BENCHMARK DOCUMENT: Rabies and Rabies-Related Initiatives. in ASEAN Member States (2014) P R O C E E D I N G S F R O M T H E

Transcription

1 BENCHMARK DOCUMENT: Rabies and Rabies-Related Initiatives in ASEAN Member States (2014) P R O C E E D I N G S F R O M T H E WORKSHOP ON RELEVANT INTERNATIONAL STANDARDS FOR RABIES CHIANG MAI, THAILAND June

2 BENCHMARK DOCUMENT: Rabies and Rabies-Related Initiatives in ASEAN Member States (2014) is the summary document of the outputs from the Workshop Background on Relevant International Standards for Dog Rabies held in Chiang Mai, Thailand on June The workshop was organised by the World Organisation for Animal Health (OIE) Sub- Regional Representation for South-East Asia in cooperation with the Department of Livestock Development, Thailand and funding support from the Department of Foreign Affairs 2 and Trade of Australia.

3 Introduction Rabies is a widespread, neglected and under-reported fatal zoonosis with an almost 100% case fatality rate in animals and humans. To date, it remains endemic in seven of the ten ASEAN Member States (AMS), and continues to pose a threat to the other three countries currently considered as rabies - free. With nearly all human rabies infections in the region transmitted mainly via rabid dog bites, rabies control and prevention in dogs is seen as the most efficient and cost-effective means to strategically address and eliminate rabies in the region. Table of Contents Background Introduction Part 1: Compliance to International Standards for rabies.. 9 Part 2: Veterinary Services, Communication and Legislation The World Organisation for Animal Health (OIE) continues to pursue its commitment to the global fight against rabies. Consistent with its longstanding support to the 2008 ASEAN Call for Action towards the Elimination of Rabies, OIE continues to pursue the shared vision of ASEAN Member States of achieving regional rabies freedom by To provide a sound knowledge on OIE international standards and approaches as they apply to rabies, and to have a good understanding of the rabies situation in ASEAN Member States, the OIE Sub-Regional Representation for South-East Asia designed and facilitated the Workshop on Relevant International Standards for Dog Rabies in Chiang Mai, Thailand on June The Concept Note and Agenda for this workshop can be found in Annex 1 and 2, respectively. Part 3: Laboratory Diagnosis of Rabies in AMS Part 4: Rabies Vaccines and vaccination Part 5: Stray dog population Management.,. 33 The Workshop Participants Part 6: Surveillance List of Participants All the ten ASEAN Member States (AMS) were represented during the workshop: Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam. Local observers from Chiang Mai, Thailand were also present. In addition to country participants, international partner organisations actively working on rabies in the region were also in attendance (Food and Agriculture Organisation for Asia and the Pacific, Global Alliance for Rabies Control, and the World Animal Protection. The workshop sessions were facilitated by OIE resource persons and moderators from the OIE Headquarters in Paris, OIE Regional Representation for Asia and the Pacific in Tokyo, and the OIE Sub-Regional Representation for South-East Asia in Bangkok. Overall, there were a total of 36 participants. A complete list and details of these participants can be found in Annex 3. 3

