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NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal
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NDWC Chennai 2013 - Prospects of elimination of human rabies transmitted by dogs in South Asia - Dr Gyanendra Gongal

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Presentation by Dr Gyanendra Gongal in National Dog Welfare Conference, Chennai India 27th and 28th February 2013.

Presentation by Dr Gyanendra Gongal in National Dog Welfare Conference, Chennai India 27th and 28th February 2013.

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  • Rabies is not a notifiable disease in most member countries and there is no accurate data and information on human and animal rabies Motivation for animal rabies control is lacking due to competing priorities and lack of burden data with the animal health authority
  • Cost of vaccinating one dog in a mass vaccination campaign is around $2 (with $ 0.30 worth of vaccine)  Cost of 1 full PEP is equivalent to that of vaccinating 50 dogs  On average 2000 PEP are needed per million inhabitants per annum and there are on average 100 000 dogs per million people
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    • 1. Prospects of elimination ofhuman rabies transmitted by dogs in South Asia Gyanendra Gongal Scientist WHO Regional Office for South–East Asia New Delhi, India
    • 2. Outlines of presentation• Introduction• Situation analysis• Key issues and challenges• Scope of elimination of human rabies• Strategic approaches• Conclusion
    • 3. Introduction• All SAARC countries except Maldives are rabies endemic and magnitude of rabies problem differs from country to country• Canine rabies is the major epidemiological pattern and dog is primary source of rabies• Economic impact of rabies in livestock production is considered high but surveillance data are missing• There has not been any substantial decrease in the rabies incidence in Asia except few island countries
    • 4. Situation analysis• Each country is trying to execute rabies control activities in isolation and dog rabies control is problematic• There is no comprehensive rabies control programme in most countries• Intersectoral cooperation for rabies control is weak or non-existent• Motivation for animal rabies control is lacking• More NGOs and INGOs are involved but confined to limited areas
    • 5. Human Rabies in SAARC Region Countries Estimated Human cases % of dog bite in human per 100,000 total animal bite cases population casesAfghanistan 2000-3000 5.7 N/ABangladesh 1500-2000 1.5 95%Bhutan <10 0.28 99%India 18000-20000 3 >95%Nepal 100-150 0.21 98.5%Pakistan 2000-5000 1.3 >90%Sri Lanka <50 0.26 95%
    • 6. Rabies: Cross-border issue!Rabies risk mapping, Nepal Rabies risk mapping, Bhutan
    • 7. Animal rabies: Economically important! Reported Animal rabies, 2006-2010, Nepal (N=430) Source: Veterinary Epidemiology Center, Kathmandu, Nepal others 6% dogs cattle 39% 55% Tenzin et al., (2011) Surveillance of animal rabies in Bhutan, 1996–2009
    • 8. Key issues• Not a priority disease Public health issue!• Inadequate data and information Lack of political support• Dog rabies – Ownership is an issue!• Intersectoral coordination• Management structure• Public cooperation – Socio-cultural dimension of rabies
    • 9. Epidemiological Trends and Current Situation 12 Bolivia Control of Absence of Dog Rabies 10 Human Cases Salvador El 8 Bolivia and El Salvador wereTightening 6 examples of a Relaxation controls recurrent loop (past of controls situation) 4 2 Human Dog 0 Rabies 1996 1998 2000 Rabies 2002 2004 2006 2008 9
    • 10. Challenges ahead….!• How to reach and maintain 70% dog vaccination coverage to minimize human rabies incidence?• How long dog vaccination programme will be carried out?• How to deal with cross-border movement of dogs?• How to make accessible modern tissue- culture rabies vaccine to general public?
    • 11. Technological advancement (R&D)• Chemical and immuno-contraception• New vaccination schedule to improve compliance• New user-friendly diagnostic tools• Improvement of vaccine delivery system• Human rabies case management 11
    • 12. Why elimination of human rabies?• Rabies is 100% fatal but preventable disease• The South Asia contribute 45% of global burden of human rabies• More than 1.5 billion people are at potential risk of rabies infection• Each year, an estimated 4 million people receive anti-rabies vaccination• Rabies elimination is an ideal mission to move forward ‘One Health’ concept
    • 13. Impact of Rabies Elimination Campaign in PAHO Region 360 25000 340 320 22500 300 20000 280 260 17500 240 220 15000Casos de rabia en humanos Casos de rabia en caninos 200 180 12500 160 140 10000 120 7500 100 80 5000 60 40 2500 20 0 0 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Años Casos Humanos transmitidos por canes Casos Humanos transmitidos por Murciélagos Casos de Rabia en Perros Source: SIRVERA, PAHO
