Because effective rabies control

and prevention programmes require reliable information on disease occurrence, they should be guided by modern epidemiological insights and driven by laboratory-based surveillance (Rupprecht et al., 2006a). Improved local diagnostic capacity is essential to achieve adequate canine vaccination coverage and to assess the impact of control and elimination efforts (Lembo et al., 2010). Since these factors are interlinked, the implementation of one will positively enhance the others. In addition to mechanisms to reduce rabies in domestic dogs, the availability of simple and affordable diagnostics will enhance reporting and identify areas where the disease is most burdensome. In many countries, rabies diagnosis still relies on clinical this website observations. In Bangladesh, for example, the true disease burden cannot be accurately determined, because human cases are reported without confirmatory laboratory tests, and surveillance systems are not available. As in other endemic countries, the first priority for the development of a national rabies control program is the establishment of a diagnostic

laboratory infrastructure (Hossain et al., 2011 and Hossain et al., 2012). As technical advances make diagnosis more rapid, accurate and cost-effective, it will become easier to initiate such programs in resource-limited settings (Rupprecht et al., 2006a). Before discussing recommendations Erythromycin for rabies surveillance and diagnosis, we should provide some definitions. The OIE defines Ribociclib surveillance as the systematic ongoing collection, collation, and analysis of information related to animal health, and the timely dissemination of that information to those who need to know, so that action can be taken ( OIE, 2012). A case of rabies is defined as any animal infected with rabies virus, as determined by the tests

prescribed in the Terrestrial Animal Health Code ( OIE, 2012). Suspect and probable cases of rabies in animals are usually defined at the national level. In the context of this review, diagnosis refers to the clinical and laboratory information that lead to confirmation of a case of rabies. The lack of laboratory capacity in endemic areas means that rabies is usually diagnosed clinically, but because the disease has no pathognomonic signs and its manifestations are highly variable, this approach is often inaccurate. For example, a study in Malawi found that three of 26 patients diagnosed with cerebral malaria actually had rabies (Mallewa et al., 2007). The differential diagnosis of all cases of encephalitis in rabies-endemic countries should therefore include rabies (Fooks et al., 2009). Rabies can, however, be diagnosed clinically when an animal bite is followed by a compatible neurological illness. It is difficult to accurately assess the rabies status of dog populations without sufficient testing of suspect dogs.