Strengthening Rabies Surveillance Capacity Using Existing Resources through an Integrated Bite Case Management Model: A Practical One Health Action

BackgroundRabies remains a cause of mortality in many low- and middle-income countries, with the majority of human infections resulting from dog-to-human transmission. The Integrated Bite Case Management (IBCM) model is a One Health approach that aims to strengthen rabies surveillance and response by linking the management of human bite cases with investigation of the implicated animals. This study aimed to evaluate the effectiveness of implementing IBCM in Quang Nam Province under existing resource conditions. Methodology/Principal FindingsA pre-post intervention study without a control group was conducted across the entire province. During the intervention period, 11,673 animal-bite cases were recorded; IBCM identified 75 animals suspected of having rabies, of which 40 tested positive for rabies virus by RT-PCR. Most of these animals were unvaccinated, free-roaming dogs. In communes where outbreaks were detected, the average number of registered dogs increased from 507 to 543 per commune, and vaccination coverage increased from 44.1% to 72.6% within 21 days. The average number of Post-exposure prophylaxis (PEP) courses administered per month increased from 349 to 971, the proportion of high-risk exposures increased from 9.3% to 11.9%, and the proportion of delayed PEP ([≥]10 days after exposure) rose slightly from 5.9% to 6.6%. At the same time, the proportion of staff with good knowledge of rabies diagnosis in animals increased substantially, from 9.1% to 55.6%. The main limitations included the pre-post design and loss to follow-up of some animals, which prevented laboratory testing. ConclusionThe implementation of IBCM within the existing health and veterinary systems substantially strengthened rabies surveillance and response in accordance with the One Health approach. IBCM was demonstrated to be feasible, resource-appropriate, and scalable, thereby contributing to progress toward the global goal of eliminating human deaths from dog-mediated rabies by 2030. Author summaryRabies is a preventable disease, yet it continues to cause deaths in many countries where dogs remain the primary reservoir and source of infection. In Vietnam, rabies surveillance remains largely separated between the human and animal health sectors. The IBCM model uses human bite cases as the "trigger point" for coordinated investigation of the implicated animals, risk assessment, and information sharing between the two sectors, thereby supporting both clinical decision-making and outbreak response. We implemented the IBCM model in Quang Nam Province and observed an increase in the number of rabid animals detected, a marked rise in dog vaccination coverage in outbreak-affected areas, and substantial improvement in the knowledge and capacity of both health and veterinary staff. Simply by strengthening collaboration and information sharing between the two sectors, the rabies surveillance system became more sensitive and effective. This represents a practical example of One Health approach in action.