Effectiveness of community-based delivery of mass dog vaccination to prevent rabies: A cluster randomized controlled trial
9 affiliations
- 1Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
- 2Rabies Free Africa, Global Health Tanzania, Arusha, Tanzania
- 3Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
- 4Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
- 5School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
- 6Department of Global Health and Biomedical Sciences, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
- 7Directorate of Veterinary Services, Ministry of Livestock Development and Fisheries, Dodoma, Tanzania
- 8School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
- 9School of Economic Studies, Washington State University, Pullman, Washington, United States of America
Abstract
Background: Approximately 60,000 people die from rabies annually, mostly in Africa and Asia. Mass dog vaccination is critical for elimination. Herd immunity has been calculated to be attained when >40% (critical threshold) of dogs are vaccinated. A common delivery method implemented in Tanzania and other countries typically involves non-local teams travelling to villages implementing dog vaccination annually through static-point clinics using cold chain stored vaccines (Team-based delivery). Determination that a canine rabies vaccine is thermotolerant enables novel Community-based dog vaccination strategies whereby community vaccinators use vaccines stored locally throughout the year (Community-based delivery). Methods: Two dog vaccination strategies were compared using a three-year cluster randomized controlled trial in Tanzania (Clinical Trials Registration Number ISRCTN14813279). The strategies were designed to represent implementation using resources typical of government-led initiatives. Wards (n = 112) were randomly assigned to either Team-based delivery or Community-based delivery. Coverage was estimated using household surveys implemented biannually. Findings: Mean coverage achieved by Community-based delivery (55%; 95% Confidence Interval (CI): 45–65%) was higher than Team-based delivery (37%; 95% CI: 28–46%). Moreover, because coverage was lower and declined over each year only in Team-based delivery, the probability of coverage being below the critical threshold was higher for Team-based delivery (60%) compared to Community-based delivery (18%). To ensure coverage does not dip below the critical threshold by the year end, coverage at the start of the year in Team-based delivery needed to be higher (61%) than in Community-based (42%). Interpretation: Community-based delivery achieved higher and more consistent vaccination coverage across a range of settings typical of many sub-Saharan African countries. Generalisation to different sociocultural/ agroecological settings requires further evidence. Although direct evidence on impact on rabies elimination was not measured, this approach could play a role in national elimination strategies, developed for the global ‘Zero by 30’ strategy to end dog-mediated rabies deaths by 2030, and in response to investment by Gavi, the vaccine alliance. Author summary: Dog-mediated human rabies is a lethal infectious disease and kills approximately 60,000 people annually, primarily in Africa and Asia. Mass dog vaccination is a proven approach to prevent human rabies by targeting the reservoir host, the domestic dog, but logistical challenges and high costs hinder implementation. Recent demonstration that a commonly used canine rabies vaccine could be stored outside of refrigeration units at 30°C for three months without loss of potency provided the foundation for the roll out of a novel approach to mass dog vaccination, called Community-based delivery, which uses vaccines stored in and managed by local communities. This study describes a randomized controlled trial to compare the effectiveness of a mass dog vaccination delivery approach (implemented using resources typical of government-led initiatives) that is commonly implemented in Tanzania and other rabies endemic countries by centralized vaccination teams (Team-based) with the novel decentralized (Community-based) delivery. Our findings demonstrate that Community-based delivery achieves higher and more consistent vaccination coverage than the Team-based approach in the rural and urban settings in which the trial took place. Although data on rabies elimination was not collected, mass dog vaccination has been shown to be an effective method to control rabies. As such, by overcoming key logistical barriers, for example needing to store vaccines under refrigeration conditions, this strategy could provide a scalable solution to eliminate dog-mediated rabies in resource-limited settings.