4 The Workshop Prior to the workshop proper, participating countries shared updates on their current rabies situation, rabies activities, and future plans. Participants were also provided an overview on the nature of structure and operations of OIE as well as the process of development and general applications of the OIE International Standards. The workshop proper primarily introduced International Standards deemed relevant to rabies and its control and prevention. Largely drawn from select Chapters of the OIE Terrestrial Animal Health Code and Terrestrial Manual, a questionnaire for each session was designed to obtain information on the current status of countries for each standard under discussion. To manage the limited workshop time, and for the convenience of responding representatives from participating countries, these questionnaires were circulated prior to the workshop. The workshop was divided into six sessions: Session 1 (International standards on rabies) covered considerations to be taken by countries in self-assessing rabies freedom which includes recommendations for importation of different animals from countries with and without rabies (Chapter 8.12 of the OIE Terrestrial Animal Health Code); Session 2 (Veterinary services, Communication and Veterinary Legislation) included discussions on how good governance in the Veterinary Services (Chapter 3.1 of the OIE Terrestrial Animal Health Code) is closely linked to rabies control and prevention efforts of the countries, and how such is reinforced by effective Communication within and beyond the Veterinary Services (Chapter 3.3 of the OIE Terrestrial Animal Health Code) and by a sound Veterinary Legislation (Chapter 3.4 of the OIE Terrestrial Animal Health Code); Session 3 (Laboratory Diagnosis of Rabies) covered discussions on international standards for sample collection, transport and processing (Chapter of the OIE Terrestrial Manual) for rabies diagnosis and the roles of Regional Reference Laboratories; Session 4 (Rabies Vaccines and Vaccination) covered international standards on minimum requirements for rabies vaccines (Chapter of the OIE Terrestrial Manual), rabies vaccine bank, and guidelines on vaccination; Session 5 (Stray Dog Population Control) covered international recommendations for control measures and methods for estimating the size of the dog population (Chapter 7.7 of the OIE Terrestrial Animal Health Code); Session 6 (International Standards on Surveillance) included discussions on rabies notification and epidemiological information (Chapter 1.1 of the OIE Terrestrial Animal Health Code) as well as WAHIS reporting requirements. Largely drawn from select Chapters of the OIE Terrestrial Animal Health Code and Terrestrial Manual, a questionnaire for each session was designed to obtain information on the current status of countries for each standard under discussion. The Workshop Objectives (1) To provide a sound knowledge on OIE international standards and approaches as they apply to rabies. (2) To have a good understanding of the rabies situation in ASEAN Member States 4

5 Workshop Output With the rich contributions from the participating countries and the exchanges during plenary sessions, the plenary concluded that the outputs from the workshop should be synthesized into a benchmarking document, which will summarise the current status, existing gaps, and regional and national priorities towards achieving ASEAN rabies freedom by Aside from providing a comprehensive overview on rabies situation and rabies initiatives in South-East Asia, this baseline document is also envisioned to be in support of the implementation of ASEAN Rabies Elimination Strategy (ARES), to serve as a resource material for its monitoring and evaluation. Workshop Outcomes The Workshop Participants: GAINED a sound understanding of the rabies situation in countries in South East Asia; GAINED an improved knowledge and understanding of OIE policies, strategies and practices as well as OIE international standards relating to rabies; SUPPORTED the development of a Benchmarking Document including comments and recommendations based on data, information and advice provided at the Workshop; AGREED that this Document will form a useful tool in identifying gaps and issues to be progressed in support the ASEAN Plus 3 call for rabies elimination by the year 2020; AGREED that this Document will also provide baseline information in support of the monitoring and evaluation of the implementation of the ASEAN Rabies Elimination Strategy (ARES) for the Animal Health Sector. AGREED that the Document be distributed to OIE including the OIE Regional Commission for Asia, the Far East and Oceania, ASEAN, and partner organisations including FAO, GARC and World Animal Protection; AGREED that the benchmarks established be formally reviewed under the Australian Aid STANDZ Project in 2016; THANKED the Thailand Department of Livestock Development for hosting the Workshop. 5

