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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

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Acknowledgments

Nunavik Research Center Nunavik Regional Board of Health and Social Services Veterinarians without Borders Canada World Society for the Protection of Animals

for supporting this research