1 ‘‘SITUATION ANALYSIS OF RABIES IN NEPAL & RABIES RELATED PROGRAMME STRATEGIES IN NEPAL’’2/17/2013   A TERM PAPER PRESENT...
2    Prepared by    SAgun PAudel                    Presented with     Health Assistant               • KALPANA GURUNG    ...
Introduction:3     Rabies, also known as hydrophobia is an acute,    highly fatal disease of CNS caused by Lyssavirous   ...
4      The rabies virus travels to the brain by following    the peripheral nerves.     The incubation period of the dis...
SYMPTOMS5    Prodromal symptoms       Headache       Malaise       Sore throat       Slight fever 3-4 days       Ting...
6       Host factors : Although all age groups are        susceptible, rabies is most common in children aged        belo...
Objectives:7    specific objective:    •To analyze the situation of rabies in Nepal and    strategies applied for rabies r...
Methodology8    Secondary data                     rabies control program   2/17/2013
Finding & Discussion:South-East Asia Region:9Rabies, an invariably fatal viral disease, is transmittedto humans through an...
10         Countries                            Number of                         Rate (Human cases per                   ...
Burden of disease in Nepal:11     Rabies has been endemic in Nepal since ancient     times.     Most human cases of rabies...
12        In Nepal, 94% of the human cases occur after         contact with rabid dogs. It is estimated that         200 ...
13        Most animal rabies cases are reported from rural         and semi-urban areas and villages adjoining wildlife  ...
Epidemiological situation in14     Nepal        Rabies in Nepal is thought to circulate in two     epidemiological cycles...
15      Rabies is unevenly distributed in Nepal. As can     be seen from Fig. 1, Terai district is densely     populated ...
16       Mountain districts rarely report rabies cases     as human and animal population distribution is     scattered a...
Map showing high, moderate and17     low rabies risk districts, Nepal                   rabies control program   2/17/2013
Rabies control in the South East18     Asia Region      Rabies is a 100% fatal but at the same time,     100% preventable...
19      Rabies elimination programme focused mainly on     mass vaccination of dogs are largely justified by the     futu...
Strategies20     WHO recommends the following five major activities     to be initiated/strengthened in the Member Countri...
Strategies21        3) Increase access to tissue cell-culture vaccines (TCVs):         TCVs are safe and effective, with ...
22     4) Prevent dog rabies through dog vaccination and dog     population management:     This includes:     •organizati...
23 Control of trade and movement of dogs. o  It has been seen that where >80% community dogs    are properly vaccinated ag...
Rabies control activities and24     achievements in Nepal:   Nepal has phased out production and use of Simple type vacci...
25        There is an ongoing study on possibility of         local production of human rabies vaccine         based on e...
26        Dog rabies vaccination is not mandatory and         pet dogs are vaccinated against rabies in         urban are...
27     Many NGOs have been involved in animal birth control     and dog rabies vaccination activities in major cities of  ...
28      Public Health Division, Kathmandu Metropolitan City     (KMC), Department of Public Health and Social Welfare,   ...
conclusion29      In Nepal Rabies elimination programme focused     mainly on mass vaccination of dogs are largely justif...
30      Ministry of Health and Population       provideTissue culture vaccine for human use       to government hospitals...
Recommendation:31      The following all the actions that are needed:     1) Establish national rabies control programmes,...
32     4)    Promote rational use of TCVs for PEP and     encourage the introduction of cost-effective     intradermal (I/...
33     6)     Develop appropriate measures to regulate     movement of dogs from one place to another     (rural to urban ...
34        www.searo.who.int        Rabies Country Profile: Nepal        www.nep.searo.who.int        k park.          ...