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7 Introduction Rabies situation in ASEAN Member States Globally, rabies infection causes about 70,000 human deaths annually, with the burden mostly pressed upon those living in poor rural communities, particularly the children. This disease, where present, also has substantial economic impact. In Asia alone, rabies is reported to have annual expenditure estimated to be at USD 563 million (Knobel et al., 2005). In spite of these, this preventable infection remains to be a neglected disease. Considering the health, social, and economic impact of this disease, the ASEAN + 3 countries (Republic of Korea, People s Republic of China, and Japan), declared a Call for Action against rabies in 2008 in Hanoi, Vietnam. Since this declaration, attention to rabies in the region has slowly but steadily progressed. Following a series of recommendation on the development of a strategy for elimination of dog rabies in the region, the OIE SRR SEA assisted Vietnam, the ASEAN lead country for rabies, in developing the South-East Asia Regional Strategy for Elimination of Dog Rabies. This strategy emphasised the need to integrate socio-cultural, technical, organisational, and political (S.T.O.P.) framework in addressing dog rabies in the region. The draft was first presented in May 2013 at the 21 st meeting of the ASEAN Sectoral Working Group for Livestock (ASWGL). With a shared interest on addressing rabies, the ASEAN Expert Group on Communicable Diseases (AEGCD) collaborated with ASWGL to build upon this document, integrating the human sector. This collaborative, inter-sectoral effort led to the joint rabies strategy on rabies called ASEAN Rabies Elimination Strategy (ARES) which was first presented in Danang, Vietnam in October 2013 and then at the 22 nd ASWGL in With a shared goal of eliminating rabies by the year 2020, the region faces the challenge of achieving this target given the varying status of disease, available resources, and competencies of Veterinary Services of its Member States. It is therefore intuitive that plans are collaboratively made by ASEAN Member States to continue to protect areas that are free, prepare those who are advancing towards freedom, and with a concerted effort address the weak points in the control, prevention, and ultimately elimination of rabies in the region. At present, among the 10 ASEAN Member States (Brunei, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam), three countries are presently rabies-free. Brunei Darussalam has never had any human or animal rabies and is considered historically free. Singapore recorded its last case in 1953 and has since been free. Malaysia reported its last case in 1999 and has been free from then onwards. The remaining seven countries (Cambodia, Indonesia, Lao PDR, Myanmar, Philippines, Thailand and Vietnam) are considered infected with rabies, with cases annually recorded in both humans and animals. In the last five years alone ( ), rabies was reported to have claimed 3,475 human lives and 7,617 animal lives in the region. These figures do not include the many undiagnosed and unreported cases of thislargely neglected zoonoses. Considering that the disease is 100% preventable, these are unwarranted losses for the region. Table 1 below shows the brief summary of rabies incidence in humans and animals in ASEAN Member States. 7

8 Table 1.Rabies situation in ASEAN Member States, ASEAN Member State Brunei Darussalam Cambodia Indonesia Lao PDR Malaysia Myanmar Philippines Singapore Thailand Year No. of animal bites reported No. of postexposure treatment No. of human rabies cases Rabies has never been reported No. of animals tested for rabies No. of animals positive for rabies 2009 *** 12,475* 6* *** 61* 2010 *** 12,475* 6* *** 61* 2011 *** 12,475* 6* *** 61* 2012 *** 12,475* 6* *** 61* 2013 *** 12,475* 6* *** 61* ,466 35, , ,574 63, , ,010 71, , ,750 74, , ,136 53, , ,515 2, ,510 4, ,944 4, ,007 N/A ,070 N/A No rabies cases since the year , , , ,424 1, , , , , , , , , , , , , , , , No rabies cases since the year *** *** 24 1, *** *** 15 1, *** *** 8 1, *** *** 7 1, *** 918,518** 7 4, *** *** *** *** Vietnam 2011 *** *** ,282 *** ,908 *** *Estimated annual average based on the humans and animal cases in Cambodia (Ly et al., 2009) ** Estimated data ***no information available at the time of reporting 8

9 Part 1 Current status of compliance to International Standards on Rabies Presently, ASEAN Member States have different rabies status and varying degrees of endemicity where the disease is present. Additionally, all AMS have different rabies activities and varying strengths in Veterinary Services, as well as available financial resources supporting rabies elimination. In a region with such variability, a shared goal of achieving rabies freedom by 2020 is a challenge especially that, persistence of the disease in infected areas continue to put other areas that have made progress, at risk of infection. To mitigate the risk of rabies to human and animal health and to prevent the international spread of rabies, Chapter 8.12 (Infection with Rabies Virus) of the OIE Terrestrial Code outlines the international standards for control of rabies in dogs, country requirements to be considered free from rabies (Box 1.1), and recommendations for importation of various animal species from rabies-free and rabies-infected countries. This section summarises the present status of compliance of AMS to international standards on rabies (Table 1.1), based on the responses to questionnaire from Session 1 of the workshop. BOX 1.1 Compliance to provisions for rabies freedom As Article of the Terrestrial Animal Health Code stipulates, a country may be considered free from rabies when: (1) the disease is notifiable and any change in the epidemiological situation or relevant events are reported in accordance with Ch. 1.1; (2) an ongoing system of disease surveillance in accordance with Ch. 1.4 has been in operation for the past two years, with a minimum requirement being an ongoing early detection programme to ensure investigation and reporting of rabies suspect animals; (3) regulatory measures for the prevention of rabies are implemented consistent with the recommendations in the Terrestrial Code including for the importation of animals; (4) no case of indigenously acquired rabies virus infection has been confirmed during the past two years; (5) no imported case in the Orders Carnivora or Chiroptera has been confirmed outside a quarantine station for the past six months. 1.1 Rabies notifiability Animal rabies is a notifiable animal disease in all ASEAN Member States, except for Cambodia. Although rabies is notifiable in humans via their CAMEWARN surveillance system, it is presently not notifiable in animals. 1.2 Rabies surveillance systems Surveillance in the last 2 years. Four countries (4/10) confirmed that rabies surveillance has been in place for more than two years as of 2014: Singapore (started in 1950s), Thailand (started in 1993), Malaysia (started in 1999), and Indonesia (started in 2010). Although Lao PDR, Philippines and Vietnam (3/10) all confirm that they do have surveillance systems in place, these countries did not indicate in which year this commenced. Brunei, Cambodia and Myanmar (3/10) presently do not have any surveillance system in place for rabies. Generally, surveillance in most countries is based on disease reporting or notification. In Malaysia, additionally, randomly selected brain samples from the stray dog population are also routinely tested for rabies. Early detection programme for rabies. Five of the 10 AMS also indicated they have an early detection programme for rabies. These are: Indonesia, Malaysia, Philippines, Singapore and Thailand. For some examples on this, please refer to Box 1.2 below. The remaining 5/10 of the AMS (Brunei, Cambodia, Lao PDR, Myanmar and Vietnam) reported they do not have an early detection programme for rabies. 9

