Risk Modeling of Bat Rabies in the Caribbean Islands.

Rabies surveillance and control measures vary significantly between Caribbean islands. The Centers for Disease Control and Prevention currently recommends certain groups of U.S. travelers to any Caribbean island receive pre-exposure rabies immunization. However, most islands self-declare as "rabies free", and have never publicly released data to support rabies-free claims. We used the Analytic Hierarchy Process to create pairwise comparison values among five risk factors determined by subject matter experts. Risk factor weights were calculated and used in a geospatial analysis to calculate a risk value for each island nation (higher values indicate higher risk). Risk values ranged from 8.73 (Trinidad) to 1.57 (The Bahamas, Turks and Caicos Islands). All four countries that have documented occurrences of laboratory confirmed rabid bats were ranked highest (Trinidad and Tobago, Grenada, Cuba, Dominican Republic), as well as Haiti. The top five highest risk countries that currently have no reports of bat rabies include St. Vincent and the Grenadines, Jamaica, Puerto Rico, the Cayman Islands, and Dominica. This study reviews the inter-island movement potential of bats, designates areas of high risk for bat-associated rabies within the Caribbean islands, and demonstrates a need for further surveillance efforts in bat populations within islands that self-declare as rabies free.

Of bats and livestock: The epidemiology of rabies in Trinidad, West Indies.

Vampire bat-transmitted human rabies was first recognized in Trinidad during a major outbreak during the first half of the 20th century. To date, Trinidad is the only Caribbean island with vampire bat-transmitted rabies. Herein, we summarized the epidemiological situation of rabies in Trinidad during the period 1971-2015 through the analysis of field and laboratory records. During the study period, 259 domestic and wild animal rabies cases were laboratory confirmed with an annual median of 2 animal rabies cases. Over the 45 years, five significant epizootic events occurred (in 1974, 1997-1998, 2000, 2010 and 2012-2013) over which there was a significant increasing trend for the occurrence of rabies cases. The highest number of cases (87 cases) occurred during the 1997-1998 event, and the rabies positive proportion, was highest (0.7, 95% CI 0.52-0.84) for the year 2000. Rabies risk was highest for cattle (negative binomial parameter estimate 4.84, 95% CI 3.45-6.76), although numerous rabies cases were seen in the caprine population during the study period. In light of this finding, consideration should be given to including the small ruminant population in the national rabies vaccination program. Outbreaks affected mainly the counties of St. Patrick and St. George East, with epidemic progression outwards, and these areas should be prioritized for prevention and control efforts.

Rabies in the Caribbean: A Situational Analysis and Historic Review.

Rabies virus is the only Lyssavirus species found in the Americas. In discussions about rabies, Latin America and the Caribbean are often grouped together. Our study aimed to independently analyse the rabies situation in the Caribbean and examine changes in rabies spatiotemporal epidemiology. A questionnaire was administered to the 33 member countries and territories of the Caribbean Animal Health Network (CaribVET) to collect current data, which was collated with a literature review. Rabies was endemic in ten Caribbean localities, with the dog, mongoose, and vampire bat identified as enzootic reservoirs. The majority of animal cases occurred in Puerto Rico, the Dominican Republic, and Haiti, while human cases only consistently occurred in the latter two areas. Rabies vaccination was conducted for high-risk animal populations with variable coverage, and rabies diagnostic capacities varied widely throughout the region. Illegal importation and natural migration of animals may facilitate the introduction of rabies virus variants into virus-naïve areas. Passive surveillance, together with enhanced methods and serological screening techniques, can therefore be of value. The insularity of the Caribbean makes it ideal for conducting pilot studies on reservoir host population management. Best practice guidelines developed for these reservoir hosts can be individually modified to the epidemiological status and available resources within each locality.

Rabies in the Americas: 1998-2014.

