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One health approaches for rabies control

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Presented by Marta Martínez Avilés at the PENAPH First Technical Workshop, Chiangmai, Thailand, 11 – 13 December 2012. …

Presented by Marta Martínez Avilés at the PENAPH First Technical Workshop, Chiangmai, Thailand, 11 – 13 December 2012.

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  • 1. Chiang Mai,11-13 December2012ONE HEALTH APPROACHESFOR RABIES CONTROLDr Marta Martínez AvilésVeterinary epidemiologistOIE Scientific and Technical Departmentm.martinez@oie.intFirst Technical Conference of the ParticipatoryEpidemiology Network for Animal and Public Health
  • 2. All mammals are susceptible (at least 130 speciesdocumented, 110 of them wild animals)Stray dog control medics or vets’ problem??Different administrative levels involvedDifferent expertise required: diagnostics, epidemiology,ecology, sociologyTHE IDEAL CANDIDATE FOR ONE HEALTH
  • 3. Rabies is a notifiable disease and one of theoldest known zoonosesHighly fatal and no treatment, yet 100%preventableTransmitted by the saliva of rabid dogsApart of the dog, the virus cycles in bats and insome wild carnivore populations (i.e. red fox inEurope)INTRODUCTION
  • 4. Rabies cases (domestic animals)never occurred or reportedclinical disease/infectionno informationdate last case unknownlast case reported >1 <25 years agolast case reported >25 years agoRABIES CASES IN DOMESTIC ANIMALS(OIE, 2005-2011)14 00014 00014 00014 000Human deaths due to rabies(PRP/GARC new estimate)< 2< 2< 2< 2<50<50<50<50<150<150<150<15030 00030 00030 00030 000andandandand riskriskriskrisk totototo humanshumanshumanshumans
  • 5. >95% of human deaths caused byrabies (mostly children) have acanine origin.Dogs are the major transmitters ofrabies in developing countries70% of vaccination coverage in apopulation of dogs sufficient tocontrol canine and human rabiesCONTROL IN DOGS
  • 6. CONTROL TOOLS AND STRATEGIES AREWELL KNOWNPasteur and rabies vaccines, 1880-1885BIOLOGICALSBIOLOGICALSBIOLOGICALSBIOLOGICALShttp://www.historyofvaccines.org/content/timelines/pasteurCONTROL STRATEGYCONTROL STRATEGYCONTROL STRATEGYCONTROL STRATEGYCOMMUNICATIONCOMMUNICATIONCOMMUNICATIONCOMMUNICATIONAWARENESSAWARENESSAWARENESSAWARENESScomprehensive onlinecompilation of toolsavailable for rabiescontrol and prevention
  • 7. vaccinationof dogsSTRATEGYefficientvaccinesavailableSCIENCE10%costPRICE>95% ofhumancasesIMPACT
  • 8. RABIES IS A NEGLECTED DISEASEWe have nobudget tovaccinate dogsOur stray dogpopulation istoo largeWildlife isresponsible!The Ministry of Agriculturethinks the VeterinaryServices should notcare about dogsDog owners do notparticipate invaccinationcampaignsIt’s the task of theministry of publichealth, not ours
  • 9. WHO TAKES CARE OF THE DOGS?Rabies predominantly affects the poorest segmentsof the population, living in remote, rural areasRural> 80%Urban%
  • 10. DIFFERENT FACTORSCompetitionCoordinationMovementsGlobal collaborationInter-sectoral collaboration
  • 11. InfecteddogActionLongincubationperiodDiagnosisInfectious dog:clinical signsHumanexposureHuman clinicalsigns
  • 12. OIE 5TH STRATEGIC PLAN 2011-2015NEW ACTIONSThe One Health ConceptA worldwide strategy for managing risks at theanimal-human interface ecosystemsOIE, FAO and WHO renewed their commitmentwith the Tripartite Concept Note created in 2010Rabies control is a priority model to apply the‘One Health’ concept by countries andintergovernmental organisations as seen at theOIE Global Conference on Rabies Control inSeptember 2011 (Republic of Korea)Rabies control as a model for intersectoralcontrol approaches (Mexico, HLTM, 2011)Resolution 27/2012 (80 GS)
