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Page 151 Millien et al. One Health Implement Res 2023;3:148-60 https://dx.doi.org/10.20517/ohir.2023.37

The true incidence of human and canine rabies in Haiti is currently unknown. However, limited
surveillance activity from 2009-2012 detected an average of four canine and seven human rabies cases
[8,9]
annually . To get a clear situation of the rabies vaccination coverage, it is worthwhile to refer to Figure 1
titled “Canine vaccination coverage from 2005 to 2015” [Figure 1].

In several Latin American countries, through primary intervention methods applied in the 1970s, deaths
caused by human rabies transmitted by dogs decreased from 350 per year to less than 10 between 1980 and
2010. Unfortunately, these positive results were not observed in Haiti, as between 1980 and 1986, 18 human
deaths from human rabies were reported (an average of 2.6 per year). Reported human deaths from human
rabies appear to have only increased over time, as a passive human rabies surveillance system in Haiti
currently detects approximately 7 to 17 human deaths from human rabies each year [8,9,18] .

The system of notification of animal and human rabies cases
However, despite the efforts made, the system for notifying cases of animal and human rabies was not yet
well-established due to a lack of competent human resources and a lack of motivation among the managers
for epidemiological surveillance. Deficiencies in animal rabies surveillance systems resulted in the
underreporting of the number of biting animals potentially at risk for rabies and the underreporting of cases
of human bites by suspect animals, the impossibility of on-site experimental diagnosis of rabies at certain
times due to various reasons such as the malfunction of laboratory equipment and the non-availability of
reagents and antigens.

Under these conditions, the data on the epidemiological situation of human rabies were quite alarming. In
2006, out of 29 cases of human rabies reported on the American continent, 11 originated from Haiti.
[8]
Furthermore, in 2011, the situation got even worse as public health services officially reported 13 cases .
Despite the fact that the number of rabies cases per year was relatively high compared to other Latin
American countries, modeled estimates suggest that this number may exceed 130 human rabies deaths
annually .
[18]
In 1993, while ten (10) cases of people exposed to rabies were reported for the entire Center Department,
less than a year later, in 1994, 11 were reported at the level of 3 municipalities of this Department. This
evolution in the data was undoubtedly due to the establishment of an initial organizational structure for the
[18]
notification of cases of bites on people by rabid animals . From 2004, alerts for rabies cases in animals,
although still limited, became more frequent. Agriculture and Public Health Ministries have worked
together more and more.

Rabies has always been considered one of the so-called neglected diseases by the Ministry of Public Health
and Population (MSPP). But during the years 2006 and 2007, Pan American Health Organization (PAHO)/
WHO and Project of Strengthening Public Agricultural Services (RESEPAG): provided significant
collaboration in vaccines for veterinary use to the Ministry of Agriculture and in vaccines for human use to
the Ministry of Public Health and Population thanks to assistance from Brazil. PAHO promoted the
elaboration of the first National Rabies Eradication.

This Plan included an epidemiological surveillance component for animal and human rabies. However, it
did not create genuine coordination of the Rabies activities among different public and private institutions
to establish a functional partnership model integrating a One Health approach. During this period, there
was some improvement in rabies vaccination campaigns, but the epidemiological surveillance of rabies
remained slow [18-20] .