Rabies control: the benefits of a one health approach

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GRF One Health Summit 2012, Davos: Presentation by Esmee RUSSELL, World Society for the Protection of Animals, London, United Kingdom

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  • I work for the World Society for the Protection of Animals, the world’s largest animal welfare organization. On World Rabies Day, 28 September, WSPA launched a programme of work with two big objectives.
  • 1) To convince all governments that the best way to eliminate canine rabies is the mass vaccination of dogs. And 2) That no healthy dog needs to be killed in the fight against rabies We are doing this because there are millions of stray dogs suffering on our streets and the humane management of these animals presents one of the world’s greatest animal welfare challenges. And because many of these dogs are suffering as a result of our fear of rabies.
  • Rabies is a fatal zoonotic disease that kills more than 55 000 people every year, maybe more (underreporting). When compared to to high profile emerging zoonoses, such as SARS or Influenza H5N1 these diseases pale into insignificance. For example, H5N1 deaths in total number less than 200. Rabies also has the highest case-fatality ration of infectious diseases. Over 99% of these deaths occur in Africa and Asia, where rabies is endemic in domestic dog populations. Although rabies can infect and be maintained in several different host species, domestic dogs are by far the most important source of infection to humans, with more than 95% of human cases caused by bites from rabid dogs. The burden of disease is not distributed evenly across age groups, with children being the major victims of rabies, as they are more often bitten than adults and when bitten, are more often bitten on the head and neck, which carries a much greater risk than other parts of the body. DALYs (Disability-ajusted life years) are a standardised measure often used to assess the global/national burden of the disease. Here again, rabies high among the neglected tropical diseases. Other important and often under-appreciated impacts include the actual morbidity from bite injuries, which occur at surprisingly high incidences (up to 300/100,000 people per year) and can be horrific. When rabid animals bite, they often grip and tear, causing terrible injuries. Human cases result in considerable trauma for families, communities, as well as health care workers and there is great fear, anxiety and uncertainty following rabid dog-bite injuries.
  • Stray dogs exist. There are millions of them. In the fight against rabies we can either kill them, impound them or vaccinate them. Many Governments choose to kill them but this is counter productive as Killing or impounding dogs – removing them from our communities – can actually impede vaccination coverage and increase the risk of rabies spreading. A sudden reduction in the number of dogs leaves greater resources for surviving dogs leading to increased reproduction and survival rates and therefore a rapid rebuilding of the population. And as the root cause of the roaming dogs is not being addressed, it will need to be repeated indefinitely. A stable and safe – ie vaccinated – dog population is THE best defence against rabies.
  • The tragedy of rabies is that each human death is entirely preventable, and the economic and psychological burden of canine rabies easily reduced. In 1885, Pasteur held the view that solving the problem of rabies would be a blessing for humanity (Debre, 1994). It was Pasteur who first developed rabies vaccines, using suspensions of dried rabies virus infected spinal cords to immunise dogs in the early experiments, followed, in 1885, by the first post exposure administration in humans. In the intervening 120 years, improvements in vaccine immunogenicity, cell culture and inactivation techniques have led to the development of safe and highly efficacious vaccines for both humans and animals. We know that by vaccinating 70% of the dogs, we can prevent 99% of the human cases. We now have all the tools that are needed to eliminate human rabies, using mass dog vaccination to prevent disease in the major reservoir and vector (domestic dogs), and appropriate human post-exposure prophylaxis, including immunoglobulin and vaccines, to prevent the development of clinical disease in exposed people.
  • But don’t just take my word for it. As the WHO and others have stated repeatedly, the mass vaccination of dogs is the most effective way to control rabies.
  • WSPA has supported many dog rabies control projects with partner organisations around the world We’ve heard about several of these already in the conference but I think it’s worth highlighting one of them again to support my argument that inhumane culling does not work, mass vaccination of dogs does
  • When rabies reached Bali in 2008, the immediate response was to cull dogs in an attempt to control the outbreak. Over 130,000 dogs were killed using strychnine poisoning - But it didn’t work – the number of humans deaths rose with 60 confirmed cases by March 2011 What did work was stopping the culling and starting a mass vaccination programme: w ithin six months 210,000 dogs were vaccinate and the number of rabies cases in humans and dogs greatly decreased. But, we know that one vaccination programme is not enough to eliminate this disease, so the Balinese Government delivered a second phase of vaccination and is about to start on a third round will start next month
  • 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
  • This slide provides an excellent demonstration of the fact that mass dog vaccination can have dramatic impacts on both dog rabies cases (blue line) and human rabies deaths (orange line). It also demonstrates the recent successes in dog rabies control throughout central and southern America. So it is now clear that large-scale control of canine rabies is feasible.
  • In the fight against rabies, the priority is to safeguard human welfare but not at the unnecessary expense of dogs, but far too often this comes down to a matter of available resources: “How can we care about animal welfare when human welfare is so low?”. Animal welfare is often seen as an added cost, a burden. WSPA believes that the adoption of good animal welfare can directly benefit human health and can actually be central to the success of our attempts to halt the spread of rabies. To ensure sustainability, coordinated dog vaccination programmes will be needed that have political support and that integrate public health, veterinary and livestock and animal welfare agencies. The implementation of an integrated “One health” approach appears as the key to a successful and sustainable rabies control programme.
  • The idea of this slide came from our discussion… I am not sure where it fits best yet. But I thought it would be good for you to have it anyway, if you want to play around with the presentation 
  • 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
  • Rabies control: the benefits of a one health approach