  • 13. CoordinatedplanningStandards,LegislationPoliticalwillTrustCommonobjectivesSharedbenefitImplementationCross-sectoralcoordinationRoutinecommunicationJoint simulationexercisesData sharingJoint riskassessmentActive cooperationKEYKEYKEYKEY SUPPORTINGSUPPORTINGSUPPORTINGSUPPORTING ANDANDANDANDOPERATIONALOPERATIONALOPERATIONALOPERATIONAL ELEMENTS FORELEMENTS FORELEMENTS FORELEMENTS FORCROSSCROSSCROSSCROSS----SECTORALSECTORALSECTORALSECTORALCOLLABORATIONCOLLABORATIONCOLLABORATIONCOLLABORATION
  • 14. POLITICAL WILL, TRUST, COMMONOBJECTIVES AND SHARED BENEFITSGovernments must recognise rabies as a major problemand as a public good. NotifiabilityKeep motivating national governments to invest in rabiescontrol at the source of infectionWHAT IS THE SITUATION OF RABIES IN THE COUNTRY? = SURVEILLANCELEARN LESSONS.Achieved rabies free areas can transfer its skills toneighbouring region, consolidated elimination and prevention ofreintroductionINNOVATE. Establish sustainable ways of working and reaching consensusRABIES CONTROL STRATEGY APPROVED
  • 15. RABIES PRESENT BUTRABIES PRESENT BUTRABIES PRESENT BUTRABIES PRESENT BUTLACK OF DATALACK OF DATALACK OF DATALACK OF DATAPROPOSEDPROGRESSIVE CONTROL PATHWAYTOWARDS RABIES ELIMINATIONFURTHER RABIESFURTHER RABIESFURTHER RABIESFURTHER RABIESRISK REDUCTIONRISK REDUCTIONRISK REDUCTIONRISK REDUCTIONMAINTAIN RABIESMAINTAIN RABIESMAINTAIN RABIESMAINTAIN RABIESELIMINATION IN HUMANSELIMINATION IN HUMANSELIMINATION IN HUMANSELIMINATION IN HUMANSAND ANIMALSAND ANIMALSAND ANIMALSAND ANIMALSSTAGESTAGESTAGEENO MORE DOGNO MORE DOGNO MORE DOGNO MORE DOGRABIES CASESRABIES CASESRABIES CASESRABIES CASESNO MORE HUMANNO MORE HUMANNO MORE HUMANNO MORE HUMANRABIES CASESRABIES CASESRABIES CASESRABIES CASESGAIN UNDERSTANDING ONGAIN UNDERSTANDING ONGAIN UNDERSTANDING ONGAIN UNDERSTANDING ONTHE EPIDEMIOLOGY OFTHE EPIDEMIOLOGY OFTHE EPIDEMIOLOGY OFTHE EPIDEMIOLOGY OFRABIES AND ASSESSRABIES AND ASSESSRABIES AND ASSESSRABIES AND ASSESSRABIES RISKSRABIES RISKSRABIES RISKSRABIES RISKSIMPLEMENTATION OF AIMPLEMENTATION OF AIMPLEMENTATION OF AIMPLEMENTATION OF ARABIES CONTROL STRATEGYRABIES CONTROL STRATEGYRABIES CONTROL STRATEGYRABIES CONTROL STRATEGYSTAGESTAGEREPORTING OF THE OCCURENCE OF RABIESTO INTERNATIONAL ORGANIZATIONS4444NATIONAL RABIES PREVENTION ANDCONTROL STRATEGY FINALIZED ANDFINANCEDDEVELOPMENT OF ADEVELOPMENT OF ADEVELOPMENT OF ADEVELOPMENT OF ARABIESRABIESRABIESRABIESCONTROL STRATEGYCONTROL STRATEGYCONTROL STRATEGYCONTROL STRATEGYSTAGERABIES RISKS ASSESSED AND CONTROLPLAN DRAFTED5555
  • 16. Activities at the national level, including enactinglegislation to facilitate cross-sectoral collaboration,should be based on the governance and standards issuedfrom the international organizationsSTRONG GOVERNANCE, LEGAL SUPPORTAND RECOGNITION OF INTERNATIONAL STANDARDSCross-sectorial legislative frameworkSustainable fundsTechnical capacities
  • 17. Chapter 8.10.Chapter 8.10.Chapter 8.10.Chapter 8.10.onononon rabiesrabiesrabiesrabiesChapter 5.11.Model veterinary certificate forimportation from rabies infectedcountriesChapter 1.4.Animal health surveillanceChapter 3.1VeterinaryVeterinaryVeterinaryVeterinaryServicesServicesServicesServicesChapter 1.1NotificationNotificationNotificationNotification of diseases andepidemiological informationChapter 7.7. Straydog populationcontrolOIE TERRESTRIAL CODE STANDARDSRELATED TO RABIESGuidelinesfor diseasecontrol(web: « ourscientificexpertise »)