Through national efforts and regional cooperation under the umbrella of the Regional Program for the Elimination of Rabies, dog and human rabies have decreased significantly in Latin America and Caribbean (LAC) countries over the last three decades. To achieve this decline, LAC countries had to develop national plans, and consolidate capabilities such as regular mass dog vaccination, opportune post-exposure prophylaxis and sensitive surveillance. This paper presents longitudinal data for 21 LAC countries on dog vaccination, PEP and rabies surveillance collected from the biannual regional meeting for rabies directors from 1998-2014 and from the Regional Epidemiologic Surveillance System for Rabies (SIRVERA). Differences in human and dog rabies incidence rates and dog vaccination rates were shown between low, middle and high-income countries. At the peak, over 50 million dogs were vaccinated annually in national campaigns in the countries represented. The reported number of animal exposures remained fairly stable during the study period with an incidence rate ranging from 123 to 191 reported exposures per 100,000 people. On average, over 2 million doses of human vaccine were applied annually. In the most recent survey, only 37% of countries reported that they had sufficient financial resources to meet the program objectives. The data show a sufficient and sustained effort of the LAC countries in the area of dog vaccination and provide understanding of the baseline effort required to reduce dog-mediated rabies incidence.

Leptospirosis in the Caribbean: a literature review

[ABSTRACT]. Objective. To describe leptospirosis epidemiology, seroprevalence, and serovars among humans and animals in the Caribbean from 1979 – 2013. Methods. A retrospective study of the literature was performed on the general epidemiology, historical records, and geographical locations of leptospirosis outbreaks and cases in the Caribbean from 1979 – 2013. The primary sources of information were identified with PubMed Central, Google Scholar, CAREC, CaribVET, and The School of Veterinary Medicine at the University of the West Indies. Search terms used were: “human leptospirosis,” “animal leptospirosis,” “serovars,” “livestock,” “seroprevalence,” “Caribbean countries,” “risk factors,” “confirmed cases,” “suspected cases,” “MAT,” and “ELISA.” Confirmed and suspected cases of human and animal leptospirosis were identified through laboratory analysis. Results. Most cases of leptospirosis occurred during the rainy season (June – December) and had a positive correlation with flood conditions. The disease was more prevalent in males than females due to behavioral and occupational exposure. The highest incidence rates of human leptospirosis were recorded in Barbados, Trinidad and Tobago, and Jamaica. In animals, leptospirosis has been found in rodents, livestock, and dogs in many Caribbean countries. Inadequate active surveillance and misdiagnosis of human leptospirosis has contributed to under-reporting of the disease. Conclusion. This review highlights the epidemiology and distribution of leptospirosis in the Caribbean. Prevalence rates and serovars vary greatly among the countries. Leptospirosis poses a significant health risk for humans and animals in the Caribbean and requires a “One Health” multisectoral approach to reduce incidence rates and protect at-risk individuals. Increased laboratory capacity to identify leptospirosis cases is required, along with awareness campaigns for both the public and animal and human health professionals.

[RESUMEN]. Objetivo. Describir las características epidemiológicas de la leptospirosis, su seroprevalencia y serovariedades en seres humanos y animales en el Caribe desde 1979 hasta el 2013. Métodos. Se realizó un estudio retrospectivo de la bibliografía en relación con las características epidemiológicas generales, los registros históricos y las ubicaciones geográficas de los brotes y casos de leptospirosis en el Caribe desde 1979 hasta el 2013. Se determinaron las fuentes primarias de información con PubMed central, Google Scholar, CAREC, CaribVET y la Escuela de Medicina Veterinaria de la Universidad de las Indias Occidentales. Los términos de búsqueda que se usaron en inglés fueron los equivalentes de “leptospirosis humana”, “leptospirosis animal”, “serovariedades”, “ganado”, “seroprevalencia”, “países del Caribe”, “factores de riesgo”, “casos confirmados”, “presuntos casos”, “MAT” y “ELISA”. Se determinaron los casos confirmados y presuntos de leptospirosis humana y animal mediante el análisis de laboratorio. Resultados. La mayor parte de los casos de leptospirosis se dieron durante la temporada de lluvias (junio a diciembre) y tuvieron una correlación positiva con las inundaciones. La enfermedad fue más prevalente en los hombres que en las mujeres debido a la exposición laboral y por los comportamientos. Las tasas de incidencia más altas de leptospirosis humana se registraron en Barbados, Trinidad y Tabago y Jamaica. En el caso de los animales, la leptospirosis se ha detectado en los roedores, el ganado y los perros de muchos países del Caribe. La vigilancia activa insuficiente y el diagnóstico erróneo de la leptospirosis humana han contribuido a que haya una subnotificación de los casos de esta enfermedad. Conclusiones. En esta revisión se ponen de relieve las características epidemiológicas y la distribución de la leptospirosis en el Caribe. Las tasas de prevalencia y las serovariedades varían enormemente de un país a otro. La leptospirosis supone un riesgo considerable para la salud de los seres humanos y los animales en el Caribe y requiere un enfoque multisectorial de “Una Salud” para reducir la incidencia y proteger a las personas en riesgo. Se necesita una mayor capacidad en materia de laboratorios para detectar los casos de leptospirosis, junto con campañas de sensibilización tanto del público como de los profesionales de la sanidad animal y la salud humana.

