Towards Sustainable Prevention of Rabies at Source: Case Report India

Transcription

1 Towards Sustainable Prevention of Rabies at Source: Case Report India S. Abdul Rahman Secretary 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

2 Annual Human Mortality Due To Rabies Global Deaths Deaths in Asia Deaths in SEA Deaths in India 20000

3 Afghanistan 40 in (37) Urban:24% Rural: 76% Rabies Free Rabies Free 58 (2009)

4 Human Mortality Due To Rabies 97% of human rabies deaths come from bites of rabid dog Children (40%approx) are more affected.

5 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.

6 Epidemiological Situation Of 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

7 Epidemiological Situation Of 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

8 Epidemiological Situation Of Rabies In India Pet/Owned/Household dog population : 28 million. Stray dog population : 25 million Annual animal bite incidence rate (per 1000 population) : 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.

9 Animal Rabies Deaths Reported in India in 2009 Annual Report of Department of Animal Husbandry, Dairying & Fisheries Ministry of Agriculture, Government of India ANNEXURE XIII Species -wise incidence of livestock diseases in India during 2009(January -December )page 99 Rabies Outbreaks Attacks Deaths Canines Bovines Buffalo Cap/Ovi Total

10 No.positive by Seller s stain Prevalence of Rabies in Animals-Bangalore, : Dept. of Pathol.,Vety.College,KVAFSU,B lore Canine Bovine Feline

11 Prevalence of Rabies in Animals Chennai, : Vety. College,TNVASU

12 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

13 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)

14 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)

15 Government of India: Pilot project on prevention and control of human rabies Vision: Rabies Control Strategy for Nation-wide Implementation 2 years: , Extended to Five cities: Ahmadabad; Bangalore; Delhi; Pune; Madurai Strategies Enhancing awareness regarding timely and appropriate Post exposure 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

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

17 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 Project GARC. RIA, CVA, Association for Prevention and Control of Rabies in India (APCRI) Evaluation of neutralizing activity monoclonal antibody combination against rabies Crucell, RIA, APCRI CVA, Veterinary Colleges, Animal Welfare Organizations OTHERS RIA-SAARC Inter-Country Meet on Rabies Indian Rabies Policy, 2011 Prepared Jointly by IPAH,APCRI,RIA,AWBI

18 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.

19 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.

20 Hands On Training of Medical and Veterinary personal in Rabies Diagnosis Direct, Rapid Immunohistochemical Test(dRIT)

21 Rabies Awareness Activities Wall Paintings Objectives of the project Wall Paintings Rabies education Calendar for the Year 2011 Rabies Volunteer educating the community Painting Competition Snake & ladder game for rabies education

22 Poster on Post Exposure Prophylaxis Poster on responsible pet ownership Rabies public awareness video in Kannada Rabies Awareness - Jatha FGD with rabies volunteers & SHGs members

23 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

24 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 million students. 9,498 secondary schools with 92,287 teachers and million students Goal: Incorporation of rabies education into 54,529 primary schools by 2013 and 9498 secondary schools in Karnataka state by 2015.

25 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

26 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

27 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

28 THE CHALLENGES 1. Accessing dogs 2. Sustainability 3. Cost-effectiveness Press Collage About Dog Menace and ABC Programme

29 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.

30 NO. OF RABIES DEATHS Declining Trend Of Human Rabies In Chennai City Following ABC Programme CITY WIDE ABC / AR STARTED SEP ' CHENNAI

31 NO. OF RABIES DEATHS ABC / AR STARTS IN MARCH ' JAIPUR- WALLED CITY

32 Dog Control through Solid Waste Management

33 World Rabies Day Programmes Education campaign involving Media and Celebrities such as Film Stars and Sport persons (Cricket)

34 Coordination of Rabies control Activities in India WHO FAO OIE NGO s APCRI RIA ARC Ministry of Health Mun Corp Ministry of Agriculture Dept. of Vet Services AWBI -Min. of Envr. Forest & Anim. Welfare Rabies Control Programmes

35 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

36 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

37 Government Legislative Support - Notifiability - Funding Public awareness and education on rabies Municipality & Community Involvement, Media and Celebrities Wound Management and Post Exposure Prophylaxis R A B I E S C O N T R O L Involvement of Veterinary Services Dog Population Management and Control Surveillance and Laboratory Diagnosis Involvement of Animal Welfare Organizations

38 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.

39 Future plans to control Rabies at Source in India General Considerations Prevention: Introduce cost-effective public health intervention techniques to improve accessibility, affordability and availability of post-exposure prophylaxis 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

40 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

41 Future plans to control Rabies at Source in India Specific Considerations Human rabies prevention is possible through promotion of responsible dog ownership, mass dog vaccination and animal birth control programme with partnership approach Mass vaccination campaigns targeting dogs of all age group to develop herd immunity. Mass dog vaccination alone is effective but providing additional dog population management interventions can help overcome the challenges

42 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

43 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 the appropriate 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.

44 We are not alone!