Applied epidemiology rabies in nepal

  • 664 views
Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to like this
No Downloads

Views

Total Views
664
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
14
Comments
1
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. ‘‘SITUATION ANALYSIS OF RABIES IN NEPAL & RABIES RELATED PROGRAMME STRATEGIES IN NEPAL’’A Term paper submitted to fulfill the partial requirement of BPH Third semester [TPP 5.1 APPLIED EPIDEMIOLOGY-I] SUBMITTED TO: DEPARTMENT OF PUBLIC HEALTH, LA GRANDEE INTERNATIONAL COLLEGE, SIMALCHAUR-8, POKHARA 2012 SUBMITTED BY: PURNIMA TIMILSINA RAJESH KUMAR YADAV KALPANA GURUNG SAGUN PAUDEL
  • 2. 1. AcknowledgementThe students of Bachelor of Public Health 3rd semester of 2nd year like to express our humblythanks to all those who have supported and helped us in accomplishing this term paper in thetopic ‘‘SITUATION ANALYSIS OF RABIES IN NEPAL & RABIES RELATEDPROGRAMME STRATEGIES IN NEPAL’’.We would like to convey our heartfelt thanks to all those who were directly or indirectlyconcerned with this and to all our well wishers.First of all we would like to thank our respected subject teacher Dr. PrasoonRana for giving usopportunity to prepare this term paper. We are fully indebted to our coordinator Mr. DilipYadavfor expert guidance, regular supervision, untiring encouragement, inspiration and valuablesuggestion and full support during preparation of term paper.This term paper is written in simple language, with every bit of necessary information related tothe topic so that studying independently also would not find any difficulties. We think that thiseffort will help every individual to understand about the information of the related topic.
  • 3. TABLE OF CONTENT1. Acknowledgement ............................................................................................................................... 2TABLE OF CONTENT ................................................................................................................................. 32. Introduction: ....................................................................................................................................... 4 Sign & symptoms; ................................................................................................................................ 43. Objectives:........................................................................................................................................... 5 specific objective: ................................................................................................................................ 5 General objectives: .............................................................................................................................. 54. Methodology ....................................................................................................................................... 65. Finding & Discussion: ........................................................................................................................... 7 South-East Asia Region ........................................................................................................................ 7 Burden of disease in Nepal: ................................................................................................................. 76.Epidemiological situation in Nepal ........................................................................................................ 87. Rabies control in the South East Asia Region ........................................................................................ 9 Strategies ............................................................................................................................................ 98. Rabies control activities and achievements in Nepal: ......................................................................... 109. Recommandations ............................................................................................................................ 1010. Reference ........................................................................................................................................ 11
  • 4. 2. Introduction:Rabies is a viral disease that causes acute encephalitis in endotherms. It is zoonotic , mostcommonly by a bite from an infected subject. For a human, rabies is almost invariably fatal ifpost exposure prophylaxis is not administered prior to the onset of severe symptoms. The rabiesvirus infects the central nervous system, ultimately causing disease in the brain and death.The rabies virus travels to the brain by following the peripheral nerves. The incubation period ofthe disease is usually a few months in humans, depending on the distance the virus must travel toreach the central nervous system. Once the rabies virus reaches the central nervous system andsymptoms begin to show, the infection is effectively untreatable and usually fatal within days.Sign & symptoms;The period between infection and the first flu-like symptoms is normally two to twelve weeks,but can be as long as two years. Soon after, the symptoms expand to slight or partial paralysis,cerebral dysfunction, anxiety, insomnia, confusion, agitation, abnormal behavior, paranoia,terror, hallucinations, progressing to delirium. The production of large quantities of saliva andtears coupled with an inability to speak or swallow are typical during the later stages of thedisease; this can result in hydrophobia, in which the patient has difficulty swallowing becausethe throat and jaw become slowly paralyzed, shows panic when presented with liquids to drink,and cannot quench its thirst.Death almost invariably results two to ten days after first symptoms.