[RESUMO]. Objetivo. Descrever o perfil epidemiológico, a soroprevalência e as sorovariedades da leptospirose em seres humanos e animais no Caribe de 1979 a 2013. Métodos. Estudo retrospectivo de revisão da literatura científica realizado sobre a epidemiologia geral, registros históricos e localizações geográficas de casos e surtos de leptospirose no Caribe no período de 1979 a 2013. As fontes primárias de informação foram identificadas através das bases de dados PubMed Central, Google Scholar, CAREC, CaribVET e Faculdade de Medicina Veterinária da Universidade das Índias Ocidentais. Os seguintes termos de busca foram usados: “human leptospirosis”, “animal leptospirosis”, “serovars”, “livestock”, “seroprevalence”, “Caribbean countries”, “risk factors”, “confirmed cases”, “suspected cases”, “MAT” e “ELISA” (leptospirose humana, leptospirose animal, sorovariedades, gado, soroprevalência, países do Caribe, fatores de risco, casos confirmados, casos suspeitos, MAT e ELISA). Os casos suspeitos e confirmados de leptospirose humana e animal foram identificados por exames laboratoriais. Resultados. A maioria dos casos de leptospirose ocorreu no período de chuvas (junho a dezembro), apresentando uma correlação positiva com a ocorrência de enchentes. A doença foi mais prevalente no sexo masculino que no feminino devido à exposição comportamental e ocupacional. As maiores taxas de incidência de leptospirose humana foram registradas em Barbados, Trinidad e Tobago e Jamaica. Entre os animais, foi verificada a ocorrência de leptospirose em roedores, gado e cães em vários países do Caribe. Vigilância ativa insatisfatória e diagnóstico incorreto dos casos de leptospirose humana são fatores que contribuem para a subnotificação da doença. Conclusões. Este estudo de revisão destacou a epidemiologia e a distribuição da leptospirose no Caribe. As taxas de prevalência e sorovariedades variam muito entre os países. A leptospirose representa um importante risco à saúde dos seres humanos e animais no Caribe, sendo necessário um enfoque multissetorial baseado no conceito de saúde única (one health) para reduzir a incidência da doença e proteger os indivíduos em risco. Faz-se necessário melhorar a capacidade laboratorial de identificar os casos de leptospirose, juntamente com campanhas de conscienti

Tribulations of the Last Mile: Sides from a Regional Program.

In Latin American and Caribbean (LAC) countries, the number of cases of dog-mediated human rabies is at its lowest since the onset of the Regional Program for Rabies Elimination in 1983, a commitment from LAC countries to eliminate dog-mediated rabies coordinated by the Pan American Health Organization. Despite minor setbacks, the decline in the number of human cases has been constant since 1983. While many LAC countries have significantly reduced rabies to a level where it is no longer significant public health concern, elimination has proven elusive and pockets of the disease remain across the region. In the 33-year period since 1983, the region has set and committed to four dates for elimination (1990, 2000, 2012, and 2015). In this paper, we ponder on the multiple causes behind the elusive goal of rabies elimination, such as blanket regional goals oblivious to the large heterogeneity in national rabies capacities. Looking ahead to the elimination of dog-mediated rabies in the region, now established for 2022, we also review the many challenges and questions that the region faces in the last mile of the epidemic. Given the advanced position of the Americas in the race toward elimination, our considerations could provide valuable knowledge to other regions pursuing elimination goals.

The History of Rabies in Trinidad: Epidemiology and Control Measures.

