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NDWC Chennai 2013 - The One Health approach towards Rabies elimination in Asia - Dr Abdul Rahman

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Dr Abdul Rahman's presentation on ''The One Health approach towards Rabies elimination in Asia'' at the National Dog Welfare Conference, Chennai India 27th and 28th February 2013.

Dr Abdul Rahman's presentation on ''The One Health approach towards Rabies elimination in Asia'' at the National Dog Welfare Conference, Chennai India 27th and 28th February 2013.

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  • Thirty years ago, cell culture rabies vaccines became available to treat humans exposed to rabies. These vaccines are among the most efficacious in the world as is clear from the very few human rabies deaths reported in patients that receive the WHO recommended PEP in a timely manner. Therefore we have to wonder why is it that people across the world still die of rabies 30 years after these excellent vaccines were initially marketed? Reasons include a lack of awareness about pet vaccination, need for PEP and primary wound care. In resource poor countries, vaccine and RIG may be scarce, patients may not know where to find vaccines and may have challenges to travel to a clinic. For example, this family had 5 children exposed to a suspect rabid dog and have had to walk many miles to a clinic to find vaccine. But, they only have enough money to buy vaccine for 1 child. They must make a choice as to which child they will vaccinate. Often families they must sell their possessions and/or livestock to pay for the vaccine, thus leaving them vulnerable to a loss of nutrition or shelter.
  • This graph shows the number of human rabies cases (orange), dog cases (blue line) and the blue bars show the umber of dogs vaccinated. As you will from the start of the vaccination programme there has been a continual and consistent decline in the number of reported dog and human rabies cases – and as you will see this graph only illustrates the findings for the first six months of the programme
  • And here is what has been accomplished: 70% of the dog population has been vaccinated. New clinics have been established thus increasing access to PEP, and training has been expanded. Over 182,000 children have been educated about how to prevent rabies. This represents all of the children enrolled in elementary schools across the island province CDC has provided training of the direct Rapid Immunochistochemical Test and is our major partner to evaluate rabies diagnostics for the program.
  • And here is what has been accomplished: 70% of the dog population has been vaccinated. New clinics have been established thus increasing access to PEP, and training has been expanded. Over 182,000 children have been educated about how to prevent rabies. This represents all of the children enrolled in elementary schools across the island province CDC has provided training of the direct Rapid Immunochistochemical Test and is our major partner to evaluate rabies diagnostics for the program.
  • WSPA – animal health , GARC public health will come together to deliver a cross border project in Marikina City and the Municipality of Cainta. Marikina has already made a serious commitment to reducing rabies, but their hard work is constantly threatened by the constant reintroduction of cases from neighbouring cities – this can be addressed through a cross border programme Our objective is elimination of rabies in 3 years and to have created a sustainable programme which will continue beyond the 3 years. And this can only be achieved if we have support from public health and livestock Provincial Government are supportive of this and have already committed funding for the three years and at the outset of the project GARC will bring on board relevant local agencies to ensure there is full community support for this programme
  • Transcript

    • 1. The “One-Health” Approach Towards Rabies Elimination in Asia S. Abdul Rahman President, Commonwealth Veterinary Association President, Association for Prevention and Control of Rabies in India (APCRI) Chairman, OIE Animal Welfare Working Group Former Dean, Bangalore Veterinary College, Bangalore 1Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 2. Ignorance is the main problem..Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 3. What is One Health? The collaborative effort of multiple disciplines working locally, nationally, and globally – to attain optimal health for people, animals and our environment -American Veterinary Medical Association, 2008Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 4. Connectivity Between Animal and Human Disease and the Environment- Ancient civilisations- Middle Ages: Black Death- Rinderpest Outbreaks C18th Europe- Human Conflict: American Civil War 1861-1865, WWI, African Context Questions of the animal origins of human disease lie behind the broadest pattern of human history, and behind some of the most important issues of human health today” -Jared Diamond, in Guns, Germs and SteelPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 5. Early Pioneers of