10 BOX 1.2 Some AMS examples for early detection systems for rabies In Indonesia, the early detection system is what they refer to as the Integrated Bite Case Management (IBCM), a coordinated SOP between the human-animal health sectors for animal bite cases (Fig 1.1). Basically, when a bite case patient presents to a clinic, the animal sector is identified via SMS text message. Likewise, when the animal health sector receives a report regarding an animal exhibiting unusual behavioral signs, the human health sector is also immediately notified. In both instances, the location and animal type involved is reported to the other party. Fig 1.1 Early detection program of Indonesia for rabies: the Integrated Bite Case Management In the Philippines, an event-based surveillance is conducted through the Epidemiology Bureau of the Department of Health. Similarly, in Malaysia, every suspected human rabies case will warrant immediate investigation and detainment of the biting animal for 14 days for observation of rabies signs. In Thailand, observed rabies clinical signs are reported by village volunteers; provincial livestock officer then take action with 24 hours after notification and outbreak investigation to trace back the source of infection origin is done, and animals in high risk areas are also vaccinated. Active surveillance is then continued for at least 6 months. 1.3 Rabies regulatory measures Regulatory measures in free countries. As Table 1.2 shows, all rabies-free countries (Brunei Darussalam, Malaysia and Singapore) have regulatory measures for rabies control and prevention and animal identification. Currently, Singapore does not allow rabies vaccination, except for animals bound for export as required by importing countries. While Malaysia and Singapore have particular rabies provisions for importation of all animals from countries considered non-infected and infected with rabies, Brunei reported to have provisions for the importation of dogs and cats only. Regulatory measures for animal importation from countries considered free from rabies. All countries (10/10) reported to have regulatory measures related to animal importation from rabies-free countries, but are often limited to certain species (mostly for dogs and cats, except for Vietnam which only has for non-pet animals). 10

