The Role of Dog Population Management in Rabies Elimination-A Review of Current Approaches and Future Opportunities.

Free-roaming dogs and rabies transmission are integrally linked across many low-income countries, and large unmanaged dog populations can be daunting to rabies control program planners. Dog population management (DPM) is a multifaceted concept that aims to improve the health and well-being of free-roaming dogs, reduce problems they may cause, and may also aim to reduce dog population size. In theory, DPM can facilitate more effective rabies control. Community engagement focused on promoting responsible dog ownership and better veterinary care could improve the health of individual animals and dog vaccination coverage, thus reducing rabies transmission. Humane DPM tools, such as sterilization, could theoretically reduce dog population turnover and size, allowing rabies vaccination coverage to be maintained more easily. However, it is important to understand local dog populations and community attitudes toward them in order to determine whether and how DPM might contribute to rabies control and which DPM tools would be most successful. In practice, there is very limited evidence of DPM tools achieving reductions in the size or turnover of dog populations in canine rabies-endemic areas. Different DPM tools are frequently used together and combined with rabies vaccinations, but full impact assessments of DPM programs are not usually available, and therefore, evaluation of tools is difficult. Surgical sterilization is the most frequently documented tool and has successfully reduced dog population size and turnover in a few low-income settings. However, DPM programs are mostly conducted in urban settings and are usually not government funded, raising concerns about their applicability in rural settings and sustainability over time. Technical demands, costs, and the time necessary to achieve population-level impacts are major barriers. Given their potential value, we urgently need more evidence of the effectiveness of DPM tools in the context of canine rabies control. Cheaper, less labor-intensive tools for dog sterilization will be extremely valuable in realizing the potential benefits of reduced population turnover and size. No one DPM tool will fit all situations, but if DPM objectives are achieved dog populations may be stabilized or even reduced, facilitating higher dog vaccination coverages that will benefit rabies elimination efforts.

Survey of electronic veterinary medical record adoption and use by independent small animal veterinary medical practices in Massachusetts.

OBJECTIVE: To estimate the proportion of independent small animal veterinary medical practices in Massachusetts that use electronic veterinary medical records (EVMRs), determine the purposes for which EVMRs are used, and identify perceived barriers to their use. DESIGN: Survey. SAMPLE: 100 veterinarians. PROCEDURES: 213 of 517 independent small animal veterinary practices operating in Massachusetts were randomly chosen for study recruitment. One veterinarian at each practice was invited by telephone to answer a hardcopy survey regarding practice demographics, medical records type (electronic, paper, or both), purposes of EVMR use, and perceived barriers to adoption. Surveys were mailed to the first 100 veterinarians who agreed to participate. Practices were categorized by record type and size (large [≥ 5 veterinarians], medium [3 to 4 veterinarians], or small [1 to 2 veterinarians]). RESULTS: 84 surveys were returned; overall response was 84 of 213 (39.4%). The EVMRs were used alone or together with paper records in 66 of 82 (80.5%) practices. Large and medium-sized practices were significantly more likely to use EVMRs combined with paper records than were small practices. The EVMRs were most commonly used for ensuring billing, automating reminders, providing cost estimates, scheduling, recording medical and surgical information, and tracking patient health. Least common uses were identifying emerging infectious diseases, research, and insurance. Eleven veterinarians in paper record-only practices indicated reluctance to change, anticipated technological problems, time constraints, and cost were barriers to EVMR use. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated EVMRs were underutilized as a tool for tracking and improving population health and identifying emerging infectious diseases. Efforts to facilitate adoption of EVMRs for these purposes should be strengthened by the veterinary medical, human health, and public health professions.

Curriculum asset mapping for One Health education.

