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W4382242809 abstract "Full text Figures and data Side by side Abstract Editor's evaluation Introduction Methods Results Discussion Data availability References Decision letter Author response Article and author information Metrics Abstract Background: Dog-mediated rabies is endemic across Africa causing thousands of human deaths annually. A One Health approach to rabies is advocated, comprising emergency post-exposure vaccination of bite victims and mass dog vaccination to break the transmission cycle. However, the impacts and cost-effectiveness of these components are difficult to disentangle. Methods: We combined contact tracing with whole-genome sequencing to track rabies transmission in the animal reservoir and spillover risk to humans from 2010 to 2020, investigating how the components of a One Health approach reduced the disease burden and eliminated rabies from Pemba Island, Tanzania. With the resulting high-resolution spatiotemporal and genomic data, we inferred transmission chains and estimated case detection. Using a decision tree model, we quantified the public health burden and evaluated the impact and cost-effectiveness of interventions over a 10-year time horizon. Results: We resolved five transmission chains co-circulating on Pemba from 2010 that were all eliminated by May 2014. During this period, rabid dogs, human rabies exposures and deaths all progressively declined following initiation and improved implementation of annual islandwide dog vaccination. We identified two introductions to Pemba in late 2016 that seeded re-emergence after dog vaccination had lapsed. The ensuing outbreak was eliminated in October 2018 through reinstated islandwide dog vaccination. While post-exposure vaccines were projected to be highly cost-effective ($256 per death averted), only dog vaccination interrupts transmission. A combined One Health approach of routine annual dog vaccination together with free post-exposure vaccines for bite victims, rapidly eliminates rabies, is highly cost-effective ($1657 per death averted) and by maintaining rabies freedom prevents over 30 families from suffering traumatic rabid dog bites annually on Pemba island. Conclusions: A One Health approach underpinned by dog vaccination is an efficient, cost-effective, equitable, and feasible approach to rabies elimination, but needs scaling up across connected populations to sustain the benefits of elimination, as seen on Pemba, and for similar progress to be achieved elsewhere. Funding: Wellcome [207569/Z/17/Z, 095787/Z/11/Z, 103270/Z/13/Z], the UBS Optimus Foundation, the Department of Health and Human Services of the National Institutes of Health [R01AI141712] and the DELTAS Africa Initiative [Afrique One-ASPIRE/DEL-15-008] comprising a donor consortium of the African Academy of Sciences (AAS), Alliance for Accelerating Excellence in Science in Africa (AESA), the New Partnership for Africa’s Development Planning and Coordinating (NEPAD) Agency, Wellcome [107753/A/15/Z], Royal Society of Tropical Medicine and Hygiene Small Grant 2017 [GR000892] and the UK government. The rabies elimination demonstration project from 2010-2015 was supported by the Bill & Melinda Gates Foundation [OPP49679]. Whole-genome sequencing was partially supported from APHA by funding from the UK Department for Environment, Food and Rural Affairs (Defra), Scottish government and Welsh government under projects SEV3500 and SE0421. Editor's evaluation In this work, the authors set out to use contact tracing and whole-genome sequencing to track the elimination of dog-mediated rabies in Pemba Island, Tanzania. A major strength is the use of multiple data types in the analysis. The work will likely have an impact on influencing the practical policies that can be implemented to target the elimination of dog-mediated rabies in other regions/contexts. https://doi.org/10.7554/eLife.85262.sa0 Decision letter Reviews on Sciety eLife's review process Introduction Every year an estimated 59,000 people die from rabies (Hampson et al., 2015), a viral infection transmitted primarily by domestic dogs in low- and middle-income countries (LMICs). While human rabies encephalitis remains incurable, the disease is readily preventable if post-exposure prophylaxis (PEP) is promptly administered to bite victims upon exposure (World Health Organization, 2018b). Moreover, mass dog vaccination has eliminated dog-mediated rabies from high-income countries and much of the Americas (Vigilato et al., 2013). Yet, in most African and Asian countries there has been little investment in dog vaccination and rabies circulates unabated (Hampson et al., 2015). A global goal to eliminate human deaths from dog-mediated rabies by 2030 (‘Zero by 30’) is now advocated (Minghui et al., 2018), with recommendations to scale up mass dog vaccination. Although dog vaccination can eliminate dog-mediated rabies, there are challenges to achieving this goal. In most rabies endemic countries in sub-Saharan Africa, dog vaccination