rabies control programmes

OIE Global Conference on Rabies Control, 7-9 Sep, 2011. Incheon, Republic of Korea

Towards Sustainable

Prevention of Rabies at Source:

Case Report India

S. Abdul RahmanSecretary Commonwealth Veterinary Association

President, Association for Prevention and Control of Rabies in India (APCRI)

Vice President Rabies in Asia Foundation (RIA)

Former Dean, Bangalore Veterinary College, Bangalore

1


Annual Human Mortality Due

To Rabies

Global Deaths 55000

Deaths in Asia 31000

Deaths in SEA 25000

Deaths in India 20000


20 000

2000-2500

(37) 150-200

1-4

58 (2009)

Urban:24%

Rural: 76%

Rabies Free

Rabies Free

Afghanistan

2000-2500

40 in 2010


Human Mortality Due To

Rabies

97% of human rabies

deaths come from bites

of rabid dog

Children (40%approx)

are more affected.


Epidemiological Situation Of

Rabies In India

No systematic studies on the incidence of

Rabies in Animals in India

Incidence of Rabies in India is generated

from Annual reports of State Departments of

Veterinary Services to the Dept.of Animal

Husbandry Govt.of India.

Postmortem records of Depts of Pathology of

Veterinary Colleges.



Rabies In India

WHO/NICD / APCRI National Multi centric Rabies survey of India, published in May 2004,reported that

Human Rabies is endemic throughout the mainland and only the islands of Andaman & Nicobar and Lakshadweep are rabies free.

Majority of the human rabies deaths occurred in adults, Males and in poor/low income group.

The most common animal reservoirs of rabies based on laboratory evidence were dogs, cattle, goats, cats and pigs and among the wild animals were mongoose and jackal



Rabies In India

The use of rabies vaccination was low and that of rabies

immunoglobulins was negligible

Annual Incidence: 17,137 (14,109 to 20,165 with 95%

confidence).

In addition of 20% to include atypical form of rabies

provided an estimation of about 20,000.

Principal Animal Reservoir: Dog (96.3%).

Frequency of Human Rabies Deaths: 1 per 30 minutes

approx.

Pet dog : Man ratio = 1 : 36



Rabies In India

• Pet/Owned/Household dog population : 28 million.

• Stray dog population : 25 million

• Annual animal bite incidence rate (per 1000 population) :

17.4.

• Unreported cases much higher out of which only 3

million receive post exposure vaccine Leaving survival

of 14 million victims to luck

• Frequency of bite : 1 bite per 2 seconds.


Animal Rabies Deaths Reported in

India in 2009

Annual Report of Department of Animal Husbandry,

Dairying & Fisheries Ministry of Agriculture, Government of IndiaANNEXURE XIII Species -wise incidence of livestock diseases in India

during 2009(January -December )page 99

Rabies Outbreaks Attacks Deaths

Canines 52 69 69

Bovines 44 233 233

Buffalo 0 21 21

Cap/Ovi 1 1 1

Total 97 324 324


0

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2001-02

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Canine

Prevalence of Rabies in Animals-Bangalore,2001-2011

: Dept. of Pathol.,Vety.College,KVAFSU,B’lore

Bovine

Feline


Prevalence of Rabies in Animals – Chennai,

2001-2011: Vety. College,TNVASU


Organisations/Agencies Involved

In Rabies Control In India

Governmental Agencies

Ministry of Health -Central and State

Ministry of Agriculture- -Central and State

State Animal Husbandry Department

Animal Welfare Board

Local Civic bodies

National Institute of Mental Health & Neurosciences,

Bangalore

Government Veterinary Colleges


Non Governmental Organisations

involved in Rabies control in India

Kempegowda Institute of Medical Sciences,

Bangalore

Rabies in Asia Foundation (RIA)

Association for the Prevention and Control of Rabies

in India (APCRI)

Commonwealth Veterinary Association (CVA)

Global Alliance for Rabies Control (GRAC)


Past And Current Control Programmes

And Accompanying Measures In Place

Government Projects and Programmes on Control of:

1.Animal Rabies

Indian Council of Agriculture Research Outreach Project on

Rabies in India-at Vet Col Bangalore

Systematic control of livestock diseases in India including

Rabies

2.Human Rabies

ICAR/ICMR Joint Task Force for Rabies Elimination

NCDC Pilot Project on Prevention of Human Rabies

3.Rabies Control Initiative in Tamil Nadu .(PHFI)


Government of India: Pilot project on

prevention and control of human rabiesVision: Rabies Control Strategy for Nation-wide Implementation

