Table 4 Management guidance based on classifications

1) ENDEMIC TRANSMISSION: control measures have not been implemented sufficiently to demonstrably reduce incidence. Mass vaccination campaigns should therefore be implemented within all administrative units, at least annually, using modern cell-culture vaccines of proven efficacy, aiming to reach > 70% of dogs in all communities. Gaps in coverage can allow persistence, even when average coverage is high [21, 26]. Therefore, if ongoing vaccination campaigns are not controlling rabies, their implementation and coverage at local levels should be monitored to identify areas for improvement.

2) DECLINING TRANSMISSION: Control measures are demonstrably effective and current mass dog vaccinations should be sustained. Plans for maintaining rabies freedom should be developed, including emergency response strategies and preparation for enhanced surveillance required to verify freedom from disease [27].

3) INTERMITTENT DETECTION: Criteria indicate that either: i) transmission is endemic but surveillance is poor; ii) transmission has been interrupted but incursions are frequent; or iii) other circulating variants are causing cases in dogs. Assuming surveillance information is available, updating the classification with removal of wildlife variants could resolve scenario iii, while case locations may allow incursions to be distinguished from local transmission (i.e. scenario ii); otherwise surveillance needs enhancing to distinguish these scenarios. Management recommendations are either for improved high coverage comprehensive vaccination campaigns to interrupt transmission (scenario i); investment in rabies control in source populations and in populations at risk from incursions (scenario ii); maintained dog vaccination to prevent further spread of these spillover variants (scenario iii).

4) ABSENT-VULNERABLE: Control efforts should be maintained while incursion risks remain high. Enhanced surveillance should be implemented for early detection of incursions and a detailed emergency response strategy prepared to ensure rapid response capacity [20]. In light of any incursions this emergency response strategy should be reviewed. All cases should be sequenced to identify variants and sources of incursions. Evidence should be compiled to verify freedom from rabies, including the absence of case detection during 2 years of enhanced surveillance [20].

5) ABSENT: Although no cases have been detected for extended periods, enhanced surveillance should be maintained and evidence compiled to verify rabies freedom.