Presented by Marta Martínez Avilés at the PENAPH First Technical Workshop, Chiangmai, Thailand, 11 – 13 December 2012.

1. Chiang Mai,
11-13 December
2012
ONE HEALTH APPROACHES
FOR RABIES CONTROL
Dr Marta Martínez Avilés
Veterinary epidemiologist
OIE Scientific and Technical Department
m.martinez@oie.int
First Technical Conference of the Participatory
Epidemiology Network for Animal and Public Health

2. All mammals are susceptible (at least 130 species
documented, 110 of them wild animals)
Stray dog control medics or vets’ problem??
Different administrative levels involved
Different expertise required: diagnostics, epidemiology,
ecology, sociology
THE IDEAL CANDIDATE FOR ONE HEALTH

3. Rabies is a notifiable disease and one of the
oldest known zoonoses
Highly fatal and no treatment, yet 100%
preventable
Transmitted by the saliva of rabid dogs
Apart of the dog, the virus cycles in bats and in
some wild carnivore populations (i.e. red fox in
Europe)
INTRODUCTION

4. Rabies cases (domestic animals)
never occurred or reported
clinical disease/infection
no information
date last case unknown
last case reported 1 25 years ago
last case reported 25 years ago
RABIES CASES IN DOMESTIC ANIMALS
(OIE, 2005-2011)
14 000
14 000
14 000
14 000
Human deaths due to rabies
(PRP/GARC new estimate)
2
2
2
2
50
50
50
50
150
150
150
150
30 000
30 000
30 000
30 000
and
and
and
and risk
risk
risk
risk to
to
to
to humans
humans
humans
humans

5. 95% of human deaths caused by
rabies (mostly children) have a
canine origin.
Dogs are the major transmitters of
rabies in developing countries
70% of vaccination coverage in a
population of dogs sufficient to
control canine and human rabies
CONTROL IN DOGS

6. CONTROL TOOLS AND STRATEGIES ARE
WELL KNOWN
Pasteur and rabies vaccines, 1880-1885
BIOLOGICALS
BIOLOGICALS
BIOLOGICALS
BIOLOGICALS
http://www.historyofvaccines.org/content/timelines/pasteur
CONTROL STRATEGY
CONTROL STRATEGY
CONTROL STRATEGY
CONTROL STRATEGY
COMMUNICATION
COMMUNICATION
COMMUNICATION
COMMUNICATION
AWARENESS
AWARENESS
AWARENESS
AWARENESS
comprehensive online
compilation of tools
available for rabies
control and prevention

7. vaccination
of dogs
STRATEGY
efficient
vaccines
available
SCIENCE
10%
cost
PRICE
95% of
human
cases
IMPACT

8. RABIES IS A NEGLECTED DISEASE
We have no
budget to
vaccinate dogs
Our stray dog
population is
too large
Wildlife is
responsible!
The Ministry of Agriculture
thinks the Veterinary
Services should not
care about dogs
Dog owners do not
participate in
vaccination
campaigns
It’s the task of the
ministry of public
health, not ours

9. WHO TAKES CARE OF THE DOGS?
Rabies predominantly affects the poorest segments
of the population, living in remote, rural areas
Rural
80%
Urban%

10. DIFFERENT FACTORS
Competition
Coordination
Movements
Global collaboration
Inter-sectoral collaboration

11. Infected
dog
Action
Long
incubation
period
Diagnosis
Infectious dog:
clinical signs
Human
exposure
Human clinical
signs

12. OIE 5TH STRATEGIC PLAN 2011-2015
NEW ACTIONS
The One Health Concept
A worldwide strategy for managing risks at the
animal-human interface ecosystems
OIE, FAO and WHO renewed their commitment
with the Tripartite Concept Note created in 2010
Rabies control is a priority model to apply the
‘One Health’ concept by countries and
intergovernmental organisations as seen at the
OIE Global Conference on Rabies Control in
September 2011 (Republic of Korea)
Rabies control as a model for intersectoral
control approaches (Mexico, HLTM, 2011)
Resolution 27/2012 (80 GS)

