1. INTEGRATED RABIES EPIDEMIOLOGY IN REMOTE INUIT COMMUNITIES IN QUÉBEC, CANADA: A “ONE HEALTH” APPROACH C. Aenishaenslin, A. Simon, T. Forde, A. Ravel, J-F Proulx, C. Fehlner-Gardiner, I. Picard, and D. Bélanger Groupe international vétérinaire et Groupe de recherche en épidémiologie des zoonoses et santé publique, Faculté de médecine vétérinaire, Université de Montréal, St-Hyacinthe, Québec Nunavik Regional Board of Health and Social Services, Kuujjuaq, Nunavik Centre of Expertise for Rabies, Canadian Food Inspection Agency (CFIA), Ottawa Ministère de l’Agriculture des Pêcheries et de l’Alimentation du Québec (MAPAQ), Québec Canadian Public Health Association Annual Meeting Toronto - May 27, 2014 1

2. Background  Arctic variant rabies virus (AVRV) in northern Canada  Arctic fox main reservoir  Epidemiology not fully understood  Exposure of human beings 2

3. Background: rabies in Nunavik  Rabies diagnosed in animals since 1947  No human cases reported  Potential exposure through dog bites and contact with wildlife  Regular post-exposure prophylaxis  Annual dog vaccination campaign by MAPAQ (once a year) since 1983  Increased animal cases in late 2011 3

4. Objective and Rationale OBJECTIVE:  To perform an integrated descriptive overview of Arctic rabies epidemiology in Nunavik (wildlife – domestic animals – humans) in line with the emerging ‘‘One Health’’ paradigm RATIONALE:  To better understand rabies risk and to provide baseline data for the improvement of the regional rabies prevention program at all levels: – human populations (education and health care services) – domestic animal populations (dog vaccination and population control) – wildlife (vaccination) 4

5. Materials & Methods  Retrospective study 1999-2012  Comprehensive data sets: – CFIA: lab results of suspect rabid animals that potentially exposed humans or domestic animals (fluorescent antibody test + tissue culture inoculation test, if potential human exposure) – MAPAQ: dog vaccination campaign (annual data) – Nunavik Regional Board of Health and Social Services: data of human cases with potential rabies exposure  Descriptive data analysis 5

6. Rabies testing in animals Proportion of positive samples 100% 0% 112 submissions, mostly dogs 44 positive (39%), mostly wildlife 6 Number of animals

7. Dog vaccination and animal tests over time  Dog vaccination: total 6,243 dogs, annual median 517  Variation over time and between regions 7 Hudson Ungava

8. Human cases of potential exposure to a rabid animal  112 cases investigated, mostly children  For 41 cases (37%), animal was tested for rabies  For 24 cases (59% of 41), the animals tested positive, mostly children were exposed  Most investigations due to dog bites, but most lab-confirmed exposures due to mucous membrane contact (one event) 8 Number of people

9. Delay between potential exposure and consultation  62 people started post-exposure prophylaxis  46 completed PEP, including the 24 cases of confirmed exposure  Delay varied, most confirmed cases started PEP 2 weeks post- exposure 9 Number of people

10. Discussion  Comprehensive overview based on available data  Confirms regular human exposure (children) to rabies virus in Nunavik  Highlights greater requirement for PEP compared to southern Quebec  Rabies still a public health issue of concern in Nunavik  Need for prevention and control action: Potential case management Education on rabies prevention Education on dog bite prevention 10

11. Discussion  Confirms rabies in dogs and wildlife (underestimation)  Surveillance of rabies in wildlife  Potential for wildlife vaccination  Actual dog vaccination coverage still unknown  Dog vaccination effect on human exposure unknown  Maintain and reinforce dog vaccination  Improve dog population estimates  Implement perennial dog population control program  Thank to a greater community participation 11

12. Conclusion  Residents of Nunavik at risk of exposure to rabies  Prevention and control should follow the ‘’One Health‘’ approach  Requires integrated actions toward public health, animal health and ecosystem health 12

13. Acknowledgments  Nunavik Research Center  Nunavik Regional Board of Health and Social Services  Veterinarians without Borders Canada  World Society for the Protection of Animals for supporting this research 13