Comparative Medicine - C19th: Hazards associated with infected meat/milk gaining recognition (TB and scarlet fever), confirmation tapeworm associated with muscular cysts in the cattle and pigs. - Rudolf Virchow coined the term zoonosis to “indicate the infectious disease links between animal andhttp://www.creationism.org/books/TaylorInMindsMen/TaylorIMMhdRudolfVirchowM.j human health” (Cardiff et al, 2008) pg “Between animal and human medicine there are no dividing lines – nor should there be. The object is different but the experience obtained constitutes the basis of all medicine” - Rudolph Virchow (1821-1902) Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 6. Calvin Schwabe (1927-2006) - “Modern Advocate of One Medicine” (Cardiff et al, 2008) - 1984:Veterinary Medicine and Human Health echoed the visions of integration between human and veterinary medicine - Advocated for the improvement of human livelihoods through animal disease control via examples such as CE, and non-ZD e.g Rinderpest in EA vetmed.ucdavis.edu “The final objective of veterinary medicine does not lie in the animal species that the veterinarian commonly treats. It lies very definitely in man and above all in humanity” - Schwabe, 1984Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 7. One Health in the 21st Century Promotion of One Health for the control of Emerging Infectious Diseases- 61% of human infectious diseases are of animal origin (Taylor et al 2001), 75% of EID over the last 30 years are zoonotic (Osburn et al et al 2009, AMVA 2008).- Many hypotheses for this “spike” in zoonotic infectious disease emergence worldwide; including increasing human population , placing natural resources under pressure and increases the contact between wildlife, domestic animals and humansPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 8. Control of Endemic Zoonoses for Poverty Alleviation 2000: 6th MDG - “To Combat HIV/AIDS, Malaria, and Other Diseases” - large scale financial interventions addressing ID and their contribution to poverty Neglected Tropical Diseases – Include WHO recognised “NZDs” - Anthrax, BTB, Brucellosis, Cysticercosis/NCC, CE, Rabies and HAT (WHO, 2009c) Poverty, reliance on livestock, close proximity between animals and people all favour the spread of ZD Livestock productivity losses/death from ZD places even greater strain on poor communities Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 9. Moving Forwards with One Health in Developing Countries Several high profile meetings to promote policy and advocacy for the NZDs - Integrated Control of Neglected Zoonoses in Africa (ICONZ) - EC funded project involving 21 partners - collaborative project to address knowledge “gaps” currently existing on NZD burdens – www.iconzafrica.org “By simultaneously saving lives and securing livelihoods, the control of neglected zoonotic diseases offers a real and highly cost-effective opportunity for alleviating poverty, especially in remote rural communities” WHO Meeting Report “Integrated Control of Neglected Zoonoses in Africa” Nairobi, 2007Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 10. Challenges of Implementing a One HealthApproach in Developing Countries Advocacy and public awareness for NZD Constraints to the diagnosis (prioritisation) of zoonotic disease Who Pays? National funding “falls between the cracks” of MoH/MoAPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 11. Rabies 3.1 billion people live in 15 countries in Asia that are endemic for dog rabies Rabies kills 55 000 people every year and also has the highest case-fatality ratio of infectious diseases. Approximately 31000 (90% ) occur in Asia 99% of deaths occur in Asia where Rabies is endemic in dog populationPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 12. Human Mortality Due ToRabies 97% of human rabies deaths come from bites of rabid dog Children (40%approx) are more affected.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 13. Rabies Rabies is a vaccine preventable disease. The most cost effective strategy for preventing rabies in people is by eliminating rabies in dogs through vaccination ~ World Health Organization (WHO) 2010 The control and elimination of rabies in dogs through vaccination remains the only cost effective way to sustainably protect humans from contracting the disease. ~ World Organisation for Animal Health (OIE) 2011 Vaccinating dogs against rabies is the key to stopping this terrifying disease. It protects the dogs from rabies and creates a barrier between the disease and the people ~ Global Alliance for Rabies Control (GARC) 2012Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 14. Why Do People Still Die of Rabies?  