    • 14. Projected costs of rabies control 6,000,000 "Rabies day" dog vaccination+ PEPIntersectoral: the most effective strategy! PEP alone without dog vaccination• Control5,000,000 dogs in domestic Current expenditure on PEP Annual cost (dollars)• Improved rabies surveillance for targeted 4,000,000control 3,000,000•Improved access to effective post-exposureprophylaxis 2,000,000• Awareness and education about rabies 1,000,000transmission and prevention 0 0 2 4 6 8 10 12 Year after start of campaign
    • 15. Strategic Approaches– Prevention: Introduce cost-effective public health intervention techniques to improve accessibility, affordability and availability of post-exposure prophylaxis and control at source, i.e. dog rabies– Promotion: Improve understanding of rabies through advocacy, awareness, education and operational research– Partnership: Provide coordinated support for anti-rabies drive with the involvement of community, civil society, government and non- government sectors and international partners
    • 16. Pre-requisites for Elimination of Human Rabies• Political commitment• Ownership and partnership• Surveillance• Community based actions• Operational research• Cross-border collaboration• Resource mobilization – Internal & external
    • 17. SAARC Initiatives for Rabies Control• The Government of Sri Lanka hosted a SAARC level workshop on rabies control in 2003 in Colombo which recommended formulation of regionally coordinated rabies control activities under the auspices of SAARC Secretariat• Rabies in Asia Foundation in collaboration with WHO and SAARC Secretariat hosted SAARC Rabies Meeting in February 2011 in Mysore and third RIACON in November 2011 in Colombo• Technical workshop on Highly Pathogenic Emerging Diseases (HPED) recommended regionally coordinated rabies elimination activities through SAARC mechanism and resources• Elimination of human rabies as a public health problem by 2020!
    • 18. Goal• To eliminate human rabies in endemic countries• To verify and maintain freedom in rabies free areas
    • 19. Objectives• To establish a SAARC Rabies Center to guide rabies elimination programme• To strengthen local, national and regional capabilities for rabies elimination• To provide early and appropriate post-exposure rabies prophylaxis to human• To plan and implement selective and sustainable preventive measures for reduction of dog-mediated rabies• To strengthen local capacity in applied research and surveillance to promote rabies elimination
    • 20. Duration and estimated costPeriod: 8 years (2013-2020)• Preparatory Phase (Four years) – Establish a regional coordinated rabies elimination programme• Final Phase (Four years) – Eliminate rabies as a public health problem
    • 21. Proposed organizational set up for implementation of project activities SAARCDevelopment Fund Regional Member Alliance for Rabies SAARC Rabies Coordinator States Elimination (RARE) Country Rabies Alliance for Collaborating Rabies Institutions Elimination (CARE) Ministry Ministry of Agri./ of Health Livestock
    • 22. Estimated cost for Phase OneS. Activities Estimated % of totalNo. budget budget (USD)1 Legal framework for rabies elimination 0.25m 2.52 Advocacy, awareness and education 1.5m 153 Surveillance and networking 1m 104 Laboratory diagnosis 0.5m 55 Human rabies prophylaxis 1.5m 156 Anti-rabies campaign and animal birth control 4.25m 42.57 Wildlife rabies 0.25m 2.58 Operational research 0.25m 2.59 Project management 0.5m 5 Total 10m 100
    • 23. Advocacy for policy decision is a key!• Advocacy for ownership and social responsibility• Appreciation of role of medical and veterinary colleges and local governments in rabies prevention and control• Alliance for elimination of human rabies at country and regional levels
    • 24. International partnership• WHO: Regional Strategic Framework for Elimination of Human Rabies transmitted by Dogs in the South East Asia Region• OIE: Establishment of regional vaccine banks for dog vaccination• FAO: Proposed PCP towards rabies elimination• SAARC Rabies Meeting in Dhaka
    • 25. MAINTAIN RABIES ELIMINATION IN HUMAN AND ANIMALS FURTHER RABIES NO MORE DOG RISK REDUCTION RABIES CASES IMPLEMENTATION OF A NO MORE HUMAN RABIES CONTROL RABIES CASES STRATEGY DEVELOPMENT OF A NATIONAL RABIES PREVENTION AND CONTROL RABIES CONTROL STRATEGY FINALIZED AND FINANCED STRATEGY GAIN UNDERSTANDING ON RABIES RISKS ASSESSED AND THE EPIDEMIOLOGY OF RABIES AND ASSESS RABIES CONTROL PLAN DRAFTED RISKS REPORTING OF THE OCCURANCE OF RABIESRABIES PRESENT BUT TO INTERNATIONAL ORGANIZATIONS LACK OF DATA Source: FAO
    • 26. Conclusion• Dog-mediated rabies is a major epidemiological pattern in rabies endemic SAARC countries• Rabies elimination programme focused mainly on mass vaccination of dogs are largely justified• Existence of a large, unvaccinated stray dog population is a major problem• Dog population management is a serious challenge in metropolitan cities• Inter-country collaboration is essential to sustain the progress made in rabies control
    • 27. Partnership for Rabies Elimination

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