Strengthening Biosafety and Epidemiological Surveillance of Infectious Diseases in North America: Lyssaviruses Surveillance as an Example of Emergency Preparedness and Response.

In 2008, the governments of Mexico, United States, and Canada signed the North American Rabies Management Plan (NARMP). The plan was designed to meet the challenge of long-term rabies management by strengthening the National Laboratory Network within each country and strengthening the capacity for a coordinated response across shared borders. Lyssaviruses are an important public health threat for North America. Epidemiological surveillance in animal and human populations has become a critical component of public health systems. There are 16 species of Lyssaviruses that have been classified within 3 or possibly more phylogroups. All Lyssaviruses are capable of causing encephalitis in mammals, but some of them seem to be more prone to produce spillovers to other species, including humans. The vaccines currently used to prevent rabies are effective against all Lyssaviruses in phylogroup 1 but ineffective against Lyssaviruses in phylogroups 2 and 3. Mexico embarked on a successful urban dog and cat rabies control program through mass vaccination campaigns, enhanced rabies surveillance along the Mexican–US border, and implementation of vampire bat population control programs. Mexico was the first country in the world to have been recognized by the World Health Organization/Pan American Health Organization as a country free of human rabies transmitted by dogs and to control dog-to-dog rabies transmission. By fostering the communication between several agencies and effective risk assessment to optimize the existing resources in the region as well as strengthening biosafety programs, Mexico began a 2-year program of emergency preparedness and response training with the RNSLP (Spanish acronym for the Public Health Laboratory Network). The first phase provided training on infectious substance shipping for the safe and secure transportation of biological samples from the local laboratories to the Reference Rabies Laboratory at the Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE). Category A containers were distributed to the RNSLP for shipping samples from cases of suspected encephalitis. For the second phase of the training, a strategy for containment and diagnostics was developed. A flow chart for decision making was designed (Figure 1). With this flow chart, the technical experts of the RNLSP can detect in a timely manner the potential and serious threat indicated by the introduction of a nonendemic rabies virus variant or another Lyssavirus species. In 2019, during the framework of “1er Foro Nacional para los Laboratorios que realizan el Diagnostico de Rabia,” the members of the RNLSP signed an agreement to use this strategic plan and the shipping instructions of all suspected and potential samples to the Biosafety Level 3 laboratory at InDRE. Long-term priorities identified for the success of a rabies management program include the development of improved or new oral vaccines and baits to immunize target species. To optimize the achievement of rabies management program goals, public health programs need to share their plans, research, transfer of technology, and direct actions in managing rabies across borders.