Presentation by Dr Gyanendra Gongal in National Dog Welfare Conference, Chennai India 27th and 28th February 2013.

1. Prospects of elimination of
human rabies transmitted by
dogs in South Asia
Gyanendra Gongal
Scientist
WHO Regional Office for South–East Asia
New Delhi, India

2. Outlines of presentation
• Introduction
• Situation analysis
• Key issues and challenges
• Scope of elimination of human rabies
• Strategic approaches
• Conclusion

3. Introduction
• All SAARC countries except Maldives are
rabies endemic and magnitude of rabies
problem differs from country to country
• Canine rabies is the major epidemiological
pattern and dog is primary source of rabies
• Economic impact of rabies in livestock
production is considered high but
surveillance data are missing
• There has not been any substantial
decrease in the rabies incidence in Asia
except few island countries

4. Situation analysis
• Each country is trying to execute rabies control
activities in isolation and dog rabies control is
problematic
• There is no comprehensive rabies control
programme in most countries
• Intersectoral cooperation for rabies control is weak
or non-existent
• Motivation for animal rabies control is lacking
• More NGOs and INGOs are involved but confined
to limited areas

5. Human Rabies in SAARC Region
Countries Estimated Human cases % of dog bite in
human per 100,000 total animal bite
cases population cases
Afghanistan 2000-3000 5.7 N/A
Bangladesh 1500-2000 1.5 95%
Bhutan <10 0.28 99%
India 18000-20000 3 >95%
Nepal 100-150 0.21 98.5%
Pakistan 2000-5000 1.3 >90%
Sri Lanka <50 0.26 95%

6. Rabies: Cross-border issue!
Rabies risk mapping, Nepal
Rabies risk mapping, Bhutan

7. Animal rabies: Economically important!
Reported Animal rabies,
2006-2010, Nepal
(N=430)
Source: Veterinary Epidemiology Center, Kathmandu, Nepal
others
6%
dogs cattle
39%
55%
Tenzin et al., (2011) Surveillance of animal rabies in Bhutan, 1996–2009

8. Key issues
• Not a priority disease Public health issue!
• Inadequate data and information Lack of
political support
• Dog rabies – Ownership is an issue!
• Intersectoral coordination
• Management structure
• Public cooperation – Socio-cultural dimension of
rabies

9. Epidemiological Trends and Current Situation
12
Bolivia
Control of Absence of
Dog Rabies
10
Human
Cases Salvador
El
8
Bolivia and
El Salvador were
Tightening 6 examples of a Relaxation
controls recurrent loop (past of controls
situation)
4
2
Human Dog
0
Rabies 1996 1998 2000
Rabies
2002 2004 2006 2008
9

10. Challenges ahead….!
• How to reach and maintain 70% dog
vaccination coverage to minimize human
rabies incidence?
• How long dog vaccination programme will be
carried out?
• How to deal with cross-border movement of
dogs?
• How to make accessible modern tissue-
culture rabies vaccine to general public?

11. Technological advancement (R&D)
• Chemical and immuno-contraception
• New vaccination schedule to improve
compliance
• New user-friendly diagnostic tools
• Improvement of vaccine delivery system
• Human rabies case management
11

12. Why elimination of human rabies?
• Rabies is 100% fatal but preventable disease
• The South Asia contribute 45% of global burden
of human rabies
• More than 1.5 billion people are at potential risk
of rabies infection
• Each year, an estimated 4 million people receive
anti-rabies vaccination
• Rabies elimination is an ideal mission to move
forward ‘One Health’ concept

13. Impact of Rabies Elimination Campaign in PAHO Region
360 25000
340
320 22500
300
20000
280
260
17500
240
220 15000
Casos de rabia en humanos
Casos de rabia en caninos
200
180 12500
160
140 10000
120
7500
100
80
5000
60
40 2500
20
0 0
1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 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
Años
Casos Humanos transmitidos por canes Casos Humanos transmitidos por Murciélagos Casos de Rabia en Perros
Source: SIRVERA, PAHO

14. Projected costs of rabies control
6,000,000 "Rabies day" dog vaccination+ PEP
Intersectoral: the most effective strategy!
PEP alone without dog vaccination
• Control5,000,000 dogs
in domestic
Current expenditure on PEP
Annual cost (dollars)
• Improved rabies surveillance for targeted
4,000,000
control
3,000,000
•Improved access to effective post-exposure
prophylaxis
2,000,000
• Awareness and education about rabies
1,000,000
transmission and prevention
0
0 2 4 6 8 10 12
Year after start of campaign

