Comparing vaccination coverage and dog population demographics among four pilot dog rabies vaccination strategies in Uganda

Akankwatsa Dickson^1,2*Terence Odoch³Kahunde Anna Mary⁴Sonja Hartnack⁵Arthur Bagonza⁶Juliet Kiguli⁶Okech George Samuel^3,7Herrera Adrian⁸Lamorde Mohammed⁹Agado Doreen³Monique Sarah Léchenne^10,11Frederic Lohr¹²Kambugu Andrew⁹Salome Dürr⁸

• ¹Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
• ²Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
• ³Makerere University College of Veterinary Medicine Animal Resources & Biosecurity, Kampala, Uganda
• ⁴Department of Production Kyegegwa District Local Government, Kyegegwa, Uganda
• ⁵Universitat Zurich Vetsuisse-Fakultat, Zürich, Switzerland
• ⁶Makerere University College of Health Sciences, Kampala, Uganda
• ⁷Department of Veterinary Pharmacy and Clinical Studies, School of Veterinary Medicine and Animal Resources, Makerere University, Kampala, Uganda
• ⁸Universitat Bern Vetsuisse Fakultat, Bern, Switzerland
• ⁹Makerere University Infectious Diseases Institute, Kampala, Uganda
• ¹⁰Swiss Tropical and Public Health Institute., Allschwil, Switzerland
• ¹¹Universitat Basel, Basel, Switzerland
• ¹²Worldwide Veterinary Service, Cranborne, United Kingdom

The zero by 30 initiative aims to eliminate dog-mediated human rabies by 2030, for which dog vaccination is a crucial pillar. This study piloted four different dog vaccination campaign strategies in Kyegegwa, a rural district in Uganda, where rabies is endemic, and compared the vaccination coverages achieved by the strategies. Four vaccination strategies were rolled out, each in three parishes from different sub-counties: i) static point vaccination (SP), ii) school-based (SB), iii) integrated dog with livestock vaccination (D-L), and iv) integrated dog vaccination with human health services (D-H). Vaccination coverage was estimated using transect and household survey data, analyzed with a Bayesian model that estimated, besides the vaccination coverage, the dog population size and the proportion of ownerless dogs for each dog population. The mean vaccination coverage achieved among the owned dog population across the three parishes for each respective strategy was 29.5% for SP strategy (the model converged in one parish only), 53.9% (range 27.4%-79.5%) for SB, 66.2% (range 53.5% and 86.0%) for the D-L, and 74.5% (range 63.7% and 88.4%) for D-H. The mean proportion of ownerless dogs in the villages investigated was estimated at 0.1% for the parishes with SP strategy, 7.0% (range 0.1-20.8%) for SB strategy, 29.7% (range 0.5-88.1%) for D-L, and 7.9% (range 0.3-17.7%) for D-H strategy villages. The strategy integrating dog vaccination with human health services outperformed the other strategies by achieving the highest mean vaccination coverage and reaching a constantly high coverage of above 60% for all the three parishes of that strategy. This demonstrates the potential of the human-animal integrated D-H vaccination strategy as an effective approach for rabies control. Sensitization strategies for dog owners also depended in the vaccination strategy performed, i.e. spread of information through health centers for the D-H strategy, which is part of the success of this strategy. The study needs to be taken as a pilot, because of limitations such as different settings between the sub-counties. Further testing across diverse settings can help assess integrated dog vaccination strategies' consistency and scalability, providing valuable insights for developing a One Health model to strengthen future rabies elimination efforts.