  • 18. The updated chapter (diagnostic methods)updated chapter (diagnostic methods)updated chapter (diagnostic methods)updated chapter (diagnostic methods) onrabies from the Terrestrial Manual wasadopted in May 2011On the working programme of the BiologicalStandards Commission: ad hoc Group onRabies Vaccine QualityRabies Vaccine QualityRabies Vaccine QualityRabies Vaccine QualityStandardisation programmes for reagentsreagentsreagentsreagents(harmonisation of diagnostic testing)Work on scientifically acceptable criteria forvalidation of diagnostic tests in wild animaldiagnostic tests in wild animaldiagnostic tests in wild animaldiagnostic tests in wild animalspeciesspeciesspeciesspecies (on-going)OIE STANDARDS ON DIAGNOSTIC TESTSAND VACCINES
  • 19. STRONG HEALTH SYSTEMSStrengthening Good Governance of Veterinary Services:PVS PathwayRegular training of OIE DelegatesEstablishment and repeated training of topic-specificnational Focal Points in each OIE Member Country
  • 20. SUPPORT TO OIE MEMBER COUNTRIESNetwork of OIE Reference Laboratories andCollaborating Centres 9 OIE RL for rabies, 5 orwhich are also WHO CCLaboratory twinning initiative => enhance technicalcapacity in the regions affectedTurkey- UKChina- UKNigeria- South Africa
  • 21. OIE manages a vaccine bank in Asia with the financialsupport of the European Union and under theframework of the regional cooperation programme onHighly Pathogenic and Emerging and Re-emergingDiseases in Asia (HPED)It operates at the request of countriesRABIES REGIONAL VACCINE BANK
  • 22. Vaccination costs ≠ cost of the vaccine only Logistics coststo administer the vaccine to every possible dog in the villages;costs of coordinated regional programmes; costs of planningprogrammeSampling and testing costs: can samples be correctly taken,dispatched, transported, tested and results communicatedwithout delayCommunication and participation of the community are keyIs PEP indicated, available and within reach?THE EXPENSES OF RABIES CONTROL
  • 23. Without a target that is sustained over time, as soon asdisease frequency is reduced, the vaccination is stopped.Patchy and irregular vaccination along a number ofyears results in loss of commitment and interest ANDincrease of risk of canine rabies as a consequence ofherd immunity decreaseMASS VACCINATIONS OF DOGS IN ENDEMICCOUNTRIES
  • 24. IMPROVE DOG VACCINATION COVERAGEUnderstand the ecological parameters of dog populationStrategies must be adapted to the epidemiologicalsituation and the resources availableLack of resources + knowledge + fear of rabies have led some communities to try tocontrol dog populations through poisoning, electrocution or drowning- High cost to capture and sterilise- Complicated logistics involved in wild dog packsvaccination- Oral vaccination not always straightforward:dominating male could be the only one accessingthe bait; live vaccine: children at risk- Location of dogs: Rural/urban- Religious reasons
  • 25. Understanding dog ecology:Identification of dogs and potential rabid casesNew introductionsVaccination registries/identificationImmediate action on human and animal casesRabies Action Group; Mr and Mrs Rabies initiativeCommunication channels between administrativelevelsROLE OF THE COMMUNITY, IN COLLABORATIONWITH NGOS AND LOCAL AUTHORITIES
  • 26. THANK YOU!12 rue de Prony, 75017 Paris, France - www.oie.int – oie@oie.intOrganisationmondialede la santé animaleWorld Organisationfor Animal HealthOrganizaciónMundialde Sanidad Animal