Lack of awareness on all levels about  Responsible pet ownership – vaccinating pets  Need for post-exposure prophylaxis (PEP)  Primary wound care  Rabies immunoglobulin (RIG) not available  Rabies vaccines not available  Greater cost of travel  Increased risk of rabies onset  Rabies vaccines are too expensive  Likelihood of giving up  Delays because of need to raise money  Control of Dog Reservoir Slide courtesy of Dr Katie Hampson, University of Glasgow14Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 15. Human Rabies in Asia, 2010 Rabies-free Up to 150 cases 151-300 301-2000 2001-10 000Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 16. Afghanistan 40 in 2010 (37) 150-200 2000-2500 1-4 20 000 Urban:24% 2000-2500 Rural: 76% Rabies Free Rabies Free 58 (2009)Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 17. Rabies Situation in Asia WHO estimation of rabies deaths in 2005 in Asia was 32,000 as compared to 41,000 in 2001 and it could still be less now. This is mainly due to:  Implementation of comprehensive rabies control programs  Phasing out of Nerve tissue vaccine from all Asian countries except Pakistan and Mongolia  Availability of tissue culture vaccines and immunoglobulins  Awareness programmes especially with World Rabies Day  Role of International and Regional Organisations such as WHO,OIE,FAO,GARC,RIA etc.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 18. Adoption and implementation of OIERecommendations and Standards Rabies should be considered as a priority by all governments Public awareness and education on rabies Active contribution of Veterinary Services to the goal of eliminating human rabies at the animal source with the appropriate financial support (public budget/Ministries of Health) Design and implementation of comprehensive and sustainable national programmes for rabies elimination, Harmonisation of control/ elimination programme strategies between neighbouring countries until rabies has been successfully eliminated.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 19. Rabies Control Initiatives In Asia 2004  2007  1st AREB Meeting, Cebu  4th AREB Meeting, Island, Philippines Bangkok,Thailand 2005  First Rabies in Asia Conference (RIACON 1) Bangalore, India  2nd AREB Meeting, Shanghai, China  OIE/WHO/EU Intl conf Towards the Elimination of Rabies in 2006 Eurasia  3rd AREB Meeting, New Delhi,  First World Rabies Day India  The Philippines enact into law  Establishment of the Rabies in the Anti-Rabies Act Asia Foundation  Vietnam: Decree Enacts a  Establishment of the Alliance Rabies elimination program for Rabies Control (ARC)Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 20. Rabies Control Initiatives In Asia 2008  2011  Creation of the Partner for Rabies  OIE Global Conference on Rabies Prevention group Incheon, Korea  Resolution of eliminating rabies by  Third Rabies in Asia Conference 2020 adopted by the ASEAN Plus (RIACON 3) Colombo, Sri Lanka Three Countries  8th AREB Meeting, Bangkok,  5th AREB Meeting, Ho Chi Minh City, Thailand Vietnam  Establishment of Global Alliance for Rabies Control Asia 2009  6th AREB Meeting, Manila,  2012 Philippines  Ilocos Norte Philippines: 1st  Second Rabies in Asia Conference Provincial Rabies Summit and (RIACON 2) Hanoi, Vietnam CARE Project Launch  Creation of a National Rabies 2010 Control Programme in 12 Five Year  7th AREB Meeting, Goa, India Plan Govt. of India  9th AREB Meeting, Yogyakarta IndonesiaPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 21. Rabies Control Programme inAsia Recent positive developments in South Asia and South-East Asia towards rabies elimination need to be enforced and supported through international partnerships and funding. Political commitment, development and execution of comprehensive rabies elimination programmes and community participation are prerequisites for successful rabies eliminationPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 22. Rabies Control Programme inAsia Necessary tools and methods for control and prevention of dog and human rabies are available, and human rabies elimination has been demonstrated in Europe, America and some countries of Asia. Coordination among major stake -holders, international partnerships, political commitment and regional cooperation are major challengesPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 23. Rabies Control Programme inAsia The ASEAN Secretariat has taken a bold decision to eliminate rabies by 2020; while SAARC is also trying to  move towards human rabies elimination. Though many international non-government and humanitarian organizations are involved in animal birth control and rabies vaccination activities in urban areas in some countries, a strong international  partnership will be needed to execute a comprehensive rabies elimination programme in the South-East Asia region.  OIE and WHO has been providing technical support to member countries to launch such a programmePaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 24. Rabies Control Programme inAsiaNew projects with international funding WHO-coordinated Bill & Melinda Gates Project for Dog Rabies Elimination (Visayas Islands) : 10m US$ funding Bohol Rabies Prevention and Eradication Program (ARC, Bohol Provincial Gvt, Private Swiss Foundation) Rabies retained in the final list of GAVI investment casePaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 25. The Need for a One-HealthApproach In the fight against rabies, the priority is to safeguard human welfare but it should not be at the unnecessary expense of dogs One health approach will provide good animal welfare which will have direct benefit to human health To ensure sustainability, dog