11 Regulatory measures for animal importation from countries considered infected with rabies. Almost all countries (9/10), except for Vietnam, reported to have existing regulations for the importation of pet animals from rabies-infected countries. Philippines and Thailand specified however, that such is only limited to dogs and cats (does not include ferrets as indicated in the code) in their respective countries. Rabies-related regulatory measures for the importation of domestic ruminants, equids and suids as well as rodents and lagomorphs are only in place in 3/10 AMS: Indonesia, Malaysia and Singapore. 1.4 Absence of indigenously acquired rabies virus infection in the last two years. Presently, three ASEAN Member States are free from rabies: Brunei Darussalam is historically free of rabies and has never had rabies in either animals or humans; Malaysia s last recorded rabies case was in 1999, and Singapore in The other seven countries (Cambodia, Indonesia, Lao PDR, Myanmar, Philippines, Thailand and Vietnam) are considered as countries infected with rabies. 1.5 Absence of imported case in the orders Carnivora or Chiroptera identified beyond the quarantine station for the past six months As in 1.4, the three (3/10) rabies free AMS confirms absence of imported case beyond the quarantine station for the past six months. Rabies-free Singapore, mandatorily examines all imported animals upon arrival in the country, checking for clinical signs of infectious and contagious diseases including rabies. Animals from most countries are required to undergo days of post-arrival quarantine, during which they will be examined daily for clinical signs of infectious and contagious diseases. Any animal that dies in quarantine will then be subjected to mandatory necropsy at the AVA lab, and their brain tested for rabies with FAT. 1.6 Other related official practices on rabies control and prevention Other related regulatory measures. Aside from regulatory measures for importation as described above and in Table 1.1, Veterinary authorities are also recommended to implement regulations on vaccination, identification and official programme on stray dog population management (Article ) to minimize public health risks due to rabies, and eventually eliminate rabies in dogs. Presently 7/10 AMS (Brunei Darussalam, Indonesia, Malaysia, Philippines, Singapore, Thailand and Vietnam) have regulatory measures for rabies control and prevention; all AMS except Cambodia (9/10) have regulatory measures for rabies vaccination, while only rabies-free countries (3/10) have regulatory measures for animal identification. Six of the 10 AMS (Brunei Darussalam, Malaysia, Myanmar, Philippines, Singapore, and Thailand) have an official programme for stray dog population management. It is worth noting that Lao PDR has recently developed a National Rabies Strategy (2013) which include some relevant strategies such as: development of regulation and SOPs, policy support, and dog population management, among many others. Internal process for declaration rabies freedom within parts of the country. Three of the 7 rabiesinfected AMS (Indonesia, Philippines and Thailand) have an official internal process for declaring rabies freedom in parts of their countries. In Indonesia, the Ministry of Agriculture is the government unit responsible for this declaration of rabies freedom, with conditions largely based on the OIE Terrestrial Code. For Thailand, the declaration is managed by the Ministry of Agriculture and co-operatives who is guided by the following criteria for declaring an area free from rabies: (1) there is no animal rabies case, (2) there is an ongoing laboratory surveillance, (3) there is movement monitoring, (4) there is at least 80% vaccination coverage; (5) there is dog registration in place; and (6) there are no stray dogs in public place. There should also be no human rabies cases, and all suspected cases are confirmed. For the Philippines, declaration is jointly handled by the Department of Agriculture and Department of Health. The process is accordingly guided by the Joint DOH-DA Order No. 1, Series of 2008 ( Guidelines for Declaring Rabies-Free Zones ). The general requirement includes (1) Local ordinance on the prevention and control of rabies, (2) localized comprehensive rabies prevention/control and elimination program (3) a list of conditions to be satisfied by the animal health sector such as: no indigenously acquired rabies cases in the last 2 years, rabies vaccination program in the last 2 years, laboratory surveillance, and other provisions; (4) a list of conditions to be satisfied by the human health sector such as: no case of indigenously acquired human case in the last 2 years, adequate surveillance system in accordance with the Philippine Integrated Disease Surveillance and Response (PIDSR), accessibility of post-exposure treatment and other related provisions. 11