Vampire bat-transmitted rabies was first recognized in Trinidad during a major outbreak reported in 1925. Trinidad is the only Caribbean island with vampire bat-transmitted rabies. We conducted a literature review to describe the changing epidemiology of rabies in Trinidad and give a historical perspective to rabies prevention and control measures on the island. The last human case of rabies occurred in 1937 and although no case of canine-transmitted rabies was reported since 1914, sporadic outbreaks of bat-transmitted rabies still occur in livestock to date. Over the last century, seven notable epidemics were recorded in Trinidad with the loss of over 3000 animals. During the 1950s, several measures were effectively adopted for the prevention and control of the disease which led to a significant reduction in the number of cases. These measures include: vampire bat population control, livestock vaccination, and animal surveillance. However, due to lapses in these measures over the years (e.g., periods of limited vampire control and incomplete herd vaccination), epidemics have occurred. In light of the significant negative impact of rabies on animal production and human health, rabies surveillance in Trinidad should be enhanced and cases evaluated towards the design and implementation of more evidence-based prevention and control programs.

Leptospirosis in the Caribbean: a literature review.

OBJECTIVE: To describe leptospirosis epidemiology, seroprevalence, and serovars among humans and animals in the Caribbean from 1979 - 2013. METHODS: A retrospective study of the literature was performed on the general epidemiology, historical records, and geographical locations of leptospirosis outbreaks and cases in the Caribbean from 1979 - 2013. The primary sources of information were identified with PubMed Central, Google Scholar, CAREC, CaribVET, and The School of Veterinary Medicine at the University of the West Indies. Search terms used were: "human leptospirosis," "animal leptospirosis," "serovars," "livestock," "seroprevalence," "Caribbean countries," "risk factors," "confirmed cases," "suspected cases," "MAT," and "ELISA." Confirmed and suspected cases of human and animal leptospirosis were identified through laboratory analysis. RESULTS: Most cases of leptospirosis occurred during the rainy season (June - December) and had a positive correlation with flood conditions. The disease was more prevalent in males than females due to behavioral and occupational exposure. The highest incidence rates of human leptospirosis were recorded in Barbados, Trinidad and Tobago, and Jamaica. In animals, leptospirosis has been found in rodents, livestock, and dogs in many Caribbean countries. Inadequate active surveillance and misdiagnosis of human leptospirosis has contributed to under-reporting of the disease. CONCLUSION: This review highlights the epidemiology and distribution of leptospirosis in the Caribbean. Prevalence rates and serovars vary greatly among the countries. Leptospirosis poses a significant health risk for humans and animals in the Caribbean and requires a "One Health" multisectoral approach to reduce incidence rates and protect at-risk individuals. Increased laboratory capacity to identify leptospirosis cases is required, along with awareness campaigns for both the public and animal and human health professionals.

Leptospirosis in the Caribbean: a literature review / Leptospirosis en el Caribe: una revisión bibliográfica / Leptospirose no Caribe: uma revisão da literatura científica

ABSTRACT Objective To describe leptospirosis epidemiology, seroprevalence, and serovars among humans and animals in the Caribbean from 1979 - 2013. Methods A retrospective study of the literature was performed on the general epidemiology, historical records, and geographical locations of leptospirosis outbreaks and cases in the Caribbean from 1979 - 2013. The primary sources of information were identified with PubMed Central, Google Scholar, CAREC, CaribVET, and The School of Veterinary Medicine at the University of the West Indies. Search terms used were: "human leptospirosis," "animal leptospirosis," "serovars," "livestock," "seroprevalence," "Caribbean countries," "risk factors," "confirmed cases," "suspected cases," "MAT," and "ELISA." Confirmed and suspected cases of human and animal leptospirosis were identified through laboratory analysis. Results Most cases of leptospirosis occurred during the rainy season (June - December) and had a positive correlation with flood conditions. The disease was more prevalent in males than females due to behavioral and occupational exposure. The highest incidence rates of human leptospirosis were recorded in Barbados, Trinidad and Tobago, and Jamaica. In animals, leptospirosis has been found in rodents, livestock, and dogs in many Caribbean countries. Inadequate active surveillance and misdiagnosis of human leptospirosis has contributed to under-reporting of the disease. Conclusion This review highlights the epidemiology and distribution of leptospirosis in the Caribbean. Prevalence rates and serovars vary greatly among the countries. Leptospirosis poses a significant health risk for humans and animals in the Caribbean and requires a "One Health" multisectoral approach to reduce incidence rates and protect at-risk individuals. Increased laboratory capacity to identify leptospirosis cases is required, along with awareness campaigns for both the public and animal and human health professionals.