13. Coordinated
planning
Standards,
Legislation
Political
will
Trust
Common
objectives
Shared
benefit
Implementation
Cross-sectoral
coordination
Routine
communication
Joint simulation
exercises
Data sharing
Joint risk
assessment
Active cooperation
KEY
KEY
KEY
KEY SUPPORTING
SUPPORTING
SUPPORTING
SUPPORTING AND
AND
AND
AND
OPERATIONAL
OPERATIONAL
OPERATIONAL
OPERATIONAL ELEMENTS FOR
ELEMENTS FOR
ELEMENTS FOR
ELEMENTS FOR
CROSS
CROSS
CROSS
CROSS-
-
-
-SECTORAL
SECTORAL
SECTORAL
SECTORAL
COLLABORATION
COLLABORATION
COLLABORATION
COLLABORATION

14. POLITICAL WILL, TRUST, COMMON
OBJECTIVES AND SHARED BENEFITS
Governments must recognise rabies as a major problem
and as a public good. Notifiability
Keep motivating national governments to invest in rabies
control at the source of infection
WHAT IS THE SITUATION OF RABIES IN THE COUNTRY? = SURVEILLANCE
LEARN LESSONS.Achieved rabies free areas can transfer its skills to
neighbouring region, consolidated elimination and prevention of
reintroduction
INNOVATE. Establish sustainable ways of working and reaching consensus
RABIES CONTROL STRATEGY APPROVED

15. RABIES PRESENT BUT
RABIES PRESENT BUT
RABIES PRESENT BUT
RABIES PRESENT BUT
LACK OF DATA
LACK OF DATA
LACK OF DATA
LACK OF DATA
PROPOSED
PROGRESSIVE CONTROL PATHWAY
TOWARDS RABIES ELIMINATION
FURTHER RABIES
FURTHER RABIES
FURTHER RABIES
FURTHER RABIES
RISK REDUCTION
RISK REDUCTION
RISK REDUCTION
RISK REDUCTION
MAINTAIN RABIES
MAINTAIN RABIES
MAINTAIN RABIES
MAINTAIN RABIES
ELIMINATION IN HUMANS
ELIMINATION IN HUMANS
ELIMINATION IN HUMANS
ELIMINATION IN HUMANS
AND ANIMALS
AND ANIMALS
AND ANIMALS
AND ANIMALS
STAGE
STAGE
STAGE
E
NO MORE DOG
NO MORE DOG
NO MORE DOG
NO MORE DOG
RABIES CASES
RABIES CASES
RABIES CASES
RABIES CASES
NO MORE HUMAN
NO MORE HUMAN
NO MORE HUMAN
NO MORE HUMAN
RABIES CASES
RABIES CASES
RABIES CASES
RABIES CASES
GAIN UNDERSTANDING ON
GAIN UNDERSTANDING ON
GAIN UNDERSTANDING ON
GAIN UNDERSTANDING ON
THE EPIDEMIOLOGY OF
THE EPIDEMIOLOGY OF
THE EPIDEMIOLOGY OF
THE EPIDEMIOLOGY OF
RABIES AND ASSESS
RABIES AND ASSESS
RABIES AND ASSESS
RABIES AND ASSESS
RABIES RISKS
RABIES RISKS
RABIES RISKS
RABIES RISKS
IMPLEMENTATION OF A
IMPLEMENTATION OF A
IMPLEMENTATION OF A
IMPLEMENTATION OF A
RABIES CONTROL STRATEGY
RABIES CONTROL STRATEGY
RABIES CONTROL STRATEGY
RABIES CONTROL STRATEGY
STAGE
STAGE
REPORTING OF THE OCCURENCE OF RABIES
TO INTERNATIONAL ORGANIZATIONS
4
4
4
4
NATIONAL RABIES PREVENTION AND
CONTROL STRATEGY FINALIZED AND
FINANCED
DEVELOPMENT OF A
DEVELOPMENT OF A
DEVELOPMENT OF A
DEVELOPMENT OF A
RABIES
RABIES
RABIES
RABIES
CONTROL STRATEGY
CONTROL STRATEGY
CONTROL STRATEGY
CONTROL STRATEGY
STAGE
RABIES RISKS ASSESSED AND CONTROL
PLAN DRAFTED
5
5
5
5

16. Activities at the national level, including enacting
legislation to facilitate cross-sectoral collaboration,
should be based on the governance and standards issued
from the international organizations
STRONG GOVERNANCE, LEGAL SUPPORT
AND RECOGNITION OF INTERNATIONAL STANDARDS
Cross-sectorial legislative framework
Sustainable funds
Technical capacities