    1. 1. Rabies Control: the benefits of a one health approach C. Sankey, E. Russell, R. Mitchell World Society for the Protection of Animals 5 th floor, 222 Grays Inn Rd, London WC1X 8HB, UK
    2. 2. No healthy dog needs to be killed in the fight against rabies The best way to eliminate canine rabies is the mass vaccination of dogs
    3. 3. The Global Burden of Rabies <ul><li>Rabies kills 55 000 people every year </li></ul><ul><li>(Coleman et al. 2004, Knobel et al. 2005) </li></ul><ul><li>Many victims are children – age <16 </li></ul><ul><li>(Pancharoen et al. 2001, Cleaveland et al. 2002, Knobel et al. 2005, Fevre et al. 2005) </li></ul><ul><li>99% of deaths in Africa & Asia, where rabies is endemic in dog population </li></ul><ul><li>(WHO 1999) </li></ul><ul><li>Disability-adjusted life years (DALYS), a standardised measure for assessing global/national disease burden </li></ul><ul><li>(Murray 1994, Knobel et al. 2005 WHO Bull) </li></ul>
    4. 4. <ul><li>Stray and roaming dogs exist and are the reservoir for rabies. > 95% of human cases caused by bites from rabid dogs </li></ul><ul><li>(WHO 1999) </li></ul><ul><li>The choices we have are to kill them, impound them, or vaccinate them. </li></ul><ul><li>We know that the mass removal of dogs can impede vaccination coverage and increase disease risk. </li></ul><ul><li>A stable, safe (i.e. vaccinated) dog population is the best defense against rabies. </li></ul>Dog population and rabies control
    5. 5. What’s the solution? <ul><li>Rabies is 100% preventable In 1885, Dr Pasteur and Dr Roux developed a rabies vaccine for humans and one for canines. </li></ul><ul><li>Rabies control and prevention is achievable </li></ul><ul><li>Vaccinating 70% of dog population  Prevents 99% of human cases </li></ul><ul><li>(Coleman and Dye, 1996) </li></ul>
    6. 6. “ 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) 2012
    7. 7. WSPA supported dog rabies control projects around the world
    8. 8. <ul><li>Island wide mass vaccination programme </li></ul><ul><li>commences. </li></ul><ul><li>March 2011 - first phase of mass vaccination programme completed. </li></ul><ul><li>210,000 dogs (70% of dog population) vaccinated </li></ul><ul><li>Comparative data of 6 month periods - </li></ul><ul><li>Before (Apr.-Sep. 2010)/During (Oct. 2010-Mar. 2011): </li></ul><ul><li>35% decrease in human rabies deaths (46  30) </li></ul><ul><li>76% decrease in dog rabies cases (267  63) </li></ul>The Bali Case Study
    9. 9. 133 169 doses STOP Dog Culling START of 1 st mass dog vaccination The vaccination of dogs Human and Dog Rabies Cases, Bali (Oct 2009 – March 2011) Human deaths Dog cases Humans Dogs 115 326 doses 213 176 doses (70% dog pop) Months
    10. 10. The vaccination of dogs: a sustainable approach Human and Dog Rabies Cases, Mexico 1990-2006
    11. 11. The need for a one-health approach Need for a global, ONE HEALTH APPROACH <ul><li>In the fight against rabies, the priority is to safeguard human welfare but it should not be at the unnecessary expense of dogs </li></ul><ul><li>WSPA is calling for one health approach – by adopting good animal welfare, direct benefit to human health can be gained </li></ul><ul><li>To ensure sustainability, dog vaccination programmes will need political support and will need to integrate public health, veterinary, livestock and animal welfare agencies </li></ul>
    12. 12. The need for a one-health approach Public health services Livestock dept Implementation of a mass dog vaccination programme Saving on human health costs (PEP, treatment of dog-bite injuries…) Responsible for mass vaccination of dogs… Need for a global, ONE HEALTH APPROACH
    13. 13. A one health example - Metro Manila <ul><li>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 </li></ul><ul><li>Objective is to eliminate canine and human rabies in 3 years </li></ul><ul><li>Department of Agriculture and the Department of Health are supportive and local veterinary and animal welfare agencies will be brought on board </li></ul>
    14. 14. Thank you for your time and attention

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