Abstract:
Haiti, a Caribbean country of 10.5 million people, is estimated to have the highest burden of caninemediated
human rabies deaths in the Western Hemisphere, and one of the highest rates of human rabies deaths in the
world. Haiti is also the poorest country in the Western Hemisphere and has numerous economic and health priorities that
compete for rabies-control resources. As a result, primary rabies-control actions, including canine vaccination programs,
surveillance systems for human and animal rabies, and appropriate postbite treatment, have not been fully implemented
at a national scale. After the 2010 earthquake that further hindered the development of public health program infrastructure
and services, the U.S. Centers for Disease Control and Prevention worked with the Ministry of Public Health
and Population and key health development partners (including the Pan-American Health Organization) to provide
technical expertise and funding for general disease surveillance systems, laboratory capacity, and selected disease
control programs; including rabies. In 2011, a cross-ministerial rabies consortium was convened with participation from
multiple international rabies experts to develop a strategy for successful rabies control in Haiti. The consortium focused on
seven pillars: 1) enhancement of laboratory diagnostic capacity, 2) development of comprehensive animal surveillance
system, 3) development of comprehensive human rabies surveillance system, 4) educational outreach, 5) sustainable
human rabies biologics supply, 6) achievement of sustained canine vaccination rates of ³ 70%, and 7) finalization of a
national rabies control strategy. From 2010 until 2015, Haiti has seen improvements in the program infrastructure for
canine rabies control. The greatest improvements were seen in the area of animal rabies surveillance, in support of which
an internationally recognized rabies laboratory was developed thereby leading to an 18-fold increase in the detection of
rabid animals. Canine rabies vaccination practices also improved, from a 2010 level of approximately 12% to a 2015 dog
population coverage level estimated to be 45%. Rabies vaccine coverage is still below the goal of 70%, however, the
positive trend is encouraging. Gaps exist in the capacity to conduct national surveillance for human rabies cases and
access to human rabies vaccine is lacking in many parts of the country. However, control has improved over the past
5 years as a result of the efforts of Haiti’s health and agriculture sectors with assistance from multiple international
organizations. Haiti is well situated to eliminate canine-mediated human rabies deaths in the near future and should serve
as a great example to many developing countries struggling with similar barriers and limitations.
