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

Despite accumulating evidence supporting lateral flow devices (LFDs) in rabies diagnosis, their impacts of decentralizing diagnostic capacity on surveillance in endemic settings have not been systematically evaluated.

We established low-resource decentralized rabies diagnostic laboratories in a target area of the Philippines, where rabies testing was previously unavailable, and evaluated both the diagnostic performance of LFD and their impacts on surveillance.

Using DFAT (direct fluorescent antibody test) as reference, LFDs performed at the decentralized laboratories showed a sensitivity of 97.0 % and a specificity of 98.2 %. After implementation, the monthly number of confirmed animal rabies cases in the target area increased from 2.09 to 8.65 cases, representing a 4.14-fold increase (p < 0.001), a change not observed in neighboring provinces without LFD implementation. Interrupted time series analysis further supported a significantly increasing trend in case detection after the implementation (coefficient = 0.565, p < 0.001), which was not observed in non-implementation provinces. Through 69 outbreak investigations triggered by LFD-positive cases, 22 unvaccinated human bite victims and 66 exposed animals were additionally identified. However, while case investigations were performed in 54.8 % of cases, integrated One Health investigations involving coordinated actions by local health and veterinary offices were conducted in only 5.6 %.

LFD-based decentralization markedly improved case detection and enabled critical outbreak responses at the local level, demonstrating its value for rabies control in endemic settings though sustained One Health approach remains a challenge following the detection of rabid animals using LFD.