Context

Rabies is endemic in Mali, but little is known about the distribution of rabies and its surveillance across the country. Documenting the evolution of rabies and the problems related to surveillance is useful to facilitate elimination of human rabies by 2030.

Method

Data collected at the Central Veterinary Laboratory (LCV) from 1999 to 2017 and through the surveillance system functioning at household, health and veterinary structure levels, as established by the Global Vaccine Alliance funded project on the burden of rabies, between 2016 and 2017 in Bamako and the Sikasso region were used in this study. All data on animals examined for rabies by the direct fluorescence antibody test (DFA) during the specified time period were summarized, and the proportion of rabies positive tested among animals suspected of rabies was estimated. From the number of dogs tested positive for rabies, a cumulative incidence was estimated for the total canine population. The number of positive tested samples was divided by the product of the estimated canine population and number of years (18). In addition, the number of human rabies cases was analyzed to estimate a cumulative incidence.

Results

Among all animal samples suspected for rabies, 93.2% [95% CI 90.6–95.3] were positive by the DFA test. From the 486 included animal samples, 94.7% [95% CI 92.3–96.5] were domestic dogs with 90.9% [95% CI 87.9–93.3] positive, which stands out as the main reservoir of rabies in Mali. Cats, cattle, sheep and donkeys also tested positive using the DFA test. The cumulative incidence of canine rabies was estimated at 0.371 [95% CI: 0.336–0.408] / 10′000 dogs. The highest incidence was observed in Bamako, the capital of Mali, with a cumulative incidence of 2.242 [95% CI: 2.001–2.504] / 10′000 dogs, followed by Koulikoro with 0.335 [95% CI: 0.258–0.429] / 10′000 dogs. For other areas far from LCV, the cumulative incidence was low, with zero in Kidal. Nationally reported cases of human rabies declined in recent years with an average of 12.6 [95% CI: 8.7–16.5] deaths per year. This result gives an annual incidence of 0.1047 [0.0742–0.1352] / 100′000 inhabitants.

Conclusion

Over the past 18 years, rabies is endemically stable in Mali despite the decrease in reported human cases. The disparity among regions in number of samples tested indicates a low level of clinical and laboratory surveillance and likely a high level of underreporting. Dogs play the main role in rabies transmission in Mali. Monitoring of and decisions for post-exposure prophylaxis (PEP) includes other animals (cats, cattle, and monkeys) involved in transmission. Mali should develop a national rabies strategy to include better communication between the public health and animal health sectors, strengthening of laboratory surveillance capacity, mass vaccination of dogs and guaranteed access to PEP.

中文翻译：

---

过去18年中马里的狂犬病监视应对措施以及对未来的要求。

语境

狂犬病是马里的特有疾病，但对狂犬病的分布及其在全国的监测知之甚少。记录狂犬病的演变以及与监测有关的问题，有助于促进到2030年消除人类狂犬病。

方法

全球疫苗联盟资助的狂犬病负担项目于2016年至2017年在中央兽医实验室（LCV）于1999年至2017年期间通过家庭，健康和兽医结构水平运行的监控系统收集的数据本研究使用西卡索地区。总结了在指定时间段内通过直接荧光抗体测试（DFA）检查的狂犬病动物的所有数据，并估计了在怀疑有狂犬病的动物中测试的狂犬病阳性比例。从狂犬病检测呈阳性的狗的数量中，可以估算出犬总种群的累积发病率。阳性测试样品的数量除以估计的犬类数量与年数的乘积（18）。此外，

结果

通过DFA测试，在所有怀疑患有狂犬病的动物样本中，有93.2％[95％CI 90.6–95.3]为阳性。在包括的486个动物样本中，有94.7％[95％CI 92.3-96.5]的家犬具有90.9％[95％CI 87.9-93.3]阳性的犬种，是马里狂犬病的主要宿主。使用DFA测试，猫，牛，绵羊和驴也呈阳性。犬狂犬病的累积发病率估计为0.371 [95％CI：0.336–0.408] / 10'000只狗。发生率最高的地区是马里首都巴马科，累计发生率为2.242 [95％CI：2.001–2.504] / 10'000只狗，其次是Koulikoro，为0.335 [95％CI：0.258–0.429] / 10 '000条狗。对于远离LCV的其他地区，累积发病率很低，基达尔为零。近年来，全国报告的人类狂犬病病例有所下降，平均下降了12.6 [95％CI：8.7-16。5]每年死亡。这一结果得出的年发病率为0.1047 [0.0742–0.1352] / 100'000居民。

结论

在过去的18年中，尽管报告的人类病例有所减少，但马里的狂犬病在地方病中仍很稳定。所测试样品数量之间的地区差异表明临床和实验室监测水平较低，而报告不足的水平可能较高。狗在马里的狂犬病传播中起主要作用。暴露后预防（PEP）的监测和决策包括与传播有关的其他动物（猫，牛和猴）。马里应制定一项国家狂犬病战略，包括加强公共卫生和动物卫生部门之间的沟通，加强实验室监测能力，对狗进行大规模疫苗接种以及保证获得PEP。