Community-based active surveillance for rabies in Machakos District, Kenya

The rabies problem in Kenya has been greatest in Machakos District where th e disease has persisted endemically for over 40 years. This paper presents the results of a one-year community based active surveillance-for rabies in six randomly selected sublocations in the district for the period 1992-199 3. Approximately 860 rabid dogs per 100 000 dogs were confirmed in this stu dy, compared to approximately 12 per 100 000 confirmed rabid dogs reported by the existing passive-surveillance system. This active surveillance under estimated the true rabies incidence, because only 41% (130/317) of the pote ntial specimens could be diagnosed. Dogs accounted for 92% (179/194) of pri mary animal-rabies suspects, 80% (66/83) of secondary suspects, and 81% of the confirmed animal-rabies cases. The annual incidence of animal-bites of humans was 234 per 100 000 people and the point estimate of human-rabies in cidence per year was 25 per million people. Almost all (97%) animal-bites o f humans were due to dogs. The traditional passive-surveillance system grossly underestimated the impo rtance of rabies as a public-health problem in Machakos District. Community -based active surveillance provides a potential cost-effective strategy for greatly improving estimates of rabies incidence and epidemiology to inform veterinary and policy decision-making. (C) 2000 Elsevier Science B.V. All rights reserved.