2 years: 2008- 2010, Extended to 2010-11

Five cities: Ahmadabad; Bangalore; Delhi; Pune; Madurai

Strategies

Enhancing awareness regarding timely and appropriate Postexposure treatment

Training health professionals

Ensure availability vaccines and anti-sera

Operationalise ID route in selected centres

Strengthen diagnostic capabilities

Interface with animal husbandry department

Involvement of NGOs and Community


3.Rabies Control Initiative in Tamil Nadu .(PHFI)Logic Model for Rabies Control Initiative in Tamil Nadu


Current Projects On Rabies

Control Sponsored By NGO’s

Village Adoption Project -

Global Alliance for Rabies Control (GARC) ;Rabies in Asia Foundation (RIA) and Commonwealth Veterinary Association (CVA)

Notifiability and Education ProjectGARC. RIA, CVA, Association for Prevention and Control of Rabies in India (APCRI)

Evaluation of neutralizing activity monoclonal antibody combination against rabiesCrucell, RIA, APCRI CVA, Veterinary Colleges, Animal Welfare Organizations

OTHERS

RIA-SAARC Inter-Country Meet on Rabies

Indian Rabies Policy, 2011Prepared Jointly by IPAH,APCRI,RIA ,AWBI


‘Adopt A Village’Programme For Rabies Control In India

Ten villages surrounding Bangalore and Pune, India will benefit from a programme aimed at reducing the incidence of human and animal rabies through improved educational awareness and mass vaccination of dogs.

A large number of medical and veterinary partners worked together in the target villages to educate people in their own language with sensitivity to their customs.


Assessment of KAP

Karuna Animal Welfare

Association (NGO) of Karnataka,

Bangalore was involved in the

activity.

Restricted/supervised pet dogs and

strays were Collared, Vaccinated

against Rabies & dewormed.


Hands On Training of Medical and

Veterinary personal in Rabies

Diagnosis

Direct, Rapid Immunohistochemical Test(dRIT)


Rabies Awareness Activities Wall Paintings –

Objectives of the projectWall Paintings –

Rabies educationCalendar for the Year 2011

Painting CompetitionSnake & ladder game for rabies

education

Rabies Volunteer educating the

community


Poster on Post Exposure

Prophylaxis

Poster on responsible pet

ownership

Rabies Awareness - JathaFGD with rabies volunteers

& SHGs members

Rabies public awareness video in

Kannada


Notifiability and Education Project

Rabies is not a notifiable disease in

India but only Reportable

Mass information campaign to

sensitize 545 Members of Parliament

with translation of Rabies information

in 12 different Indian languages

Media campaign to highlight the need

for making Rabies a notifiable disease

http://www.whereincity.com/photo-gallery/93/443.htm


Pilot Education Project in Karnataka State

TACTICAL OBJECTIVE/GOAL

To relieve the burden of Rabies in animal population especially in dogs in India and eliminate human rabies deaths.

Project is based on the premise that children are best medium to adopt the concept of responsible pet ownership Furthermore up to 60% of all people who die of rabies are children.

Target beneficiaries: 54,529 primary schools with 252,875 teachers and 8.495 million students. 9,498 secondary schools with 92,287 teachers and 1.384 million students

Goal: Incorporation of rabies education into 54,529 primary schools by 2013 and 9498 secondary schools in Karnataka state by 2015.


Project On Evaluation Of Neutralizing Activity

Monoclonal Antibody Combination Against Rabies

For reasons of safety and availability, alternative

products to HRIG and ERIG are advocated, and the

development of rabies virus-specific monoclonal

antibodies has been recommended by WHO

Genotypic characterisation of Rabies virus from different

geographical locations in India

The aim of the project in India will be to provide an

alternative therapy to rabies immune globulins (RIGs) by

developing a human monoclonal antibody (mAb) cocktail

for Post Exposure Prophylaxis


Animal Birth Control Programmes

• “Eliminating rabies in dogs is the optimal control method

for preventing spread of the disease.” OIE 2009

• We cannot realistically hope to control or eliminate

rabies in Asia without targeting the dog population…


Animal Birth Control Programme For

Street Dogs In Urban Areas

Guidance for Dog Population Management:

Animal Welfare Board Guidelines

WHO/WSPA 1990 ICAM Coalition 2006 OIE 2009


1. Accessing dogs

2. Sustainability

3. Cost-effectiveness

THE CHALLENGES

Press Collage About Dog Menace and

ABC Programme


Animal Birth Control Programme For Street Dogs

In Urban Areas Ex. Chennai and Jaipur

Dog catching vehicles each with trained dog catchers are deployed for catching dogs

Monthly on an average 1800 dogs Stray dogs caught are immunized.