RESUMEN Objetivo Describir las características epidemiológicas de la leptospirosis, su seroprevalencia y serovariedades en seres humanos y animales en el Caribe desde 1979 hasta el 2013. Métodos Se realizó un estudio retrospectivo de la bibliografía en relación con las características epidemiológicas generales, los registros históricos y las ubicaciones geográficas de los brotes y casos de leptospirosis en el Caribe desde 1979 hasta el 2013. Se determinaron las fuentes primarias de información con PubMed central, Google Scholar, CAREC, CaribVET y la Escuela de Medicina Veterinaria de la Universidad de las Indias Occidentales. Los términos de búsqueda que se usaron en inglés fueron los equivalentes de "leptospirosis humana", "leptospirosis animal", "serovariedades", "ganado", "seroprevalencia", "países del Caribe", "factores de riesgo", "casos confirmados", "presuntos casos", "MAT" y "ELISA". Se determinaron los casos confirmados y presuntos de leptospirosis humana y animal mediante el análisis de laboratorio. Resultados La mayor parte de los casos de leptospirosis se dieron durante la temporada de lluvias (junio a diciembre) y tuvieron una correlación positiva con las inundaciones. La enfermedad fue más prevalente en los hombres que en las mujeres debido a la exposición laboral y por los comportamientos. Las tasas de incidencia más altas de leptospirosis humana se registraron en Barbados, Trinidad y Tabago y Jamaica. En el caso de los animales, la leptospirosis se ha detectado en los roedores, el ganado y los perros de muchos países del Caribe. La vigilancia activa insuficiente y el diagnóstico erróneo de la leptospirosis humana han contribuido a que haya una subnotificación de los casos de esta enfermedad. Conclusiones En esta revisión se ponen de relieve las características epidemiológicas y la distribución de la leptospirosis en el Caribe. Las tasas de prevalencia y las serovariedades varían enormemente de un país a otro. La leptospirosis supone un riesgo considerable para la salud de los seres humanos y los animales en el Caribe y requiere un enfoque multisectorial de "Una Salud" para reducir la incidencia y proteger a las personas en riesgo. Se necesita una mayor capacidad en materia de laboratorios para detectar los casos de leptospirosis, junto con campañas de sensibilización tanto del público como de los profesionales de la sanidad animal y la salud humana.

RESUMO Objetivo Descrever o perfil epidemiológico, a soroprevalência e as sorovariedades da leptospirose em seres humanos e animais no Caribe de 1979 a 2013. Métodos Estudo retrospectivo de revisão da literatura científica realizado sobre a epidemiologia geral, registros históricos e localizações geográficas de casos e surtos de leptospirose no Caribe no período de 1979 a 2013. As fontes primárias de informação foram identificadas através das bases de dados PubMed Central, Google Scholar, CAREC, CaribVET e Faculdade de Medicina Veterinária da Universidade das Índias Ocidentais. Os seguintes termos de busca foram usados: "human leptospirosis", "animal leptospirosis", "serovars", "livestock", "seroprevalence", "Caribbean countries", "risk factors", "confirmed cases", "suspected cases", "MAT" e "ELISA" (leptospirose humana, leptospirose animal, sorovariedades, gado, soroprevalência, países do Caribe, fatores de risco, casos confirmados, casos suspeitos, MAT e ELISA). Os casos suspeitos e confirmados de leptospirose humana e animal foram identificados por exames laboratoriais. Resultados A maioria dos casos de leptospirose ocorreu no período de chuvas (junho a dezembro), apresentando uma correlação positiva com a ocorrência de enchentes. A doença foi mais prevalente no sexo masculino que no feminino devido à exposição comportamental e ocupacional. As maiores taxas de incidência de leptospirose humana foram registradas em Barbados, Trinidad e Tobago e Jamaica. Entre os animais, foi verificada a ocorrência de leptospirose em roedores, gado e cães em vários países do Caribe. Vigilância ativa insatisfatória e diagnóstico incorreto dos casos de leptospirose humana são fatores que contribuem para a subnotificação da doença. Conclusões Este estudo de revisão destacou a epidemiologia e a distribuição da leptospirose no Caribe. As taxas de prevalência e sorovariedades variam muito entre os países. A leptospirose representa um importante risco à saúde dos seres humanos e animais no Caribe, sendo necessário um enfoque multissetorial baseado no conceito de saúde única (one health) para reduzir a incidência da doença e proteger os indivíduos em risco. Faz-se necessário melhorar a capacidade laboratorial de identificar os casos de leptospirose, juntamente com campanhas de conscientização dirigidas ao público em geral e aos profissionais de saúde humana e animal.