vaccination programmes will need political support and will need to integrate public health, veterinary, livestock and animal welfare agenciesPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 26. Examples of “One Health” Initiativesfor Rabies Control in AsiaIndia : 1. Adopt a Village Programme 2. Pilot Project on Prevention and Control of Human Rabies 3. Proposed National Rabies Control Programme in 12th PlanIndonesia: Indonesian Project –The Bali Case StudyBangladesh: WSPA’s Red Collar Campaign in Cox’s BazarPhilippines – Bohol ProjectThe CARE Project in Ilocos Norte, Sorsogon and Metro Manila in Philippines and Nias in IndonesiaWHO – Bill & Melinda Gates Foundation Project in The Philippines (Visayas)Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 27. INDIA1. Adopt a Village Programme Ten villages surrounding Bangalore and Pune, India have benefited from a programme aimed at reducing the incidence of human and animal rabies through improved educational awareness and mass vaccination of dogs. A large number of medical and veterinary partners worked together in the target villages to educate people in their own language with sensitivity to their customs.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 28. Model Rabies Prevention Programme: (Based on one health experiment ) Medical Veterinary Messenger: Medium:•Primary health care Behavioral •Rabies video film volunteers Change •Rabies Calendar •School children & Communication •Posters Teacher •Wall paintings •Local leaders •Snake & ladder game •Rabies rally Rabies •Book labels Awareness •Folk MediaPost exposure prophylaxis Animal Welfare Activities Laboratory Diagnosis by dRIT & • Responsible pet ownershipPre exposure vaccination • Anti rabies vaccination of by ID route dogs • Deworming Rabies preventionPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 29. N Bangalor Subjects and Methods: e Ramohall y Bhimanakup S e Project Villages Vinayak nagara India Control Gerupaly Villages a Rabies deaths in AnimalsVillage name 09 08 07 Kumbalgodu A A A StudyRamohally 1 1 - VillagesBhimanakupe 1 - 1Vinayak nagara 1 - 1 Tagachgup * No Human Rabies death e Rabies Death in Human & Animals Location of Project Villages Bangalore Village name 09 08 07 06 05 04 H A H A H A H A H A H A Gerupalya - 1 - 1 - 1 - NA - NA - NA Kumbalgodu - 2 - 2 1 2 - NA - NA 1 NA Tagachgupe - 2 - 2 - 2 - NA - NA 29 - NA H=Human 29 Mysore Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India A=Animal
    • 30. INDIA1. Adopt a Village Programme Empowering local communities to take action against rabies Building partnerships & providing expertise Using existing networks to improve public health Human, veterinary & animal welfarePaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 31. Rabies Awareness Activities Wall Paintings – Wall Paintings – Objectives of the project Calendar for the Year 2011 Rabies educationRabies Volunteer educating the Snake & ladder game for rabies community Painting Competition educationPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 32. Poster on Post Exposure Poster on responsible pet Prophylaxis ownership Rabies public awareness video in Kannada FGD with rabies volunteers Rabies Awareness - Jatha & SHGs membersPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 33. Laboratory Methods in Rabies Diagnosis & Handson training in Direct Rapid ImmunohistochemistryTest (dRIT) Dr. S Abdul Rahman -Addressing the Dr. S N Madhusudana , NIMHANS – participants -Auditorium, Government Discussion on dRIT . Veterinary College, Bangalore. Brain sample for dRIT Ms. Lillian Orciari, CDC, AtlantaPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India Rabid cow explaining about dRIT procedure
    • 34. Results Animal bite/Exposure - Incidence Incidence in 1 year Baseline End line Z PStudy villages (N=1735) 47 (2.7) 33 (1.9) 2.05 0.0398Control villages (N=1080) 31 (2.8) 27 (2.5) 0.59 0.5501 Note: Overall there was 30% reduction in incidence of animal bite /exposures in study villages.  Human rabies Incidence: There was no case of human rabies reported in study and control village.  Animal Rabies Incidence: There were six cases from study village and one case from control village of animal rabies confirmed by dRIT Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 35. Results Summary Significant improvement in the KAP of people in the study villages following implementation of rabies prevention strategies. Incidence of animal bite/exposure reduced by 30 % in study villages when compared to control villages. Post exposure prophylaxis was provided to all animal bite/cases in the study villages. Dog, particularly pet dog was found to be the most common biting animal and majority of the cases were category III exposures. Pre exposure vaccination by Intradermal route to school children & other risk groups using PCECV was safe & immunogenic.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 36. Results Summary There were no human rabies cases in project villages during the two year project period. Laboratory diagnosis of animal rabies using direct rapid immunohistochemical test (dRIT) was feasible at field conditions. The animal welfare activity involving collar, anti rabies vaccination & deworming was well accepted by the community in study villages. Adequate RVNA titer in dogs was observed with annual booster dose of rabies vaccine.