The document summarizes the evolution and results of Tunisia's National Program for Rabies Control. It finds that: 1) Rabies is endemic in Tunisia, primarily spread by dogs. A national program was established in 1983 to control rabies through dog vaccination campaigns, human post-exposure prophylaxis, and rabies surveillance. 2) The program successfully reduced rabies incidence between 1983-1988 and 1993-2010. However, cases have increased again from 2012-2015, calling for improvements to the program, including increasing dog vaccination coverage and public education. 3) The Pasteur Institute Rabies Laboratory plays a key role in epidemiological surveillance and evaluation of control efforts in Tunisia. It

1. RABIES IN TUNISIARABIES IN TUNISIA
Evolution and result ofEvolution and result of
« National Program of Rabies Control »« National Program of Rabies Control »
Kharmachi H.,
“National Reference Rabies Laboratory”, Institut Pasteur de Tunis – Tunisia”
With collaboration of the team of « National Commission of Rabies Control »:
Zaouia I., Khoufi S., Hrabech K., Mejri M., Turki I., Oukaïli K., Kortas J.
and the team of “National Reference Rabies Laboratory”:
Ben Maïz S., Bouslama Z., Ben Salem J., Basdouri N. and Handous M.

2. ContentsContents
 Epidemiology of Rabies in Tunisia
Animal Rabies
Human Rabies
 National Program of Rabies Control
 Role of I.P.T. in the epidemiological surveillance
 Impact of Control measures on the evolution
of rabies
 Conclusion
2

3. Epidemiology of RabiesEpidemiology of Rabies
in Tunisiain Tunisia
3

4. Epidemiology of Rabies in TunisiaEpidemiology of Rabies in Tunisia
 Rabies is Enzootic and Endemic
 Dog = « Reservoir and Vector » of Rabies
 Other Domestic Animals = Victims
 Wild Animals : Rares cases
 Human = MAIN VICTIM of the disease

5. Animal RabiesAnimal Rabies
5

6. 6
Dog
62,2%Cat
5,4%
Bovin
19,5%
Equin
6,2%
Sheep
5,2%
Goat
1,0%
Rodent
0,2%
Jackal
0,2%
Animal Rabies:
Species affected (2015)

7. Kair09N
Kef06N
Mon08N
Sil04N
kef08N
1Kef08N
Zag07N
sous05N
Kef09N
Bej04N
Zag09N
Med08N
Jend07N
1Jend06N
1Jend05N
Bej00N
Jend05N
Jend06N
1Sil06N
Sil05N
PV
Mokola
Ref: Amouri IK, Kharmachi H, Djebbi A, Saadi M, Hogga N, Zakour LB, Ghram A.
Molecular characterization of rabies virus isolated from dogs in Tunisia: evidence of two phylogenetic variants.
Virus Res. (2011 Jun); 158(1-2):246-50.
Cluster 1: N.O
Mokola
0.05
Cluster 2: N.C.S
Animal Rabies:
Genotype1: Canine rabies strain = Two Phylogenic variants:

8. Ref: Amouri IK, Kharmachi H, Djebbi A, Saadi M, Hogga N, Zakour LB, Ghram A.
Molecular characterization of rabies virus isolated from dogs in Tunisia: evidence of two phylogenetic variants.
Virus Res. (2011 Jun); 158(1-2):246-50.
Mokola
0.05
Animal Rabies:
Genotype1: Canine rabies strain = Two Phylogenic variants:

9. 9
Animal Rabies:Animal Rabies:
Evolution of Rabies IncidenceEvolution of Rabies Incidence
(2000(2000 –– 2015)2015)
0
50
100
150
200
250
300
350
400
450
500
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
ANIMALS
DOGS

10. Animal Rabies:
Geographical Distribution:Geographical Distribution:
20132013 20142014 20152015

11. 11
Human RabiesHuman Rabies

12.  Rabies is Notifiable Disease:
Since 1969 (law 69/53 of 29/7/1969)
 All cases are confirmed by Laboratory:
 Rabies laboratory of IPT
 Since 1961
 Human (and Animal) rabies diagnosis
 Only One laboratory for diagnostic in the country :
Methods used: FAT + RTCITFAT + RTCIT
12
Human RabiesHuman Rabies

13. Annual Incidence ofAnnual Incidence of
Human Rabies: 2000Human Rabies: 2000 -- 20152015
2
0
2 2
3 3
1
2
4
0
2
1
3
6
3
6
0
1
2
3
4
5
6
NumberLaboratoryconfirmedofCases
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Years
13