campaigns have been sparse and localised (World Health Organization, 2018a). Moreover, the high reproductive rates and short lifespan of dogs in many LMICs quickly lead to drops in vaccination coverage, with repeat campaigns required to maintain coverage (Davlin and Vonville, 2012). The virus can easily spread in dog populations that have low and heterogeneous vaccination coverage (Mancy et al., 2022) and incursions leading to outbreaks are commonly reported (Bourhy et al., 2016; Zinsstag et al., 2017; Rysava et al., 2020), often facilitated by human-mediated movement of dogs incubating infection (Townsend et al., 2013b; Tohma et al., 2016). This situation is compounded by weak surveillance which hinders effective outbreak response and poses a challenge for monitoring progress towards elimination, including how to determine disease freedom (Nel, 2013). Across the African continent there are very few documented examples of elimination of dog-mediated rabies. We found just four papers reporting locations on the continent with potential interruption of transmission by dog vaccination; the cities of N’Djamena, Chad (Zinsstag et al., 2017) and Harare, Zimbabwe (Coetzer et al., 2019), Serengeti district in northwest Tanzania (Cleaveland et al., 2003) and KwaZulu-Natal province in South Africa (Sabeta and Ngoepe, 2018). In all four locations, endemic circulation has since re-established, with resurgences explained by movement of infected dogs from surrounding areas after dog vaccination campaigns lapsed. The importance of reintroductions in maintaining rabies circulation is further highlighted from long-term surveillance from Bangui, the capital of the Central African Republic (Bourhy et al., 2016) and from long-term contact tracing in Serengeti district, Tanzania (Mancy et al., 2022). Genomic surveillance can potentially play a role in differentiating rabies introductions from undetected sustained transmission, and thus in confirming or refuting rabies elimination and therefore targeting of control efforts. However, sequencing of rabies viruses also remains limited in Africa. Dog-mediated rabies is endemic in East Africa where thousands of human rabies deaths occur each year (Hampson et al., 2019). Rabies has circulated on Pemba Island, off mainland Tanzania, since the late 1990s. Dog vaccinations on Pemba first began in 2010, with a small-scale campaign conducted by the animal welfare organisation, World Animal Protection (formerly WSPA). Over the next 5 years, a rabies elimination demonstration project, funded by the Bill & Melinda Gates Foundation, coordinated by the World Health Organisation and led by the Tanzanian government, was implemented across southeast Tanzania, including Pemba (Mpolya et al., 2017). Here, we show how these efforts led to rabies elimination, while highlighting how introductions pose challenges to achieving and maintaining rabies-freedom even on a small, relatively isolated, island. Our study is the first to confirm rabies elimination from an African setting, including in response to reintroduction, through quantifying case detection. Using rigorous contact tracing, we identified chains of transmission within the domestic dog reservoir informed by in-country whole-genome sequencing (the first example in Africa) and cross-species transmission from domestic dogs to humans. This enabled us to estimate the public health burden and associated cost-effectiveness of both post-exposure vaccination and dog vaccination, as well as their combined use, in achieving and maintaining rabies freedom on Pemba. Our findings illustrate the critical need to holistically link surveillance with public health and veterinary interventions to cost-effectively reduce the burden of zoonotic pathogens. This case study provides timely lessons given the global strategic plan to eliminate dog-mediated human rabies by 2030. Methods Study population Pemba (988 km2) is situated fifty kilometres from the Tanzanian mainland. The island comprises four administrative districts with 121 villages (shehias) and a projected human population of 438,765 in 2020 (National Bureau of Statistics Tanzania, 2012). The human: dog ratio is very high (~118 humans to 1 dog), in this predominantly muslim population. Almost all dogs on Pemba are unconfined and 10–20% are thought to be unowned, potentially posing a problem for reaching the vaccination coverage needed for elimination using central point vaccination strategies. Epidemiological and laboratory investigations Records of bite patients presenting to health facilities and of suspect or probable rabid animals reported to the district veterinary offices on Pemba Island from January 2010 until January 2021 were used to initiate contact tracing (Mancy et al., 2022). Bite victims and, if known, the owners of biting animals were exhaustively traced, recording details of all bite incidents, including dates and coordinates. Other people or animals that were identified as bitten were further traced. The status of animals was assessed from their reported