  • 5. 3. Objectives:specific objective:  To analyze the situation of rabies in Nepal and strategies applied for rabies related programme.General objectives:  To study the Burden of disease and epidemiological situation.  To study about the rabies prevention strategies in Nepal  To study the WHO strategies for rabies control for SEAR.  To study about Rabies control activities and achievements. Etc.
  • 6. 4. Methodology Secondary data
  • 7. 5. Finding & Discussion:South-East Asia RegionRabies, an invariably fatal viral disease, is transmitted to humans through animal bites, mostcommonly dogs. The disease is preventable through timely pre-and post-exposure vaccination.However, once the disease occurs, death is inevitable.Countries Number of Rate (Human estimated/reporte cases per 100 d cases 000)Bangladesh 180 (reported in 0.14 2008) Estimation: Approx. 2000Bhutan Sporadic (Two 0.28 cases in 2008)DPR Korea Sporadic N/AIndia Approx. 20 000 3Indonesia Approx. 100 0.045Myanmar Approx. 1000 0.35Nepal 32# (2007) 0.21Sri Lanka 51^ (2008) 0.26Thailand 8* (2008) 0.012N/A: Not available#Personal communication, Epidemiology and Disease Control Division, Ministry of Health andPopulation, Kathmandu, Nepal^Weekly Epidemiological Report, http://www.epid.gov.lk/wer.htm*http://thaigcd.ddc.moph.go.thBurden of disease in Nepal:Rabies has been endemic in Nepal since ancient times. Most human cases of rabies in theCountry are reported from urban areas where stray dogs outnumber pet dogs and dog rabiesvaccination coverage is low. Canine rabies is the major epidemiological pattern and the dog isthe primary source of rabies. Most human and animal rabies cases are reported on the basis ofclinical observation and dog-bite history.In Nepal, 94% of the human cases occur after contact with rabid dogs. It is estimated that 200people on average die annually due to rabies. National statistics show that about 30 000 peoplereceive post-exposure prophylaxis (PEP), and the number of people seeking PEP is increasingevery year. Most animal rabies cases are reported from rural and semi-urban areas and villages
  • 8. adjoining wildlife parks and reserves. It is estimated that more than 1000 animals succumb torabies each year. Cattle and buffaloes represented 84% of the total of 430 animal rabies casesreported to the Veterinary Epidemiology Centre during the period of 2006-2010 and it clearlyshows the economic impact of rabies in livestock production in Nepal.6.Epidemiological situation in NepalRabies in Nepal is thought to circulate in two epidemiological cycles: an urban cycle involvingmaintenance of infection in dog populations and a sylvatic cycle involving mongooses, jackals,and wolves. There is a possibility of spill-over of rabies virus from dogs to wildlife and vice-versa.Rabies is unevenly distributed in Nepal. As can be seen from Fig. 1, Terai district is denselypopulated and there are wildlife parks and dense forest areas. Outbreaks of rabies are frequentlyreported in and around wildlife parks and domestic animals are mainly affected. Mountaindistricts rarely report rabies cases as human and animal population distribution is scattered andmaintaining rabies transmission cycle is difficult due to geographical barrier and food scarcity. Map showing high, moderate and low rabies risk districts, Nepal
  • 9. 7. Rabies control in the South East Asia RegionRabies is a 100% fatal but at the same time, 100% preventable disease. It is a disease of poverty,affecting the very vulnerable populations and children. The necessary tools and methods forcontrol and prevention of human and canine rabies are available and the proof of the feasibilityof rabies elimination has been demonstrated in countries like Japan, Singapore and Malaysia.Rabies elimination programme focused mainly on mass vaccination of dogs are largely justifiedby the future savings of human rabies prevention programme. A concerted effort between the human and animal health sectors and support from otherstakeholders is needed to achieve the goals of rabies elimination. WHO will continue to providetechnical inputs and support such effort.StrategiesWHO recommends the following five major activities to be initiated/strengthened in the MemberCountries of the SEA Region : 1) Develop a comprehensive national rabies control programme: Consensus on national strategy and policy and multisectoral and coordinated approach for rabies control at different levels. 