14. National Program ofNational Program of
Rabies ControlRabies Control

15. National Program of RabiesNational Program of Rabies
Control (NPRC)Control (NPRC)
 Strategy:
◦ Mass vaccination of dogs: Ministry of Agriculture
◦ Prevention of Human Rabies: Ministry of Health
◦ Control of dog population : Ministry of Interior
 Management: by National Multidisciplinary
Commission of Rabies Control
15

16. Mass Vaccination Campain:Mass Vaccination Campain: every yearevery year
+ Public education & public awareness+ Public education & public awareness
Rabies is FatalVaccinate me you protect meVaccinate me you protect me
& you will be protected& you will be protected

17. PostPost--exposure Prophylaxyexposure Prophylaxy
 Structures
◦ Number of centers: 206206 specific centres
(+emergency hospital services) = 310310 (total PEP c.)
◦ Localisation : All regions of country
◦ Management : Ministry of health (free of charge)
17

18. Role of Pasteur InstituteRole of Pasteur Institute
Rabies LaboratoryRabies Laboratory
18

19. 19
National Ref.National Ref.
LABORATORYLABORATORY
I.P.T.I.P.T.
VETS
(CRDA)
Prime Health
Centers
Public Collectivities
(Control of Dog Population )
Specimen
Collect Information
Epidemiological surveillance of Animal RabiesEpidemiological surveillance of Animal Rabies

20. 20
Epidemiological surveillance of Animal Rabies:Epidemiological surveillance of Animal Rabies:
458
415 423
282
627
952
1148
1055
0
200
400
600
800
1000
1200
1995-
2008
2009
2010
2011
2012
2013
2014
2015
Years
Evolution of number of samples tested
_
m:

21. Impact ofImpact of
Control Measures in theControl Measures in the
Evolution of RabiesEvolution of Rabies
21

22. Impact of actions of N.P.R.C. on the evolution of
Humaine Rabies incidence
16/an
5 5
0
8
1
0
3
5
11
25
6
4
5
7
3
1 1
2
0
2 2
3 3
1
2
4 (+2c)*
0
2
1
3
6 (+1c)*
3
6
0
5
10
15
20
25
NombredecasconfirmésauLaboratoire
1960-1982
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
2012
2013
2014
2015
Années
Start of
NPRC
Stop of
Mass Vaccination
Campaigns for Dogs
Re-start of
Mass Vaccinations
Camoaigns for Dogs

23. 16/an
5 5
0
8
1
0
3
5
11
25
6
4
5
7
3
1 1
2
0
2 2
3 3
1
2
4 (+2c)*
0
2
1
3
0
5
10
15
20
25
NombredecasconfirmésauLaboratoire
1960-1982
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
2012
Années

24. 16/an
5 5
0
8
1
0
3
5
11
25
6
4
5
7
3
1 1
2
0
2 2
3 3
1
2
4 (+2c)*
0
2
1
3
0
5
10
15
20
25
NombredecasconfirmésauLaboratoire
1960-1982
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
2012
Années
N=N=66;;
S=S=1919
M=M=33,,22
N=4; S=44;
M=M=1111,,00
N=N=2020;;
S=S=5454
M=M=22,,77

25. ProgramProgram AchievementsAchievements.
= Saved lives
16/an
5 5
0
8
1
0
3
5
11
25
6
4
5
7
3
1 1
2
0
2 2
3 3
1
2
4 (+2c)*
0
2
1
3
0
5
10
15
20
25
NombredecasconfirmésauLaboratoire
1960-1982
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
2012
Années
N=6;N=6;
S=19S=19
M=3,2M=3,2
N=4;
S=44;
M=11,0M=11,0
N=20;N=20;
S=54S=54
M=2,7M=2,7
6x16=966x16=96
9696--1919==77
2020xx1616==320320
320320--5454==266266

26. ConclusionConclusion
 Rabies is endemic and enzootic in Tunisia
 National Rabies Control Program reduces rabies incidence
during many years (1983 to 1988 and 1993 to 2010)
 Actually: Increase in the incidence (2012 to 2015)
 NRCP need improvements:
 Improvement of vaccination coverage of dogs:
- Actually 50%-60%;
- Objective: to reach75% of canine population
 Better management of dog’s polpulation
 Improvement public education and awerness about rabies
 Rigourous application for recommendations of PEP protocols
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27. ConclusionConclusion
 Pasteur Institute Rabies Laboratory (National Reference
Laboratory of Rabies) plays a leading role in
epidemiological surveillance of rabies in Tunisia
 NRLR contributes in the national commission to evaluate
the actions of rabies control.
 NRLR conducts applied research program to propose
solutions to improve control of rabies
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28. THANKS FOR YOURTHANKS FOR YOUR
ATTENTIONATTENTION
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