SPEEDIER: Surveillance integrating Phylogenetics and Epidemiology for Elimination of Disease: Evaluation of Rabies Control in the Philippines

A group of rural dogs

Rabies is a horrific but preventable disease that kills over 200 people annually in the Philippines. While the Philippine government catalysed control efforts, with some provinces nearing freedom from rabies, outbreaks continue. Access to lifesaving post-exposure prophylaxis (PEP) for rabid bite victims has improved and has reduced mortality. However, rising PEP use places a strain on local and national budgets, even as rabies circulation has declined. This is unsustainable. At the same time, routine rabies surveillance has shortcomings and is not sufficiently sensitive for international agencies to recognize rabies-free areas, or to respond rapidly to incursions. The Philippines needs to strengthen its surveillance and rationalize its use of PEP so as to fully benefit from rabies control measures that are currently underway. Integrated Bite Case Management (IBCM) is a strategy that can potentially enhance surveillance to enable verification of rabies freedom and rapid detection of incursions for effective outbreak responses to maintain rabies freedom. However, there are significant implementation challenges. 

SPEEDIER aims to operationalize IBCM as a key component of enhanced surveillance which should have immediate beneficial applications within the Philippines and could more broadly benefit the global campaign to eliminate human rabies deaths by 2030. From 2019-2021, SPEEDIER’s goal is to deliver a cost-effective, epidemiologically robust, enhanced surveillance and response package to guide and sustain the elimination of rabies from the Philippines. 

The study design comprises a feasibility study followed by an implementation study of IBCM with an embedded stepped-wedge randomized controlled trial (RCT) of rationalized use of PEP in the low socio-economic class provinces of Romblon and Oriental Mindoro, that include geographically isolated and disadvantaged communities. Through this implementation research we will develop best practice for an enhanced surveillance approach using IBCM as a strategy to detect rabid animals, with risk assessment of bite patients triggering epidemiological investigations and informing PEP use. 

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