35     rabies control program   2/17/2013
36     rabies control program   2/17/2013
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Rabies in nepal

  1. 1. 1 ‘‘SITUATION ANALYSIS OF RABIES IN NEPAL & RABIES RELATED PROGRAMME STRATEGIES IN NEPAL’’2/17/2013 A TERM PAPER PRESENTATION
  2. 2. 2 Prepared by SAgun PAudel Presented with Health Assistant • KALPANA GURUNG Student of BPH @ • PURNIMA TIMILSINA • RAJESH KUMAR LA GRANDEE YADAV International college, Simalchour Pokhara, Nepal rabies control program 2/17/2013
  3. 3. Introduction:3  Rabies, also known as hydrophobia is an acute, highly fatal disease of CNS caused by Lyssavirous type I,  It is zoonotic, most commonly by a bite from an infected subject. For a human, rabies is almost invariably fatal if post exposure prophylaxis is not administered prior to the onset of severe symptoms.  The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. rabies control program 2/17/2013
  4. 4. 4  The rabies virus travels to the brain by following the peripheral nerves.  The incubation period of the disease is usually a few months in humans, depending on the distance the virus must travel to reach the central nervous system. Once the rabies virus reaches the central nervous system and symptoms begin to show, the infection is effectively untreatable and usually fatal within days. rabies control program 2/17/2013
  5. 5. SYMPTOMS5 Prodromal symptoms  Headache  Malaise  Sore throat  Slight fever 3-4 days  Tingling sensation at the site of the bite rabies control program 2/17/2013
  6. 6. 6  Host factors : Although all age groups are susceptible, rabies is most common in children aged below 15 years  Reservoirs: o Rabies exists in 3 epidemiological forms: • Urban rabies • Wild- life rabies • Bat rabies rabies control program 2/17/2013
  7. 7. Objectives:7 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. rabies control program 2/17/2013
  8. 8. Methodology8 Secondary data rabies control program 2/17/2013
  9. 9. Finding & Discussion:South-East Asia Region:9Rabies, an invariably fatal viral disease, is transmittedto humans through animal bites, most commonly dogs.The disease is preventable through timely pre-andpost-exposure vaccination. However, once the diseaseoccurs, death is inevitable. rabies control program 2/17/2013
  10. 10. 10 Countries Number of Rate (Human cases per estimated/reported 100 000) casesBangladesh 180 (reported in 2008) 0.14 Estimation: Approx. 2000Bhutan Sporadic (Two cases in 2008) 0.28DPR 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) 0.012 #Personal communication, Epidemiology and Disease Control Division, Ministry of Health and Population, rabies control program 2/17/2013 Kathmandu, Nepal ^Weekly Epidemiological Report, http://www.epid.gov.lk/wer.htm
  11. 11. Burden of disease in Nepal:11 Rabies has been endemic in Nepal since ancient times. Most human cases of rabies in the Country are reported from urban areas where stray dogs outnumber pet dogs and dog rabies vaccination coverage is low. Canine rabies is the major epidemiological pattern and the dog is the primary source of rabies. Most human and animal rabies cases are reported on the basis of clinical observation and dog-bite history. rabies control program 2/17/2013
  12. 12. 12  In Nepal, 94% of the human cases occur after contact with rabid dogs. It is estimated that 200 people on average die annually due to rabies. National statistics show that about 30 000 people receive post-exposure prophylaxis (PEP), and the number of people seeking PEP is increasing every year. rabies control program 2/17/2013
  13. 13. 13  Most animal rabies cases are reported from rural and semi-urban areas and villages adjoining wildlife parks and reserves. It is estimated that more than 1000 animals succumb to rabies each year. Cattle and buffaloes represented 84% of the total of 430 animal rabies cases reported to the Veterinary Epidemiology Centre during the period of 2006-2010 and it clearly shows the economic impact of rabies in livestock production in Nepal rabies control program 2/17/2013
  14. 14. Epidemiological situation in14 Nepal  Rabies in Nepal is thought to circulate in two epidemiological cycles: an urban cycle involving maintenance 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 control program 2/17/2013
  15. 15. 15  Rabies is unevenly distributed in Nepal. As can be seen from Fig. 1, Terai district is densely populated and there are wildlife parks and dense forest areas. Outbreaks of rabies are frequently reported in and around wildlife parks and domestic animals are mainly affected. rabies control program 2/17/2013
  16. 16. 16  Mountain districts rarely report rabies cases as human and animal population distribution is scattered and maintaining rabies transmission cycle is difficult due to geographical barrier and food scarcity. rabies control program 2/17/2013
  17. 17. Map showing high, moderate and17 low rabies risk districts, Nepal rabies control program 2/17/2013
  18. 18. Rabies control in the South East18 Asia Region  Rabies 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 for control and prevention of human and canine rabies are available and the proof of the feasibility of rabies elimination has been demonstrated in countries like Japan, Singapore and Malaysia. rabies control program 2/17/2013