17. Chapter 8.10.
Chapter 8.10.
Chapter 8.10.
Chapter 8.10.
on
on
on
on rabies
rabies
rabies
rabies
Chapter 5.11.
Model veterinary certificate for
importation from rabies infected
countries
Chapter 1.4.
Animal health surveillance
Chapter 3.1
Veterinary
Veterinary
Veterinary
Veterinary
Services
Services
Services
Services
Chapter 1.1
Notification
Notification
Notification
Notification of diseases and
epidemiological information
Chapter 7.7. Stray
dog population
control
OIE TERRESTRIAL CODE STANDARDS
RELATED TO RABIES
Guidelines
for disease
control
(web: « our
scientific
expertise »)

18. The updated chapter (diagnostic methods)
updated chapter (diagnostic methods)
updated chapter (diagnostic methods)
updated chapter (diagnostic methods) on
rabies from the Terrestrial Manual was
adopted in May 2011
On the working programme of the Biological
Standards Commission: ad hoc Group on
Rabies Vaccine Quality
Rabies Vaccine Quality
Rabies Vaccine Quality
Rabies Vaccine Quality
Standardisation programmes for reagents
reagents
reagents
reagents
(harmonisation of diagnostic testing)
Work on scientifically acceptable criteria for
validation of diagnostic tests in wild animal
diagnostic tests in wild animal
diagnostic tests in wild animal
diagnostic tests in wild animal
species
species
species
species (on-going)
OIE STANDARDS ON DIAGNOSTIC TESTS
AND VACCINES

19. STRONG HEALTH SYSTEMS
Strengthening Good Governance of Veterinary Services:
PVS Pathway
Regular training of OIE Delegates
Establishment and repeated training of topic-specific
national Focal Points in each OIE Member Country

20. SUPPORT TO OIE MEMBER COUNTRIES
Network of OIE Reference Laboratories and
Collaborating Centres 9 OIE RL for rabies, 5 or
which are also WHO CC
Laboratory twinning initiative = enhance technical
capacity in the regions affected
Turkey- UK
China- UK
Nigeria- South Africa

21. OIE manages a vaccine bank in Asia with the financial
support of the European Union and under the
framework of the regional cooperation programme on
Highly Pathogenic and Emerging and Re-emerging
Diseases in Asia (HPED)
It operates at the request of countries
RABIES REGIONAL VACCINE BANK

22. Vaccination costs ≠ cost of the vaccine only Logistics costs
to administer the vaccine to every possible dog in the villages;
costs of coordinated regional programmes; costs of planning
programme
Sampling and testing costs: can samples be correctly taken,
dispatched, transported, tested and results communicated
without delay
Communication and participation of the community are key
Is PEP indicated, available and within reach?
THE EXPENSES OF RABIES CONTROL

23. Without a target that is sustained over time, as soon as
disease frequency is reduced, the vaccination is stopped.
Patchy and irregular vaccination along a number of
years results in loss of commitment and interest AND
increase of risk of canine rabies as a consequence of
herd immunity decrease
MASS VACCINATIONS OF DOGS IN ENDEMIC
COUNTRIES

24. IMPROVE DOG VACCINATION COVERAGE
Understand the ecological parameters of dog population
Strategies must be adapted to the epidemiological
situation and the resources available
Lack of resources + knowledge + fear of rabies have led some communities to try to
control dog populations through poisoning, electrocution or drowning
- High cost to capture and sterilise
- Complicated logistics involved in wild dog packs
vaccination
- Oral vaccination not always straightforward:
dominating male could be the only one accessing
the bait; live vaccine: children at risk
- Location of dogs: Rural/urban
- Religious reasons

25. Understanding dog ecology:
Identification of dogs and potential rabid cases
New introductions
Vaccination registries/identification
Immediate action on human and animal cases
Rabies Action Group; Mr and Mrs Rabies initiative
Communication channels between administrative
levels
ROLE OF THE COMMUNITY, IN COLLABORATION
WITH NGOS AND LOCAL AUTHORITIES

26. THANK YOU!
12 rue de Prony, 75017 Paris, France - www.oie.int – oie@oie.int
Organisation
mondiale
de la santé animale
World Organisation
for Animal Health
Organización
Mundial
de Sanidad Animal