12 BOX 1.3 Some AMS examples of related regulatory measures for rabies Brunei has supporting laws such as the Animal Diseases and Quarantine Order, which has special provisions on rabies, as well as the Dog Act which refers to the registration, identification, capture and management of stray dogs. They also have a programme on stray dog management led by the Municipal Board and supported by the District Offices, Royal Brunei Police Force (RBPF), Department of Agriculture and Agri-food (DAA) and non-governmental organisations, who all meet at least once yearly. Malaysia reports to have an effective importation procedures in line with the legislation laid down in Section 8 of the Animal Rules Procedures for trade in animals, as well as for travelling with companion animals/pets, have been made more stringent after the adoption of a new regulation for importing animals into Malaysia, allowing only the import of animals that have fulfilled the requirements stated in the regulation. Specific risk assessments will be conducted under certain circumstances for imports from specific countries with a favourable rabies situation. The import procedures are also guided by Veterinary Standard Procedure APTVM 17(a):1/2011: Animal Quarantine Process; APTVM 17(d):1/2011: Import Risk Analysis; and APTVM 17(c):1/1211: Import and Export of Animals, animal products, animal byproducts, biological materials and animal feed. Comments: 1. Countries considered as rabies free should continue to be vigilant in preventing introduction of the rabies virus into their area of jurisdiction. Singapore and Malaysia are recommended to maintain and continue strengthening existing systems, regulatory measures and practices. Historically-free Brunei is also recommended to (a) set-up surveillance system and early detection mechanisms for rabies, (b) develop relevant regulatory measures to ensure prevention of virus entry, and (c) develop standard operating procedures for rabies case investigation. 2. Countries considered infected with rabies should take action in ensuring that the provisions for rabies freedom are satisfied, and that other related practices regarding rabies control and elimination are addressed. This would primarily involve establishing (a) rabies as officially notifiable disease (Cambodia), (b) rabies surveillance (Cambodia and Myanmar), and (c) early detection program for rabies (Cambodia, Lao PDR, Myanmar, Vietnam). Certain import procedures should also be improved to ensure prevention of introduction of rabies virus from other infected countries, in particular for the importation of domestic ruminants, equids, suids, lagomorphs, rodents and wildlife (Cambodia, Indonesia, Lao PDR, Myanmar, Philippines, Thailand, Vietnam). Furthermore, regulations on rabies control and prevention (Cambodia, Lao PDR, Myanmar), regulations on rabies vaccination (Cambodia), regulations on dog identification (all rabies infected countries), and official programme on stray dog population management (Cambodia, Indonesia, Lao PDR and Vietnam) should be put in place in order to reinforce rabies elimination in these countries, and the region overall. 12

13 Table 1.1 Current status of compliance of AMS to International Standards on Rabies, in accordance with the OIE Terrestrial Animal Health Code Chapter 8.12 AMS Rabies is notifiable Has rabies surveillance systems With rabies surveillance in the past 2 years With early detection programme Domestic and wild captive mammals from RFC 1 Import procedures ensure prevention of rabies entry into the country Wild mammals from RFC 1 Dogs, cats, ferrets from RIC 2 Ruminants, equids, camelids, suids from RIC 2 Rodents, lagomorphs from RIC 2 Wildlife from RIC 2 No indigenous rabies cases Brunei Cambodia *** *** Indonesia Lao PDR - *** *** Malaysia Myanmar Philippines - 3 *** 3 *** Singapore Thailand 3 *** 3 *** Vietnam - 4 *** 1 RFC = Rabies-free country 2 RIC = Rabies-infected country 3 For dogs and cats only 3 For domestic ruminants, equids and camelids only ***No information at the time of reporting No imported rabies cases outside quarantine 13

14 Table 1.2 Other practices and measures related to the control of dog rabies in AMS AMS With protocol for case/outbreak investigation Conducts rabies case/outbreak investigation Regulatory Measures For rabies control and For rabies prevention vaccination For dog identification With official programme for management of stray dogs With internal process for declaration of rabies freedom within parts of the country Government unit responsible for declaration Brunei N/A - Cambodia - Indonesia Ministry of Agriculture Lao PDR - Malaysia N/A Department of Veterinary Services Myanmar - Philippines Dept of Agriculture and Dept of Health Singapore N/A Agri-Food and Veterinary Thailand Vietnam - N/A = Not applicable (rabies-free count Authority of Singapore Ministry of Agriculture and cooperatives 14

