Rabies surveillance in action: Saving lives in Cross River State, Nigeria

In Nigeria, rabies continues to claim an estimated 10,000 human lives annually; this figure is likely an underestimation. This disease mainly affects suburban and rural communities where prevention programs are limited. Surveillance remains one of the most under-resourced pillars of rabies control. Without reliable surveillance, cases are underreported, and rabies is neglected, but in Cross River State, a unique effort is changing this narrative.

In 2022, the Department of Veterinary Services in Cross River State partnered with the Global Alliance for Rabies Control (GARC) to address this long-standing challenge of weak rabies surveillance. GARC provided technical support and tools to enable real-time dog vaccination , dog bite incidents  and both human and animal rabies  case tracking using a DHIS2-based mobile app.  For the first time, systematic tracking of rabies was possible in the region.

The DHIS2-based rabies surveillance app displaying real time bite and case reports across Cross River State. Source: Cross River Rabies Surveillance Team

Rabies surveillance, however, requires more than just technology. Once a suspected rabies case or bite is reported, responders must act quickly: travel to the site (sometimes hours away), conduct investigations, identify suspected animals and victims, collect samples, and send for confirmation.

Leading this rabies surveillance and response efforts are Dr. John Bassey and Dr. Moses Efenji, veterinarians based in Cross River State. In a state where it can take up to nine hours to travel from the southern to the northern end, logistics posed a signifiant challenge. The solution was to recruit and train the state’s existing network of para-veterinarians, who are civil-service trained animal health workers already stationed in each local government area. Once a suspected human or animal rabies case  is flagged, the nearest trained officer is deployed to investigate, collect data and samples. While samples are sent to the National Veterinary Research Institute (NVRI) in Vom, Plateau State, for confirmatory testing, the project has also strengthened its diagnostic capabilities and response protocols by establishing rapid field-testing procedures to speed up risk assessment and response.

Collected brain samples are preserved in ice for transport to laboratory, while a rapid test kit enables immediate onsite rabies screening. Sources: Cross River Rabies Surveillance Team

 Tracking rabies: Cases and challenges.

The results are startling. In just two years of systematic surveillance, 22 rabies cases (21 dogs and 1 human) were identified in a state that had reported zero cases for over a decade. This confirmed what many public health experts had long suspected; rabies was present but undocumented, silently claiming lives. Animal cases ranged from free roaming dogs to owned animals, including one bought for consumption, underscoring the need for locally tailored, multifaceted prevention strategies.

Despite these successes, the team faces persistent challenges. With no formal government support, the project relies on personal commitment and volunteer effort. Cultural practices also complicate efforts: In Cross River State, dogs are both pets and a meat source, creating pressures for investigation and sample collection. Of the 21 animal cases reported, 12 were laboratory confirmed and 9 classified as probable based on clinical signs witnessed by community members before the dogs were slaughtered.  “Carcasses of rabid animals should not be consumed under any circumstances,” emphasizes Dr. Eze Adaeze, a veterinary epidemiologist documenting rabies surveillance in Nigeria. “Surveillance must go hand-in-hand with community education and responsible dog ownership.”

Veterinary doctors collecting brain sample from a suspected rabid dog for testing in Cross River State. August 12, 2023. Sources: Cross River Rabies Surveillance Team

 Visibility Saving lives; Data for Action

A surveillance system's true measure of success lies in its impact on human health. When  an animal rabies case is reported, bite victims can access lifesaving post-exposure prophylaxis (PEP). Yet, access and cost of PEP remains a critical barrier. A complete regimen costs  approximately $150 with rabies immunoglobulin costing around $100, more than the monthly minimum wage in Nigeria ($46). The patient must bear the complete cost. Hence, the surveillance teams found themselves not just identifying cases but also financially assisting victims to access treatment.

"Every case of rabies is heartbreaking when you know that it could have been prevented, sometimes the difference between life and death comes down to $150." says Dr. John Bassey.

The documented rabies burden led to Cross River State receiving over 10,000 anti-rabies vaccines between 2022 and 2023 for dogs through the World Bank's REDISSE project, demonstrating how effective surveillance can mobilize resources for prevention and control. However, since the project ended the same year, vaccine supplies have dwindled with no new funding, highlighting the ongoing challenge of sustaining intervention resources.

The Cross River model is now being considered for national adoption. Late last year, stakeholders from human health, animal health, environment and wildlife sectors gathered with GARC and other partners (FAO, WHO)  to develop a National Rabies Rapid Response Toolkit for Nigeria which provides a One Health framework for rabies prevention and response. As Nigeria aims to eliminate dog-mediated human rabies by 2030, Cross River model offers a scalable blueprint both nationally and regionally in Africa. But for this momentum to last, there must be government engagement and sustained investment. With countries like Nigeria tapping into new global opportunities like GAVI’s human anti-rabies vaccine program and renewed World Bank funding, coupled with this surveillance system, community awareness, responsible pet ownership, affordable PEP for bite victims, sustainable vaccine supply for animals, Cross River's approach could become a fully integrated One Health success story.