behaviour and outcome (whether they died, disappeared or survived), and classified according to WHO case definitions (World Health Organization, 2018a). Briefly, an animal showing any clinical signs of rabies was considered a suspect case; if a suspect case had a reliable history of contact with a suspect rabid animal and/or was killed, died or disappeared within 10 days of observation of illness, the animal was considered a probable case. Animals that remained alive for more than 10 days after biting a person, were considered healthy. Brain tissue samples were collected from animal carcasses for diagnostic testing whenever possible (Rupprecht et al., 2018). Two batches of sequencing were performed to obtain 16 near whole-genome sequences (WGS) of rabies virus (RABV) from dog brain samples collected on Pemba, with the approach changing as protocols and capacity for in-country sequencing developed (Brunker et al., 2020). Eight of these sequences have been previously published within a methods paper (Brunker et al., 2020) and 8 are published for the first time here. The latter are archived 2011/12 samples (3) and samples (5) from early outbreak surveillance (September/October 2016) that were confirmed RABV positive at Pemba Veterinary Laboratory Department and shipped to the Animal & Plant Health Agency (APHA), UK. Total RNA was extracted using Trizol (Invitrogen) and a real-time PCR assay (Marston et al., 2019) was performed to confirm the presence of RABV and indicate viral load. Metagenomic sequencing libraries were prepared and sequenced on an Illumina MiSeq as previously described (Brunker et al., 2015). Subsequent sequencing of the 8 additional samples (September 2016 to May 2017) was conducted in-country in August 2017 at the Tanzania Veterinary Laboratory Agency (TVLA) following an end-to-end protocol using a multiplex PCR approach (Quick et al., 2016) for MinION (Oxford Nanopore Technology, Oxford, UK) sequencing of RABV genomes (Brunker et al., 2020). Fourteen previously unpublished WGS (via the metagenomic approach) from mainland Tanzania (2009 to 2017) are also published here and included in analyses. The newly published sequences are detailed in Supplementary file 1. Control and prevention measures We compiled data on rabies control and prevention measures implemented on Pemba, including numbers and timing of dog vaccination campaigns, and costs of dog vaccination and PEP provisioning (Supplementary file 2). Briefly, the first small-scale dog vaccination campaign (705 dogs vaccinated) on Pemba took place in 2010. This was followed by four annual islandwide campaigns from 2011 through to 2014 carried out by livestock field officers under Pemba’s department of livestock as part of the elimination demonstration project (Mpolya et al., 2017). One week before each campaign, a meeting was held between District Veterinary Officers, Livestock Field Officers (LFOs), and Community Animal Health Workers (CAHWs) to review protocols and distribute vaccination equipment. CAHWs for each shehia then moved door-to-door inviting owners to bring their dogs to the nearest vaccination point and distributed posters. One day before the campaign, CAHWs walked repeatedly through each shehia announcing the forthcoming vaccination over a loudspeaker. Vaccination points were mostly situated in the centre of shehias but for small neighbouring shehias, vaccination points were located at central convenient locations. Each point was operated by two LFOs and a CAHW and campaigns ran from 9.00am to 3.00pm on a single day with vaccinations provided free-of-charge. During the 2013 and 2014 campaigns, dogs were marked with temporary collars upon vaccination and post-vaccination transects were carried out in each shehia to estimate coverage achieved. As part of the demonstration project PEP was procured for free provisioning at Pemba’s four district hospitals. Training in administering both intradermal and intramuscular post-exposure vaccination was completed in early 2011. Following the end of the demonstration project in 2015, bite patients were required to pay 30,000 TSh ($12.9) per vial when undergoing post-exposure vaccination, with multiple vials required for a complete PEP course. In late 2016, a rabies outbreak was detected. The initial government response involved conducting central point dog vaccination campaigns in shehias reporting cases. However, these efforts were limited. Island-wide vaccination campaigns were therefore conducted from 2017 onwards, including door-to-door vaccination in some shehias where dog owners could not bring dogs to allocated central points. In 2017, the government of Zanzibar also began to subsidise PEP, making vaccines free-of-charge at Pemba’s main hospital and in hospitals in Zanzibar (1 day’s ferry travel), otherwise, post-exposure vaccines were available to purchase on the mainland. Analyses Dog population and vaccination coverage To estimate time-varying vaccination coverage at the shehia level, it was necessary to first estimate dog population sizes. This was