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 37. Notifiability and Education Project  Rabies is not a notifiable disease in India but only Reportable  Mass information campaign to sensitize 545 Members of Parliament with translation of Rabies information in 12 different Indian languages  Media campaign to highlight the need for making Rabies a notifiable diseasePaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 38. Pilot Education Project in Karnataka State  TACTICAL OBJECTIVE/GOAL To relieve the burden of Rabies in animal population especially in dogs in India and eliminate human rabies deaths.  Project is based on the premise that children are best medium to adopt the concept of responsible pet ownership Furthermore up to 60% of all people who die of rabies are children.  Target beneficiaries: 54,529 primary schools with 252,875 teachers and 8.495 million students. 9,498 secondary schools with 92,287 teachers and 1.384 million students  Goal: Incorporation of rabies education into 54,529 primary schools by 2013 and 9498 secondary schools in Karnataka state by 2015.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 39. Project On Evaluation Of Neutralizing ActivityMonoclonal Antibody Combination Against Rabies For reasons of safety and availability, alternative products to HRIG and ERIG are advocated, and the development of rabies virus-specific monoclonal antibodies has been recommended by WHO Genotypic characterisation of Rabies virus from different geographical locations in India The aim of the project in India will be to provide an alternative therapy to rabies immune globulins (RIGs) by developing a human monoclonal antibody (mAb) cocktail for Post Exposure ProphylaxisPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 40. INDIA2. Pilot project on Prevention and Control of Human Rabies Objectives  Prevention of human deaths due to rabies.  Sensitization of veterinary and animal husbandry departments for reducing the transmission of disease in animals. Strategy  Enhancing awareness regarding timely and appropriate Post exposure treatment  Ensure availability vaccines and anti-sera  Training health professionals  Operationalise ID route in selected centres  Strengthen diagnostic capabilities  Interface with animal husbandry department  Involvement of NGOs and Community Pilot Project Cities  Ahmedabad  Bangalore  Delhi  Pune  MaduraiPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 41. Challenges faced in Surveillance and Intersectoral coordination • No single administrative unit thus collection and collation of data from all the agencies involved in animal bite management is a challenge • Involvement of Intra-city multiple stakeholders • Continues to remain a disease of low priority with Dept of Animal HusbandryPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 42. INDIA3. Proposed National Rabies Control Programme in 12th Plan of Government of India Components:  Human Health : to reduce mortality due to rabies  Animal Health : to cut down transmission of disease  Strengthening Intersectoral coordination  Maintaining rabies -free areas as rabies -freePaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 43. Coordination of Rabies controlActivities in India NGO’s WHO FAO OIE APCRI RIA ARC Ministry of Ministry of Health Mun Corp Agriculture Dept. of Vet Services AWBI -Min. of Envr. Forest & Anim. Welfare Rabies Control ProgrammesPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 44. World Rabies Day Programmes Education campaign involving Media and Celebrities such as Film Stars and Sport persons (Cricket)Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 45. Vietnam Government’sCommitment Instruction No.92/TTg signed by Prime Minister on 07/12/1996; Ordinance on Animal Health was adopted by the National Assembly in 2004; Decree No.05/2007/ND-CP signed by Prime Minister on 09/01/2007.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 46. INDONESIAIndonesian Project –The Bali Case Study In 2010, the Bali Animal Welfare Association (BAWA), funded by the World Society for the Protection of Animals (WSPA) and the Australian Agency for International Development (AusAID), initiated island- wide mass vaccination campaigns for free, targeting the outside dog population. The result was a marked decline in the new reports of rabies infections in humans. The Indonesian Directorate of Animal Health, seeing the concrete results, reached out to FAO for technical support to maintain the momentum and build upon the lessons learned battling the rabies virus in Bali.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 47. INDONESIAIndonesian Project –The Bali Case StudyFAOs Assistance In early 2011, the FAO began working with the veterinary services to develop a targeted strategy to combat rabies, coordinating at various levels: local, provincial and with central authorities in Jakarta. In addition, human health services, local NGOs and animal welfare groups have also been involved in mounting a united front against rabies. FAO supported the government by helping to bring all sides to the table to launch an effective control programme against rabies.