2) Promote prompt and proper care of dog bite wounds: Immediate and thorough cleansing and flushing of dog-bite wounds with simple soap water is the most effective first-aid treatment against rabies. There is a need to educate the public on this important first step in the prevention of rabies. 3) Increase access to tissue cell-culture vaccines (TCVs): TCVs are safe and effective, with very low failure rates. Multi-site intra-dermal administration of TCVs greatly reduces the cost of post-exposure treatment, without sacrificing safety and efficacy. WHO strongly recommends discontinuation of the old nerve-tissue vaccines (NTVs), which are still produced and used in two countries of the Region, viz. Bangladesh, and Myanmar. NTVs have a high rate of adverse reactions and failures, and lower efficacy. 4) Prevent dog rabies through dog vaccination and dog population management: This includes:  organization of sustainable mass dog vaccinationprogrammes using highly potent tissue-culture rabies vaccine;  promotion of responsible dog ownership at the community level;  promotion of oral rabies vaccine for stray dogs to improve vaccination coverage;  dog population management through animal birth control (ABC) programme, and  Control of trade and movement of dogs. It has been seen that where >80% community dogs are properly vaccinated against rabies, the occurrence of human rabies cases ceases promptly. 5) Public health education and advocacy: This is an important component of any public health programme and Member States are encouraged to implement public education and awareness campaigns on rabies prevention and control.
  • 10. 8. Rabies control activities and achievements in Nepal:Nepal has phased out production and use of Semple type vaccine for humans in 2006. Tissueculture vaccine for human use is purchased and supplied by the Ministry of Health andPopulation to government hospitals on regular basis.Tissue-culture dog rabies vaccine has been produced since 2005 and dog rabies vaccine is alsoimported by private sector. There is an ongoing study on possibility of local production of humanrabies vaccine based on experience of animal tissue-culture rabies vaccine by Rabies vaccineProduction Unit under Directorate of Animal Health.Dog rabies vaccination is not mandatory and pet dogs are vaccinated against rabies in urbanareas. About 55 000 dogs are immunized against rabies. Dog vaccination campaigns areorganized as a part of the World Rabies Day events by the government as well as non-governmental organizations.Many NGOs have been involved in animal birth control and dog rabies vaccination activities inmajor cities of Nepal in the last 10 years. In 2007 a workshop on "Consensus Building amongNationalAlliance Partners to Eliminate Canine Rabies in Nepal and Development of Strategic Plan" wasorganized and supported by the World Health Organization (WHO). The Alliance Group forRabiesControl in Nepal has been formed, comprising the Department of Livestock Services, theVeterinaryPublic Health Division, Kathmandu Metropolitan City (KMC), Department of Public Health andSocialWelfare, Kathmandu Animal Treatment (KAT) Centre and National Zoonoses and Food HygieneResearch Centre (NZFHRC). A National Workshop was organized in December 2010 toformulate aRabies Control Strategy, which was attended by all partners involved in rabies control in Nepal.TheRabies Control Strategy will serve as a roadmap for control and subsequent elimination ofhuman rabies.9. RecommandationsThe following all the actions that are needed:  Establish national rabies control programmes, including appointment of National Programme Officers, and develop five-year strategic plans of action.  Improve rabies surveillance and data collection.  Initiate measures to phase out nerve tissue vaccines and replace them with modern tissue culture vaccines.  Promote rational use of TCVs for PEP and encourage the introduction of cost-effective intradermal (I/D) human rabies vaccination schedule in major rabies vaccination centres.
  • 11.  Strengthen inter-ministerial and intersectoral collaboration for rabies control in canine population through mass vaccination, dog population management and active community participation. Many NGOs and animal welfare groups are interested and involved in rabies control.  Develop appropriate measures to regulate movement of dogs from one place to another (rural to urban or island to island).  Community participation10. Reference  www.searo.who.int  Rabies Country Profile: Nepal  www.nep.searo.who.int  k park. THANKYOUDo not forget to give comment or feedback for me……mail4sagun@gmail.comwww.facebook.com/publichealthstudentswww.facebook.com/sagun.paudelwww.facebook.com/preventionisbest