The complaints are attended in both morning and evening.


Declining Trend Of Human Rabies In

Chennai City Following ABC Programme

CITY WIDE ABC / AR STARTED SEP '96

120

107

44

2417

35

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5 50

0

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120

1996 1997 1998 1999 2000 2001 2002 2003 2004 2008

CHENNAI

NO

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AB

IES

DE

AT

HS


ABC / AR STARTS IN MARCH '96

9

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1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

JAIPUR- WALLED CITY

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Dog Control through Solid Waste

Management


World Rabies Day Programmes

Education campaign

involving Media and

Celebrities such as

Film Stars and Sport

persons (Cricket)


Coordination of Rabies control

Activities in India

WHO OIEFAO

Ministry of

Agriculture

Ministry of Health

Mun Corp

AWBI -Min. of Envr. Forest & Anim. Welfare

Rabies Control Programmes

NGO’s

APCRI RIA ARC

Dept. of

Vet

Services


Challenges for Rabies Control in India

Key issues

Not a priority disease both in Animals and Humans

Inadequate data and information

Lack of political support

Lack of consensus on strategy

Dog Ownership is an issue!

Weak intersectoral coordination

Inadequate management structure

Lack of public cooperation


Challenges for Rabies Control in

India

Limited surveillance data, gaps in surveillance

standardisation across reporting departments and poor

coordination between departments

along with absence of ABC-AR programme in rural areas

and limited role played by Animal Husbandry

Department

are key impediments to rabies prevention and control

in India

Available surveillance data, both human and animal,

does not allow definitive comment on the impact of

various interventions for prevention and control of rabies


R A B I E S

C O N T R O L

Public

awareness

and education

on rabies

Involvement of

Veterinary

Services

Dog

Population –

Management

and Control

Surveillance

and Laboratory

Diagnosis

Wound

Management

and Post

Exposure

Prophylaxis

Involvement of

Animal

Welfare

Organizations

Municipality &

Community

Involvement,

Media and

Celebrities

Government

Legislative

Support -

Notifiability -

Funding


Challenges for Rabies Control in India

Generating the political awareness and will for large-scale control programme – Ownership for dog rabies control

Development and implementation of a national rabies control strategy

Devolving responsibility to local government authorities

Legislation: Registration/Licensing and vaccination of dogs.


Future plans to control Rabies at Source

in India

General Considerations

Prevention: Introduce cost-effective public healthintervention techniques to improve accessibility,affordability and availability of post-exposure prophylaxis

Promotion: Improve understanding of rabies throughadvocacy, awareness, education and operational research

Partnership: Provide coordinated support for anti-rabiesdrive with the involvement of community, civil society,government and non-government sectors and internationalpartners


General Considerations

Establish surveillance on human as well as animal side

and identify Rabies as a Notifiable disease

Strengthen State-level coordination committees

Identify and fill gaps in current implementation

programmes eg. Rural and peri-urban areas pose a

major threat to the success of rabies control efforts

Document Rabies intervention as a model for replication

Draft a blueprint that can guide the national disease

control programme to combat rabies and other zoonoses

in the country


Future plans to control Rabies at Source

in India

Specific Considerations

• Human rabies prevention is possiblethrough promotion of responsible dogownership, mass dog vaccination andanimal birth control programme withpartnership approach

Mass vaccination campaigns targeting dogsof all age group to develop herd immunity.

Mass dog vaccination alone is effective butproviding additional dog populationmanagement interventions can helpovercome the challenges


Strengthening Of Available Laboratory Facilities

For Rabies Diagnosis In Animals And Humans

Currently very few facilities for Rabies Diagnosis are

available:

For rabies diagnosis in humans:

NIMHANS, Bangalore

NCDC, Delhi

NIV, Pune

For rabies diagnosis in animals:

Laboratories in different states and

at Veterinary colleges

Negri Bodies, FAT & dRIT


Adoption and implementation of OIE

Recommendations and Standards

Rabies should be considered as a priority by all governments

Public awareness and education on rabies

Active contribution of Veterinary Services to the goal of eliminating human rabies at the animal source with theappropriate financial support (public budget/Ministries of Health)

Design and implementation of comprehensive and sustainable national programmes for rabies elimination,

Harmonisation of control/ elimination programme strategies between neighbouring countries until rabies has been successfully eliminated.


We are not alone!

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http://www.rabiescontrol.net/

http://www.hsi.org/

rabies control programmes

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