  19. 19. 19  Rabies elimination programme focused mainly on mass vaccination of dogs are largely justified by the future savings of human rabies prevention programme.  A concerted effort between the human and animal health sectors and support from other stakeholders is needed to achieve the goals of rabies elimination. WHO will continue to provide technical inputs and support such effort. rabies control program 2/17/2013
  20. 20. Strategies20 WHO recommends the following five major activities to be initiated/strengthened in the Member Countries of the SEA Region : 1) Develop a comprehensive national rabies control programme: Consensus on national strategy and policy and multi sectoral 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. rabies control program 2/17/2013
  21. 21. Strategies21  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. rabies control program 2/17/2013
  22. 22. 22 4) Prevent dog rabies through dog vaccination and dog population management: This includes: •organization of sustainable mass dog vaccination programmes 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 rabies control program 2/17/2013
  23. 23. 23 Control of trade and movement of dogs. o 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. rabies control program 2/17/2013
  24. 24. Rabies control activities and24 achievements in Nepal:  Nepal has phased out production and use of Simple type vaccine for humans in 2006.  Tissue culture vaccine for human use is purchased and supplied by the Ministry of Health and Population to government hospitals on regular basis.  Tissue-culture dog rabies vaccine has been produced since 2005 and dog rabies vaccine is also imported by private sector. rabies control program 2/17/2013
  25. 25. 25  There is an ongoing study on possibility of local production of human rabies vaccine based on experience of animal tissue-culture rabies vaccine by Rabies vaccine Production Unit under Directorate of Animal Health. rabies control program 2/17/2013
  26. 26. 26  Dog rabies vaccination is not mandatory and pet dogs are vaccinated against rabies in urban areas. About 55 000 dogs are immunized against rabies. Dog vaccination campaigns are organized as a part of the World Rabies Day events by the government as well as non-governmental organizations. rabies control program 2/17/2013
  27. 27. 27 Many NGOs have been involved in animal birth control and dog rabies vaccination activities in major cities of Nepal in the last 10 years.  In 2007 a workshop on "Consensus Building among National Alliance Partners to Eliminate Canine Rabies in Nepal and Development of Strategic Plan" was organized and supported by the World Health Organization (WHO). The Alliance Group for Rabies Control in Nepal has been formed, comprising the Department of Livestock Services, the Veterinary rabies control program 2/17/2013
  28. 28. 28  Public Health Division, Kathmandu Metropolitan City (KMC), Department of Public Health and Social Welfare, Kathmandu Animal Treatment (KAT) Centre and National Zoonoses and Food Hygiene Research Centre (NZFHRC).  A National Workshop was organized in December 2010 to formulate a Rabies Control Strategy, which was attended by all partners involved in rabies control in Nepal.  The Rabies Control Strategy will serve as a roadmap for control and subsequent elimination of human rabies. rabies control program 2/17/2013
  29. 29. conclusion29  In Nepal Rabies elimination programme focused mainly on mass vaccination of dogs are largely justified by the future savings of human rabies prevention programme.  A concerted effort between the human and animal health sectors [jointed effort] for rabies elimination was established. WHO also provide technical inputs and support such effort contineously. rabies control program 2/17/2013
  30. 30. 30  Ministry of Health and Population provideTissue culture vaccine for human use to government hospitals on regular basis.  WHO recommendition of five major activities are applied. rabies control program 2/17/2013
  31. 31. Recommendation:31 The following all the actions that are needed: 1) Establish national rabies control programmes, including appointment of National Programme Officers, and develop five-year strategic plans of action. 2) Improve rabies surveillance and data collection. 3) Initiate measures to phase out nerve tissue vaccines and replace them with modern tissue culture vaccines. rabies control program 2/17/2013
  32. 32. 32 4) 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. 5) 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. rabies control program 2/17/2013
  33. 33. 33 6) Develop appropriate measures to regulate movement of dogs from one place to another (rural to urban or island to island). 7) Community participation rabies control program 2/17/2013
  34. 34. 34  www.searo.who.int  Rabies Country Profile: Nepal  www.nep.searo.who.int  k park. rabies control program 2/17/2013
  35. 35. 35 rabies control program 2/17/2013
  36. 36. 36 rabies control program 2/17/2013
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