LFD implementation uncovers hidden rabies burden: Pre- and post-implementation analysis and comparison with...

Area of Science:

• Veterinary Medicine
• Public Health
• Epidemiology

Background:

• Rabies diagnosis relies on laboratory testing, often centralized, limiting surveillance in endemic regions.
• Lateral flow devices (LFDs) show promise for rabies diagnosis but their impact on decentralized surveillance needs evaluation.

Purpose of the Study:

• To evaluate the diagnostic performance of LFDs in decentralized, low-resource settings.
• To assess the impact of LFD implementation on rabies surveillance and case detection in the Philippines.

Main Methods:

• Established decentralized diagnostic labs in a rabies-endemic area of the Philippines.
• Assessed LFD diagnostic accuracy against direct fluorescent antibody test (DFAT).
• Analyzed changes in rabies case detection rates pre- and post-LFD implementation using interrupted time series analysis.

Main Results:

• LFDs demonstrated high sensitivity (97.0%) and specificity (98.2%) compared to DFAT.
• Monthly confirmed rabies cases increased 4.14-fold post-LFD implementation (p < 0.001).
• LFDs triggered investigations identifying additional unvaccinated bite victims and exposed animals, but integrated One Health investigations were infrequent (5.6%).

Conclusions:

• LFD-based decentralization significantly enhances rabies case detection and local outbreak response capabilities.
• LFDs are valuable tools for rabies control in endemic settings.
• Sustaining a One Health approach for integrated investigations remains a challenge after LFD-detected rabies cases.