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 48. INDONESIAIndonesian Project –The Bali Case StudyIsland wide mass vaccination programme commences.  In the first round of vaccinations implemented by BAWA, some 239,000 dogs were vaccinated.  During the second round, coordinated by the Bali Province Livestock Service and the central governments Directorate of Animal Health, with funding from FAO, Australia and United States, another 235,000 dogs were vaccinated within four months.  A third round of vaccination is ongoing now and will cover another 250 000 dogs.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 49. The vaccination of dogs Human and Dog Rabies Cases, Bali (Oct 2009 – March 2011) STOP Dog Culling START of 1 st mass dog vaccination 14 90 13 13 213 176 doses 80 12 Humans 77Human deaths 70 Dog cases 68 (70% dog pop) 10 10 62 60 8 8 8 50 7 7 6 38 6 38 40 5 5 5 5 30 4 28 4 28 4 23 22 24 3 19 3 20 2 Dogs 2 14 12 2 9 10 9 9 9 10 133 169 doses 115 326 doses 0 0 Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- 09 09 09 10 10 10 10 10 10 10 10 10 10 10 10 11 11 11 Months Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 50. INDONESIAIndonesian Project –The Bali Case StudyHerd Immunity With more than 70 percent of dogs vaccinated, the dogs have ‘herd immunity. At this level of vaccination coverage, the rabies virus is unable to spread in a dog population that has immune protection, and it eventually dies out. Rabies deaths in humans have declined from 83 in 2010 to 26 in 2011. So far in 2012, just seven people have fallen victim to rabies.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 51. BANGLADESHWSPA’s Red Collar Campaign in Cox’s Bazar WSPA’s mass vaccination project in Bangladesh is helping to protect thousands of dogs, as well as local families, from rabies. The teams put red collars on vaccinated dogs, or sprayed their backs with toxin-free yellow paint, to indicate that the animals were protected against the deadly disease. Further, the teams educated the community about the importance of vaccination in the fight against rabies.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 52. The Global Alliance for Rabies Control “Striving to free people and animals from rabies” Collaborative programs:  World Rabies Day Campaign  It is a global campaign, celebrated every 28th September of the year, to raise awareness and give a voice to people at most risk on rabies  Bohol Rabies Project, demonstrated that rabies can be eliminated and children saved by:  empowering communities to take responsibility  mobilizing local resources  developing & sharing adequate tools for sustainability  working with global experts  Other programs where we share our expertise and support governments to monitor their rabies program (i.e. Adopt a Village in India)Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 53. PHILLIPINESThe Bohol Project Luzon Luzon Partnership with government and the Global Alliance for Rabies Control Manila Manila PHILIPPINES PHILIPPINES Additional funds from WHO and other Samar Panay Samar Panay Cebu NGOs Leyte Cebu Ley Palawan Bohol Negros Palawan Negros Bohol Initiated in 2007 Mindanao Mindanao Basilan Basilan Cost estimate conducted in 1991 Jolo Sulu Jolo Sulu Estimated $2.5 million/year in cost- savings by eliminating dog rabies in Philippines Costs would be repaid in 4 –11 yearsPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 54. Bohol Project Philippines:Controlling Canine Rabies and PreventingHuman Deaths  Community mobilization  140 to >15,000 persons involved in program  Vaccination  70% of dog population  Increased access to postexposure prophylaxis (PEP)  New clinics  Expanded training  Integration of rabies education into school curriculum  All elementary school children educated (182,000 children)  CDC training of direct Rapid Immunohistochemical Test (dRIT) and evaluation of diagnostics Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 55. Bohol Project Philippines:Controlling Canine Rabies and PreventingHuman Deaths  No human or dog rabies deaths reported since Oct 2008  In 2 prior years, 10 cases/year reported  Program strategy to be self-sustainable when outside funding no longer available Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 56. Bohol Updates Galing Pook Award 2011 for Outstanding Local Government Program for Governance and Innovation  presented by the President of the Philippines and every year recognizes 10 local governance projects for excellence  held up as an example for other communities to emulate in their rabies control.  It is powerful endorsement of the project model and a step forward in global rabies control.