Rabies free zone in Thailand Dr. Pornpitak Panlar

Bureau of General Communicable Disease

Department of Disease Control

Rabies remains a public health concern in Thailand.

There are some people death from rabies every year.

The mean age of the patients was 40 years old.

Over 1 million people are potentially at risk of rabies infection.

More than 5 hundred thousand patients receive rabies vaccination annually at an estimated cost of 1 billion Bath.

More than 99% of all human deaths from rabies did not have post-exposure prophylaxis.

Domestic dogs the major source of human cases.

Burden of Rabies

Source: R.36 and TRN

Distribution of the risk levels of humans contracting rabies, worldwide, 2011

Rabies situation in Thailand

44.5 47.1 49.9

41.5

32.7 29.1 27.6 28.9 28.7

24.5 22 18.8 21.6

24.1

18.2 20.2

29.2

17.8 13.7 13.2

2.9 5.7 3.6

91

78

74

77

58 57

68

50

37 30

18 19 20 22

14 9

24

15 7

4 7 7

3

0

10

20

30

40

50

60

70

80

90

100 19

93

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

% animal rabies positive no. human death

Year

Source: R.36 and TRN Update: 15 Jul 2015

Rabies risk areas 2015

Divide by 1. No. of human rabies cases 2. No. of positive rabies in animals

Source: R.36 and TRN

Why human rabies still remain? • Public health

– Most of rabies case did not receive post exposure prophylaxis. – Lack of public participation from people – Inadequate of risk communication. – Provider error. – Health services accessibility.

• Livestock – Vaccine coverage in dogs is less than 80% – Inadequate of laboratory diagnosis. – Stray dogs especially in border line.

What’s next ?

SAARC and the ASEAN Plus 3 ( SEA + China, Japan and Rep. of Korea)

2020

2030

2015

2013

2014 2015

2017 2020

Road map to Rabies free area 2020

Control area level C Control area level B Control area level A Rabies Free Area

A = 27 provinces

A =18 provinces RFZ= 44 provinces

A =15 provinces RFZ= 47 provinces

RFZ= 77 provinces

RFZ= 77 provinces

Thailand will become the Rabies Free

Country by 2020.

6 Missions

5 core strategic

Visions Missions Strategies

Goal To achieve a long-term goal of zero rabies fatality both in human and animal populations

Efficient management and integrated approach to prevention and control of rabies

Increased role and active engagement from local administration organizations in rabies prevention and control

Surveillance, prevention and control of rabies in human and animal populations

Multi-sectoral engagement and public participation

Efforts to raise awareness, increase knowledge and skills, and influence behavior changes among the public for rabies prevention and control

Rabies control programs and results 1. Foster multi-sectorial efforts and collaboration to prevent and control rabies in local communities nationwide.

- 91.43% of local community in Thailand join in Rabies free zone project.

58% 30% 12%

Areas of Rabies free zone in Thailand during 2013-2014

A B C ปลอดโรค

60% 30%

9% 1%

2014

2013

Rabies control programs and results

2. Promote dog registration and rabies vaccination.

- The estimated vaccine coverage in dog is 78.97%

- Unable to consolidate updated and accurate dog populations.

3. Control and minimize the number of stray dogs.

4. Continued rabies surveillance prevention and control in both humans (Rabies) and animal (Thai Rabies Net)

Surveillance System

http://r36.ddc.moph.go.th/r36/home

Rabies control programs and results

5. Raise public knowledge, understanding and awareness on rabies prevention.

Animal health:

- Thailand’s dog vaccination program: 2 rounds of vaccination annually

1st round: April – May

2nd round: September – October

Public health:

- The patients have to see a doctor, if they are bitten by animals.

6. Enforce applicable laws related to rabies prevention and control.

RB campaign

Credit: District livestock office, Chiang Kong and Terng, Chiang Rai province

RB campaign

Challenge

• Prevention and control : Introduce cost-effective public health intervention techniques to improve accessibility, affordability and availability of post-exposure prophylaxis including mass dog vaccination and dog population control.

• Promotion : Improve understanding of rabies through awareness, education and operational research.

• Partnership : Collaboration between involvement of community, civil society, government and non-government sectors and international partners i.e. CDC, DLD, OIE, FAO, WHO

Thank you