RT Journal Article SR Electronic T1 Surveillance to Establish Elimination of Transmission and Freedom from Dog-mediated Rabies JF bioRxiv FD Cold Spring Harbor Laboratory SP 096883 DO 10.1101/096883 A1 Katie Hampson A1 Bernadette Abela-Ridder A1 Kirstyn Brunker A1 S. Tamara M. Bucheli A1 Mary Carvalho A1 Eduardo Caldas A1 Joel Changalucha A1 Sarah Cleaveland A1 Jonathan Dushoff A1 Veronica Gutierrez A1 Anthony R Fooks A1 Karen Hotopp A1 Daniel T Haydon A1 Ahmed Lugelo A1 Kennedy Lushasi A1 Rebecca Mancy A1 Denise A Marston A1 Zac Mtema A1 Malavika Rajeev A1 LĂșcia R. Montebello P Dourado A1 J. F. Gonzalez Roldan A1 Kristyna Rysava A1 Silene Manrique Rocha A1 Maganga Sambo A1 Lwitiko Sikana A1 Marco Vigilato A1 Victor Del Rio Vilas YR 2016 UL http://biorxiv.org/content/early/2016/12/31/096883.abstract AB Background With a global target set for zero human deaths from dog-mediated rabies by 2030 and some regional programmes close to eliminating canine rabies, there is an urgent need for enhanced surveillance strategies suitable for declaring freedom from disease and elimination of transmission with known confidence.Methods Using exhaustive contact tracing across settings in Tanzania we generated detailed data on rabies incidence, rabid dog biting behaviour and health-seeking behaviour of bite victims. Using these data we compared case detection of sampling-based and enhanced surveillance methodologies and investigated elimination verification procedures.Findings We demonstrate that patients presenting to clinics with bite injuries are sensitive sentinels for identifying dog rabies cases. Triage of patients based on bite history criteria and investigation of suspicious incidents can confirm >10% of dog rabies cases and is an affordable approach that will enable validation of disease freedom following two years without case detection. Approaches based on sampling the dog population without using bite-injury follow-up were found to be neither sensitive nor cost-effective.Interpretation The low prevalence of rabies, and short window in which disease can be detected, preclude sampling-based surveillance. Instead, active case finding guided by bite-patient triage is needed as elimination is approached. Our proposed methodology is affordable, practical and supports the goal of eliminating human rabies deaths by improving administration of lifesaving post-exposure prophylaxis for genuinely exposed but untreated contacts. Moreover, joint investigations by public health and veterinary workers will strengthen intersectoral partnerships and capacity for control of emerging zoonoses.