achieved using two datasets: (1) government dog population surveys for the years 2012 and 2017–2019, and (2) post-vaccination transects from the 2013 to 2014 vaccination campaigns together with associated numbers of dogs vaccinated in the preceding campaigns. Where at least one collared (i.e. vaccinated) dog and >10 total dogs were observed on a transect, the dog population of a shehia at the time of the transect was estimated as: D=Vd1+PARCdCd+Ud where D is the dog population size, Vd is the number of dogs vaccinated in the campaign preceding the transect, Cd is collared dogs, Ud is unmarked dogs, and PAR is the ratio of pups (<3 months) to adult dogs (Sambo et al., 2018). PAR was estimated to be 0.256 from a census of the Serengeti District dog population in Northern Tanzania between 2008–2016 (Sambo et al., 2017). By multiplying by (1+PAR), we assume both that vaccination campaigns fail to reach pups, and that pups are not counted during transects (Sambo et al., 2018). At least one Government or transect-based dog population estimate was available for each shehia, with some having estimates at up to six time points. For each shehia, the dog population in every month throughout the study period for which we did not already have an estimate was then projected. For months that lay between two known population estimates, a population projection was obtained via the exponential growth rate calculated between those two estimates. For months where there was only a preceding or subsequent dog population estimate available, we projected the population based on a human:dog ratio calculated from this preceding/subsequent estimate and the human population projected from the 2012 national census (National Bureau of Statistics Tanzania, 2012). In some cases, the projected dog population obtained for a month using this approach was lower than the number of dogs vaccinated during a campaign in that month. Where this occurred, the population estimates were adjusted as necessary to prevent coverage estimates exceeding 100%. The coverage achieved by each vaccination campaign in each shehia was obtained by dividing the number of dogs vaccinated by the estimated dog population for the month when the campaign occurred. We estimated the monthly number of dogs with vaccine-induced immunity as follows: λ=e−(1v+d)(112)min(1,DmDm−1) Pm={max(0,Vm−1λ−Nm),ifJanuarymax(0,Pm−1λ−Nm),ifanyothermonth Vm=min(Dm,Vm−1λ+max(0,Nm−Pm−1λ)) where Vm is the number of immune dogs at month m, Nm is the number of newly vaccinated dogs at m, Dm is the dog population at m estimated using the methods described above, and Pm is the number of immune dogs that were vaccinated during campaigns in previous years, not in the current year. Immunity wanes according to both v, the mean duration of vaccine-induced immunity (assumed to be 3 years), and d=0.595, the annual dog death rate (Czupryna et al., 2016). This approach conservatively assumes both that dogs that are immune from previous campaigns are preferentially vaccinated in subsequent campaigns and that, if the dog population declines between months, then this is a consequence of an above average death rate, rather than a below average birth rate. It also assumes that any top-up campaigns in a shehia in the current year focus on vaccinating susceptible dogs, avoiding re-vaccination of already vaccinated animals. Phylogenetics Sequence data were used to understand the source and timing of introductions to Pemba and to resolve transmission chains. Raw sequence reads were processed and underwent quality control filtering (Brunker et al., 2020; Brunker et al., 2015). Pemba sequences were submitted to RABV-GLUE to determine which global RABV subclade they belonged to (Campbell et al., 2022). Clade assignment indicated that all Pemba sequences grouped within the RABV minor clade Cosmopolitan-AF1b. Therefore, an exploratory dataset of publically available genome sequences (coverage >90% of genome) from the Cosmopolitan-AF1b clade was obtained from RABV-GLUE (n=244) and supplemented with new sequences published in this paper (n=22, Supplementary file 1). Since the genome region and number of sequences varied widely in publically available data, an additional analysis was undertaken using an alignment, downloaded from RABV-GLUE, of all Cosmopolitan-AF1b sequences up to the year 2017 (inclusive) regardless of genome position or length. For the whole genome sequences, an alignment was created in MAFFT (Nakamura et al., 2018) and used to build a maximum likelihood (ML) phylogeny in IQ-TREE (Nguyen et al., 2015) with default model selection. To simplify and focus analysis on Pemba outbreak cases, a subtree encompassing all 2016/17 Pemba sequences and relevant contextual sequences was extracted from the ML phylogeny and these sequences were used for Bayesian phylogeographic analysis in BEAST (Suchard et al., 2018) For the BEAST analysis, one sequence from Uganda and one sequence from Rwanda were removed from the subset to avoid influencing phylogeographic analysis as the only two