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 57. The CARE Project in Ilocos Norte,Sorsogon and Metro Manila in Philippinesand Nias in IndonesiaProject Components: prevention of dog bites and human rabies; establishment of sustainable diagnostic and surveillance systems; elimination of rabies in the vector species (dogs); community awareness and mobilization; integration of rabies prevention education into elementary schoolsPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 58. CARE Project SitesIndonesia and Philippines Ilocos Norte – 547k people, 40k dogs Sorsogon – 709k people, 64k dogs Metro Manila – 690k people, 20k dogs (Cross border Marikina & Cainta) Nias 750k people 45k dogsPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 59. A One Health Example – Metro Manila  To demonstrate the benefit of a one health approach, WSPA and the Global Alliance for Rabies Control (GARC) will jointly deliver a cross border dog rabies elimination project in Metro Manila  Objective is to eliminate canine and human rabies in 3 years  Department of Agriculture and the Department of Health are supportive and local veterinary and animal welfare agencies will be brought on boardPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 60. WHO – Bill & Melinda Gates FoundationProject in The Philippines (Visayas)  From a short-list of ten countries, sites in three countries have been identified to demonstrate the feasibility, cost-effectiveness and benefits for human health of controlling and eliminating canine rabies in five years.  Selected countries:  Tanzania (South Eastern part)  South Africa (Kwa Zulu Natal) and  The Philippines (Visayas)Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 61. Project area in the Philippines Visayas group of islands covering 25% of the total number of animal rabies cases, 28% of the total human rabies and 27% of the animal bites in the entire country. The project will serve almost 19 % of the country’s human population (with 17 million inhabitants in the area) and an estimated 9 million dogs.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 62. Challenges for Rabies Control in Asia Generating the political awareness and will for large-scale control programme – Ownership for dog rabies control Development and implementation of a national rabies control strategy Devolving responsibility to local government authorities Legislation: Registration/Licensing and vaccination of dogs.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 63. Government Public Legislative awareness Support - and education Notifiability - on rabies Funding Municipality & Community Involvement Involvement, of Veterinary Media and Services Celebrities RABIES CONTROL Wound Dog Management Population – and Post Management Exposure and Control Prophylaxis Surveillance Involvement and of Animal Laboratory Welfare Diagnosis OrganizationsPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 64. Future plans to control Rabies atSource in AsiaGeneral Considerations Prevention: Introduce cost-effective public health intervention techniques to improve accessibility, affordability and availability of post-exposure prophylaxis 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 partnersPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 65. General Considerations Establish surveillance on human as well as animal side and identify Rabies as a Notifiable disease Strengthen State-level coordination committees Identify and fill gaps in current implementation programmes eg. Rural and peri-urban areas pose a major threat to the success of rabies control efforts Document Rabies intervention as a model for replication Draft a blueprint that can guide the national disease control programme to combat rabies and other zoonoses in the countryPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 66. Future plans to control Rabies at Source in India Specific Considerations• Human rabies prevention is possible through promotion of responsible dog ownership, mass dog vaccination and animal birth control programme with partnership approach Mass vaccination campaigns targeting dogs of all age group to develop herd immunity. Mass dog vaccination alone is effective but providing additional dog population management interventions can help overcome the challenges Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 67. Strengthening Of Available Laboratory FacilitiesFor Rabies Diagnosis In Animals And Humans Currently very few facilities for Rabies Diagnosis are available:For rabies diagnosis in humans: NIMHANS, Bangalore NCDC, Delhi NIV, PuneFor rabies diagnosis in animals Dedicated Rabies Laboratory hasBeen set up at Bangalore Vet ColWhich will be twinned under OIETwinning programme with CDC: Laboratories in different states andat Veterinary colleges Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 68. ConclusionA Rabies Control programme focused on mass vaccination of dogs and animal birth control is largely justified by the future savings in human rabies prevention. This is where dog owners, civic societies, animal welfare and non-government organizations need to play a proactive role. A concerted effort between the human and animal health sectors can achieve the goals of rabies elimination.Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 69. We are not alone!Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India
    • 70. Thank You For Your Attention Merci de votre attentionPaper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India

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