morgan. The subsequent session aimed to give some guidelines towards the group work on guideline development for bat rabies surveillance. Drs. Wallace and Vigilato each spoke about the surveillance types in the United States and Latin America respectively and also informed participants on the locations of rabies reference laboratories and the operations of rabies laboratory networks. The last presentation was made by Dr. Vigilato who outlined the public health response to a rabies positive bat citing a scenario in Latin America as an example and illustrating the importance of contingency planning in the event that rabies virus or exposure to the virus is discovered. See appendix V for workshop presentations.

Participants were then divided into three groups based on their current rabies status (bat rabies endemic, bat rabies non-endemic and canine rabies endemic) for group work and discussions towards developing or improving rabies surveillance within each country or country group. Workgroups reported their recommendations back to the plenary after discussions and options for laboratory support for surveillance exercises were proposed and collectively discussed. The workshop concluded at this point with instructions given for transport to the Botanical Gardens for the field exercise in bat trapping and handling The field exercise was about 90 minutes with 25 bats of 6 different species captured during the exercise.

Workshop Outputs

1)    Guidelines for surveillance:

Recommendations for surveillance in canine rabies endemic countries:

• Continue following recommendations of PAHO/PANAFTOSA towards the regional goal of canine rabies eradication by 2022.
• Focus on human surveillance in the DR
• Improve the availability of biologics in Haiti
• Examine canine to mongoose transmission in these countries

Recommendations for surveillance in bat rabies endemic countries:

• Improve passive surveillance systems in animals including data collection and collation
• Countries without surveillance are encouraged to set up a system for passive reporting of clinical suspects and implement diagnostic testing (utilizing external laboratories for testing)
• Countries which share land borders with canine rabies endemic countries are encouraged to maintain border control through vaccination
• Clarify Post Exposure Prophylaxis recommendations
• Conduct evaluations on diagnosed encephalitis in countries to determine the ability to detect human rabies cases
• Work on proving canine rabies freedom utilizing the new WHO guidelines

Recommendations for surveillance in bat rabies non-endemic countries:

• Review existing regulations and policies as it pertains to rabies surveillance
• Find out what regulations exist that govern the import of vaccines and export of samples
• Identify countries that want to conduct bat rabies surveillance
• In these countries then identify if any personnel are available that have had pre-exposure vaccination
• Develop a regional proposal for bat surveillance to prove bat rabies freedom with regional support to implement and international support to conduct diagnostic testing. Including the justification for surveillance (e.g. tourism, potential risk to researchers/biologists, domestic recommendations etc.)
• Formulate country specific plans for conducting sampling
• Investigate potential sources of funding for conducing the diagnostic testing

 2)    Other outputs

• UWI Trinidad requested a proficiency panel from CDC to set up rabies PCR testing.

Funding

* SIRVERA - Sistema de Información Regional para la Vigilancia Epidemiológica de la Rabia (Regional Information System for the Epidemiological Surveillance of Rabies)