Breaking Down Barriers, Strengthening Rabies Diagnostic Capacity Internationally

By Lauren Greenberg, MS, microbiologist with Poxvirus and Rabies Branch, DHCPP, NCEZID, CDC

Rabies is a deadly but vaccine-preventable disease that kills an estimated 59,000 people globally each year. In many countries, the greatest risk stems from dog populations that roam free with little to no care. Poor access to quality healthcare, vaccine shortages (both human and canine), lack of knowledge about appropriate bite wound care, and limited disease surveillance can further complicate the efforts to control rabies in countries that are most affected.

Over the past two years, I have worked in Ethiopia as a subject matter expert to coordinate rabies lab preparations and provide technical assistance to local public health microbiologists on rabies laboratory diagnostics. CDC and the Ethiopian Public Health Institute, along with other government institutions, are collaborating to build the country’s capacity for diagnosing rabies in order to gain a more accurate assessment of the rabies burden in Ethiopia. With a clearer understanding of the disease burden, local officials will be better equipped to design targeted prevention and control programs based on community-specific recommendations.

People Are the Key

The key to building rabies diagnostic laboratory capacity resides in effective human resource development. People’s discomfort working with both dogs and the rabies virus can present a significant challenge. Even though microbiologists and laboratory technologists hired for training in rabies diagnostic work receive the rabies pre-exposure prophylaxis vaccine series, they can still be unsure about how to safely work with the virus, which presents a barrier to passing along important technical knowledge.

Emphasizing how to work safely in the laboratory is the first critical step of training. Basic safety skills, including proper use of personal protective equipment (PPE) and appropriate biosafety measures, are at the forefront of the training. This helps establish that laboratory personnel safety is the number one priority, allowing local staff to feel much more comfortable and confident in their abilities to conduct rabies testing in their new labs.

Overcoming Logistical Challenges

To build fully functional rabies diagnostic laboratories equipped with sample testing and reporting capabilities, we first needed to assess availability of laboratory spaces, supplies, and equipment. Three laboratories in Ethiopia—one in the capital of Addis Ababa and two regional labs—were selected to become the country’s diagnostic hubs for laboratory-based rabies surveillance.

During the process of equipping these laboratories, complications involving infrastructure conditions, field sample collection and transfer, and partner communication have been inevitable. We are working diligently with in-country counterparts and other stakeholders to overcome these challenges and prepare the labs to accurately and safely test suspect rabies samples.

Raising a New Generation of Rabies Lab Experts

Transferring supplies and providing training is not enough to help developing countries build their own rabies diagnostic laboratories. Such initiatives must be linked to national and local efforts to build trust and provide services for individual communities through long-term collaborations and hands-on activities. Empowering regional and national laboratory workers to become the frontline experts in this manner encourages them to share these best practices with colleagues for years to come. By working side-by-side with our in-country partners, we can help create a healthier and more engaged community.

In celebration of World Rabies Day on September 28, I am reminded of what a truly amazing opportunity it has been to work with so many bright and motivated microbiologists willing to play such a critical role in the fight against canine rabies.