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BibTeX
@article{lankester2026effectiveness,
title = {{Effectiveness of community-based delivery of mass dog vaccination to prevent rabies: A cluster randomized controlled trial}},
author = {Felix Lankester and Ahmed Lugelo and Joel Changalucha and Danni Anderson and Christian Tetteh Duamor and Anna Czupryna and Kennedy Lushasi and Elaine Ferguson and Emmanuel S. Swai and Maganga Sambo and Jonathan Yoder and Sarah Cleaveland and Sally Wyke and Benezeth Lutege Malinda and Paul C. D. Johnson and Katie Hampson},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = sep,
doi = {10.1371/journal.pntd.0014704},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014704},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Effectiveness of community-based delivery of mass dog vaccination to prevent rabies: A cluster randomized controlled trial
AU - Felix Lankester
AU - Ahmed Lugelo
AU - Joel Changalucha
AU - Danni Anderson
AU - Christian Tetteh Duamor
AU - Anna Czupryna
AU - Kennedy Lushasi
AU - Elaine Ferguson
AU - Emmanuel S. Swai
AU - Maganga Sambo
AU - Jonathan Yoder
AU - Sarah Cleaveland
AU - Sally Wyke
AU - Benezeth Lutege Malinda
AU - Paul C. D. Johnson
AU - Katie Hampson
PY - 2026
DA - 2026/09/25
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014704
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014704
AB - Background: Approximately 60,000 people die from rabies annually, mostly in Africa and Asia. Mass dog vaccination is critical for elimination. Herd immunity has been calculated to be attained when >40% (critical threshold) of dogs are vaccinated. A common delivery method implemented in Tanzania and other countries typically involves non-local teams travelling to villages implementing dog vaccination annually through static-point clinics using cold chain stored vaccines (Team-based delivery). Determination that a canine rabies vaccine is thermotolerant enables novel Community-based dog vaccination strategies whereby community vaccinators use vaccines stored locally throughout the year (Community-based delivery). Methods: Two dog vaccination strategies were compared using a three-year cluster randomized controlled trial in Tanzania (Clinical Trials Registration Number ISRCTN14813279). The strategies were designed to represent implementation using resources typical of government-led initiatives. Wards (n = 112) were randomly assigned to either Team-based delivery or Community-based delivery. Coverage was estimated using household surveys implemented biannually. Findings: Mean coverage achieved by Community-based delivery (55%; 95% Confidence Interval (CI): 45–65%) was higher than Team-based delivery (37%; 95% CI: 28–46%). Moreover, because coverage was lower and declined over each year only in Team-based delivery, the probability of coverage being below the critical threshold was higher for Team-based delivery (60%) compared to Community-based delivery (18%). To ensure coverage does not dip below the critical threshold by the year end, coverage at the start of the year in Team-based delivery needed to be higher (61%) than in Community-based (42%). Interpretation: Community-based delivery achieved higher and more consistent vaccination coverage across a range of settings typical of many sub-Saharan African countries. Generalisation to different sociocultural/ agroecological settings requires further evidence. Although direct evidence on impact on rabies elimination was not measured, this approach could play a role in national elimination strategies, developed for the global ‘Zero by 30’ strategy to end dog-mediated rabies deaths by 2030, and in response to investment by Gavi, the vaccine alliance. Author summary: Dog-mediated human rabies is a lethal infectious disease and kills approximately 60,000 people annually, primarily in Africa and Asia. Mass dog vaccination is a proven approach to prevent human rabies by targeting the reservoir host, the domestic dog, but logistical challenges and high costs hinder implementation. Recent demonstration that a commonly used canine rabies vaccine could be stored outside of refrigeration units at 30°C for three months without loss of potency provided the foundation for the roll out of a novel approach to mass dog vaccination, called Community-based delivery, which uses vaccines stored in and managed by local communities. This study describes a randomized controlled trial to compare the effectiveness of a mass dog vaccination delivery approach (implemented using resources typical of government-led initiatives) that is commonly implemented in Tanzania and other rabies endemic countries by centralized vaccination teams (Team-based) with the novel decentralized (Community-based) delivery. Our findings demonstrate that Community-based delivery achieves higher and more consistent vaccination coverage than the Team-based approach in the rural and urban settings in which the trial took place. Although data on rabies elimination was not collected, mass dog vaccination has been shown to be an effective method to control rabies. As such, by overcoming key logistical barriers, for example needing to store vaccines under refrigeration conditions, this strategy could provide a scalable solution to eliminate dog-mediated rabies in resource-limited settings.
SN - 1935-2735
ER -