15. Strategic Approaches
– Prevention: Introduce cost-effective public health
intervention techniques to improve accessibility,
affordability and availability of post-exposure
prophylaxis and control at source, i.e. dog rabies
– Promotion: Improve understanding of rabies
through advocacy, awareness, education and
operational research
– Partnership: Provide coordinated support for
anti-rabies drive with the involvement of
community, civil society, government and non-
government sectors and international partners

16. Pre-requisites for Elimination of
Human Rabies
• Political commitment
• Ownership and partnership
• Surveillance
• Community based actions
• Operational research
• Cross-border collaboration
• Resource mobilization – Internal & external

17. SAARC Initiatives for Rabies Control
• The Government of Sri Lanka hosted a SAARC level
workshop on rabies control in 2003 in Colombo which
recommended formulation of regionally coordinated rabies
control activities under the auspices of SAARC Secretariat
• Rabies in Asia Foundation in collaboration with WHO and
SAARC Secretariat hosted SAARC Rabies Meeting in
February 2011 in Mysore and third RIACON in November
2011 in Colombo
• Technical workshop on Highly Pathogenic Emerging
Diseases (HPED) recommended regionally coordinated
rabies elimination activities through SAARC mechanism and
resources
• Elimination of human rabies as a public health problem by
2020!

18. Goal
• To eliminate human rabies in endemic
countries
• To verify and maintain freedom in rabies
free areas

19. Objectives
• To establish a SAARC Rabies Center to guide
rabies elimination programme
• To strengthen local, national and regional
capabilities for rabies elimination
• To provide early and appropriate post-exposure
rabies prophylaxis to human
• To plan and implement selective and
sustainable preventive measures for reduction of
dog-mediated rabies
• To strengthen local capacity in applied research
and surveillance to promote rabies elimination

20. Duration and estimated cost
Period: 8 years (2013-2020)
• Preparatory Phase (Four years) – Establish a
regional coordinated rabies elimination
programme
• Final Phase (Four years) – Eliminate rabies
as a public health problem

21. Proposed organizational set up for implementation of
project activities
SAARC
Development
Fund
Regional
Member Alliance for
Rabies
SAARC Rabies
Coordinator States Elimination
(RARE)
Country
Rabies Alliance for
Collaborating Rabies
Institutions Elimination
(CARE)
Ministry
Ministry
of Agri./
of Health
Livestock

22. Estimated cost for Phase One
S. Activities Estimated % of total
No. budget budget
(USD)
1 Legal framework for rabies elimination 0.25m 2.5
2 Advocacy, awareness and education 1.5m 15
3 Surveillance and networking 1m 10
4 Laboratory diagnosis 0.5m 5
5 Human rabies prophylaxis 1.5m 15
6 Anti-rabies campaign and animal birth control 4.25m 42.5
7 Wildlife rabies 0.25m 2.5
8 Operational research 0.25m 2.5
9 Project management 0.5m 5
Total 10m 100

23. Advocacy for policy decision is a key!
• Advocacy for ownership and social responsibility
• Appreciation of role of medical and veterinary
colleges and local governments in rabies
prevention and control
• Alliance for elimination of human rabies at
country and regional levels

24. International partnership
• WHO: Regional Strategic Framework for
Elimination of Human Rabies transmitted by
Dogs in the South East Asia Region
• OIE: Establishment of regional vaccine
banks for dog vaccination
• FAO: Proposed PCP towards rabies
elimination
• SAARC Rabies Meeting in Dhaka

25. MAINTAIN RABIES
ELIMINATION IN
HUMAN AND
ANIMALS
FURTHER RABIES NO MORE DOG
RISK REDUCTION RABIES CASES
IMPLEMENTATION OF A NO MORE HUMAN
RABIES CONTROL RABIES CASES
STRATEGY
DEVELOPMENT OF A NATIONAL RABIES PREVENTION AND CONTROL
RABIES CONTROL STRATEGY FINALIZED AND FINANCED
STRATEGY
GAIN UNDERSTANDING ON
RABIES RISKS ASSESSED AND
THE EPIDEMIOLOGY OF
RABIES AND ASSESS RABIES CONTROL PLAN DRAFTED
RISKS
REPORTING OF THE OCCURANCE OF RABIES
RABIES PRESENT BUT
TO INTERNATIONAL ORGANIZATIONS
LACK OF DATA
Source: FAO

26. Conclusion
• Dog-mediated rabies is a major epidemiological
pattern in rabies endemic SAARC countries
• Rabies elimination programme focused mainly on
mass vaccination of dogs are largely justified
• Existence of a large, unvaccinated stray dog
population is a major problem
• Dog population management is a serious
challenge in metropolitan cities
• Inter-country collaboration is essential to sustain
the progress made in rabies control

27. Partnership for Rabies Elimination