The major premise of One Health is engagement of multiple disciplines to address shared problems spanning human, animal, and ecosystem health. The current model of academic specialization encourages development of isolated disciplines within the university setting, thereby creating barriers to resource sharing and academic collaboration. The aim of this project was to develop a systematic approach to mapping university assets that could be harnessed to advance One Health education. Asset in this context was defined as a course, program, or faculty expertise relevant to a particular One Health problem. The approach adopted comprised the following steps: (1) identify a current problem that would benefit from an integrated, interdisciplinary perspective (e.g., EIDs [emerging infectious diseases]); (2) identify individual disciplinary teaching areas pertinent to the problem (e.g., health communication, wildlife ecology); (3) identify competencies expected to be attained by graduates who will address the problem (e.g., respond to outbreaks); (4) survey faculty members on their teaching areas and curricular offerings that address these competencies; and (5) compile responses in a database that is searchable by teaching area and competency. We discuss our recent experiences mapping the assets at Tufts University that are relevant to the problem of EIDs with emphasis on zoonotic-disease surveillance, outbreak investigation, and outbreak response. Using 13 teaching areas and 16 competencies relevant to applied epidemiology, we identified and characterized previously untapped resources across the university. Asset mapping is thus a useful tool for identifying university resources and opportunities that can be leveraged to support interdisciplinary education for One Health.

Reported rabies pre-exposure immunization of students at US Colleges of Veterinary Medicine.

In 2008, the US experienced a disruption in human rabies vaccine supplies, leading public health authorities to prioritize vaccine release for post-exposure prophylaxis (PEP) and limit vaccine supplies for pre-exposure prophylaxis (PreEP) in high-risk groups. In 2008, the Association of American Veterinary Medical Colleges (AAVMC) surveyed its member institutions on rabies vaccination policies and practices. Senior administrators at Colleges of Veterinary Medicine (CVMs) and departments of veterinary science and comparative medicine were asked to identify the person most knowledgeable about their institution's student rabies vaccination program. Respondents were asked to describe their policies and procedures for administering PreEP to veterinary medical students and staff and to estimate the annual demand for student and staff PreEP vaccine. Twenty-one CVMs responded. Twenty (95%) reported requiring PreEP of veterinary medical students and 16 (80%) of those 20 required vaccination upon matriculation. An estimated 7,309 doses of vaccine were required for PreEP of an estimated 2,436 first-year US veterinary medical students. Seventy-two percent of respondents administered PreEP in August, September, and October, coinciding with the highest public demand for PEP. CVMs should consider altering the timing of rabies vaccine administration to veterinary medical students and staff to other months, thereby helping to ensure that PEP rabies vaccine will be available to people with validated rabies exposures and to ensure that supplies will be available for PreEP of students and staff. AAVMC may wish to identify and support a point of coordination to facilitate the purchase and distribution of human rabies vaccine among its US member CVMs.

Education of veterinary medical and other public health providers: linking interventions with health outcomes.

A systematic literature review was performed to summarize the nature, implementation, outcomes, and long-term impacts of previously instituted interventions and programs aimed at educating veterinary public health providers. A logic model was developed to direct the literature search strategy, provide a framework for evaluating the relationship between veterinary public health professional education and their associated population health outcomes, and guide future training development and recommendations for the education of veterinary health professionals. Our literature review indicates that there is a relative lack of published literature that connects veterinary public health educational interventions to population health outcomes. Reasons for the lack of evidence to connect educational programs and population health outcomes include the evaluation of outcomes on a short-term rather than intermediate- or long-term basis, a lack of experimental studies, and infrequent grounding in population health or educational theory. Future intervention recommendations as suggested in the reviewed articles are also summarized.

The combined master of public health program at Tufts University.

The Combined Master of Public Health program at Tufts University unites medical and veterinary medical students in a four-year curriculum that integrates students' clinical studies with simultaneous studies on population health. Thirty years ago, Tufts University adopted a "One Medicine" approach to teaching health professionals. That perspective has been updated as "One Health" and is now being applied in a university environment that emphasizes interdisciplinary education, a global outlook, and civic engagement.