non-Tanzania sequences. Two sequences (GenBank accessions: MN726823, MN726822) were also removed as they contained a high proportion of masked bases (Ns) that affected tree convergence. This resulted in a reduced dataset of 153 sequences, exclusively from Tanzania, spanning the years 2001–2017. Note that this excluded two historical, previously published Pemba sequences (2010/12) belonging to a divergent lineage, previously defined as Tz5 (Brunker et al., 2015). TempEst was used to assess the temporal signal in the data, with a moderate association between genetic distances and sampling dates (R2=0.37) indicating suitability for phylogenetic molecular clock analysis in BEAST (Rambaut et al., 2016). A Bayesian discrete phylogeographic analysis was conducted in BEAST v1.10.4 on the 153 Tanzanian RABV genomes, of which 13 were from the 2016/17 Pemba outbreak. Two independent MCMC chains were run for 250 million steps with an uncorrelated log-normal relaxed molecular clock. Sequences were partitioned into concatenated coding sequence and non-coding sequence, each with a GTR +G substitution model. Two locations were specified for phylogeographic analysis, ‘Mainland’ or ‘Island’ for identifying the source of introductions. Sampled trees were subset to 10,000 trees and summarised as a maximum clade credibility tree, which was examined to determine the timing of introductions. Phylogenies were visualised and annotated in R using the ggtree package (Yu, 2020). The full dataset (i.e. all available sequences) extracted from RABV-GLUE was combined with the new sequences generated in this paper (n=22, Supplementary file 1) using MAFFT’s function to add new sequences to an existing alignment. R was used to categorise data into sequence types as follows: partial gene length sequences typically obtained from polymerase chain reaction (PCR) based diagnostic assays, full length (>90% coverage) gene sequences (gene) and whole (>90% coverage) genome sequences (WGS). Sequences were further categorised into genome position by gene: nucleoprotein (n), phosphoprotein (p), matrix protein (m), glycoprotein (g), RNA polymerase (l). This facilitated detailed exploration of publicly available RABV sequence data to obtain the most informative datasets to compare Pemba outbreak sequences. Background ML phylogenies were produced in IQ-TREE with default settings, using alignments of the variable length gene sequences. Extreme outliers with long branches (upper and lower 1st percentile of branch length distribution) were removed and a subtree extracted stemming from the most recent common ancestor (or one node back from) of all Pemba (historical and outbreak) sequences. Sequences from these subtrees (N and G gene) were subject to a more robust phylogenetic reconstruction with rapid bootstrapping in IQ-TREE and an outgroup sequence from the Cosmopolitan-AF1a minor clade (GenBank Accession: KC196743). Transmission trees Using the case data, we reconstructed transmission trees building on previously described methods (Mancy et al., 2022). Traced progenitors were assigned, otherwise links between cases were inferred probabilistically from dispersal kernel and serial interval distributions incorporating uncertainties in timings. We used distributions previously parameterized from contact tracing in northwest Tanzania (Lognormal serial interval, meanlog 2.85, sdlog 0.966, n=1107 rabid dog case histories; Weibull distance kernel, shape 0.698, scale 1263.954, n=6626 rabid dog biting incidents, with 3275 right-censored due to the unknown start location of the biting dog) (Mancy et al., 2022). We refined the tree-building algorithm to generate trees consistent with the phylogeny. This required creating a pairwise patristic distance matrix from the maximum likelihood phylogeny in R using the ape package (Paradis and Schliep, 2019), from which genetic clusters were assigned using the adegenet package (Jombart, 2008; Jombart and Ahmed, 2011), with a cutoff value of 0.002. Following the steps outlined in Figure 4—figure supplement 1, we then built a directed graph of the transmission tree and sequentially sampled edges connecting mismatched genetic clusters to rebuild these paths to generate trees consistent with phylogenetic assignments. First, we sampled by frequency, that is, how often edges occur in paths with mismatches, then by the scaled probability of the dispersal distance and serial interval from the assigned progenitor, generally selecting lower probability links to resample. For edges that were broken, we sequentially resampled a progenitor from those that generated trees consistent with the phylogenetic assignments. To further resolve transmission chains, we applied additional pruning steps to filter out case pairs where the time interval or distance exceeded the 99th percentile of the serial interval and distance kernel distributions (without pruning or integration of phylogenetic information, the tree reconstruction results in a single large chain). The tree reconstruction methods are wrapped into an R package (available at https://github.com/mrajeev08/treerabid and archived on Zenodo DOI: 10.5281/zenodo.5269062; Rajeev, 2023). We compared pruned trees (split into transmission chains) to transmission trees reconstructed to be consistent with the phylogeny. For each pruning algorithm, we compared across the consensus trees (i.e. the most frequently assigned progenitors for each case), the Maximum Clade Credibility (MCC) trees (the tree within the bootstrap that had the highest product of progenitor probabilities) and the majority transmission trees (the tree within the bootstrap that had the highest number of consensus progenitors), shown in Figure 4—figure supplements 3–5, respectively. The effective reproduction number Re, which describes transmission in the presence of control measures, was estimated from the number of secondary cases per case in the transmission trees. We examined Re over time by fitting a LOESS regression with date of case as our predictor and Re as our response. We also looked at individual Re estimates in relation to vaccination coverage at the time of symptoms in the shehia where each case occurred (Figure 2—figure supplement 1) and compared the distributions of Re from different tree summaries. We estimated the case detection achieved from our contact tracing using recently developed analytical methods (Mancy et al., 2022; Cori et al., 2018). Specifically, we used the times between statistically or directly-linked cases from the transmission tree reconstructions and the serial interval distribution for rabies, to fit the simulated distribution of numbers of unobserved intermediates, assuming all infected individuals have the same probability of being detected. To account for the long-tailed distribution of serial intervals, we sorted simulated values for initial intervals to most closely match observed values (i.e. so long incubators are accounted for and not always taken to be cases with multiple generations separating them from their progenitors). This approach with sorting generally performs better than the unsorted approach (Mancy et al., 2022) but tends to underestimate detection probabilities by about 10%, in particular for values between 0.3 and 0.75. We examined the fit across a range of detection probabilities for the endemic period (2010–2014), the subsequent outbreak (2016–2018) and overall, applying the method to 100 bootstrapped trees generated by the pruning strategies (with and without genetic information), and to the majority tree and the MCC tree, taking the mean of 10 estimates as the detection probability for each tree. Cost-effectiveness analyses We used the contact tracing data to inform a probabilistic decision tree model to estimate the impacts and cost-effectiveness of interventions on Pemba (Figure 6). We compared a baseline scenario without dog vaccination and with patients charged for PEP (as was initially the case on Pemba), with scenarios of free PEP provisioning but without dog vaccination, and with both free PEP and sustained island-wide dog vaccination carried out annually, that is, a One Health approach, over a ten-year time horizon. From compiled cost data (Supplementary file 2), we estimated the per campaign cost of island-wide dog vaccination and the per patient cost of PEP for use in the model. We estimated the probability of rabies-exposed bite victims starting and completing PEP (defined as at least 3 doses) from 2010 to 2015 (when most bite victims paid for PEP) and 2016–2020 (when most bite victims received free PEP), and the frequency of healthy dog bite victims presenting for PEP. After adjusting for case detection, we sampled the time series of rabid dogs on Pemba, to generate rabies incidence under scenarios with and without dog vaccination. For scenarios with dog vaccination, we assumed the first campaign took place in year one, translating to reduced incidence from year two onwards, as per the contact tracing data, sampled from 2010 to 2015 and from 2016 to 2020 with zero incidence thereafter. Using negative binomial parameters fitted to the offspring distribution of bite victims per rabid dog, adjusted for case detection, we simulated corresponding time series of rabies exposures. We tuned the simulated incidence of healthy bite patients to match the data under these scenarios. Parameter estimates for probabilities of starting and completing PEP and for rabies progression in the absence of PEP (Hampson et al., 2019) were used to estimate deaths and deaths averted. We took the perspective of the health provider" @default.
W4382242809 created "2023-06-28" @default.
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W4382242809 date "2023-02-12" @default.
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W4382242809 title "Decision letter: Integrating contact tracing and whole-genome sequencing to track the elimination of dog-mediated rabies: An observational and genomic study" @default.
W4382242809 doi "https://doi.org/10.7554/elife.85262.sa1" @default.
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