15 Part 2 Veterinary Services, Legislation and Communication relevant to rabies control efforts in AMS Any country who wish to eliminate rabies (or maintain freedom), will need the leadership of a well-operated national veterinary service. Although it is warranted that other government sectors are also engaged in the process of achieving freedom from this fatal disease, the Veterinary Authority remains to be the core institution who will be responsible for the most critical operations that will determine the success of a national rabies programme. This includes providing effective systems for animal rabies diagnosis, surveillance, reporting, notification and managing animal vaccination campaigns. Legislation is a recognized key to achieving good veterinary governance. With multiple stakeholders involved within and beyond the veterinary services, a country s active engagement to eliminate rabies by 2020 will also critically involve effective communication between all stakeholders. This will cover communications relating to animal health (surveillance, early detection and rapid response, prevention and control), animal welfare and veterinary public health (public awareness campaign and rabies education). The fundamental principles of quality Veterinary Services is outlined in Chapter 3.1 of the OIE Terrestrial Code. Chapter 3.4 provides advice and assistance to Member Countries when formulating or modernising veterinary legislation so as to comply with OIE standards. Chapter 3.3 provides guidance for the development of a communication system, strategic and operational communication plans and elements to assess their quality. Session 2 of the workshop aimed to describe the line of command, existing legal instruments, and existing communication mechanisms and network relevant to rabies control and/or prevention in the ASEAN Member States. 2.1 The Veterinary Authority and Rabies Control and Prevention in the Country As anywhere else in the world, National Veterinary Authorities in ASEAN Member States are structured and operated according to their national purpose, and while there are basic similarities across countries in the region, some aspects still vary. Nevertheless, in this unified regional effort to eliminate rabies, it is important that AMS are made aware of each other s nature of operations where rabies efforts are concerned. This will help facilitate bridging of communications of responsible government units between AMS, and understanding of the nature of implementation of rabies activities, from which lessons can be learned and accordingly adopted. Table 2.1 summarises the responsible government units in AMS for operations related to rabies elimination. It is evident that in most countries and in most instances, rabies-related activities are shared responsibilities of different government units. This underscores the need for sound coordination and communication in managing rabies elimination, within, and occasionally beyond, the Veterinary Authority. The summary also exhibits some examples of shared roles of the human animal health sectors, such as that on the rapid response to rabies cases in Brunei and Lao PDR and Thailand. It is important to highlight that while rabies elimination in ASEAN aims to achieve freedom from this disease, the efforts channeled towards this also insentiently transcends into the strengthening of One Health coordination mechanisms. Such progress in intersectoral collaboration in a way contributes to the joint preparedness of the AMS in addressing any future emergency zoonoses event, should this happen. 15

16 Table 2.1Responsible Government Units for activities related to rabies in ASEAN Member States Responsible Government Units for Brunei Cambodia Indonesia Lao PDR Malaysia Myanmar Philippines Singapore Thailand Vietnam national rabies surveillance DAA NaVRI/VPHO DIC DLF Biosecurity and SPS Mgt. Div. LBVD/DOH AHD AVA DLD MoPH and DAH animal rabies diagnosis DAA NaVRI DIC NAHL, DLF Biosecurity and SPS Mgt. Div. LBVD PAHC AVA DLD and QSMI (Thai Red Cross) NCVDs, RAHOs rapid response for rabies cases management of rabies vaccination campaigns Animal only: DAA Animal + human case: DAA + MoH DAA VPHO/AHO VPHO/AHO Local government Directorate of Animal Health DLF, DCDC DLF Biosecurity and SPS Mgt. Div. Biosecurity and SPS Mgt. Div. Animal LBVD LBVD rabies: BAI, DARFO, LGU, Regulatory Div/Livestock div BAI, DARFOs, LGUs AVA AVA DLD MoPH and DLD and LAO Steering committee for rabies prev. and control DAH, Sub-DAH rabies public awareness DAA VPHO / Extension Office Directorate of Vet Public Health DLF, DCDC Biosecurity and SPS Mgt. Div. LBVD/DOH BAI, DARFOs, LGUs AVA DLD, MoPH and LAO DAH management of stray dogs Municipal board/rbpf/distr. Offices/DAA DAHP/PAHPO Directorate of Vet Public Health - Biosecurity and SPS Mgt. Div. LBVD/ Municipal LGUs AVA DLD and LAO Sub-DAH animal welfare DAA VPHO Directorate of Vet Public Health DLF Biosecurity and SPS Mgt. Div. LBVD BAI, DARFOs AVA DLD DAH management of rabies initiatives over-all DAA DAHP Directorate of Animal Health DLF Biosecurity and SPS Mgt. Div. LBVD/DOH BAI AVA national rabies focal point All notifications go direct to DG and relevant Group AHD = Animal Health Division, BAI (Philippines) LAO = Local Administrative Office (Thailand) AHO = Animal Health Office LBVD = Livestock Breeding and Veterinary Division (Myanmar) AVA = Agri-food and Veterinary Authority (Singapore) LGU = Local Government Unit (Philippines) BAI = Bureau of Animal Industry (Philippines) MoPH = Ministry of Public Health (Thailand) DAA = Department of Agriculture and Agrifood (Brunei) NAHL = National Animal Health Laboratory (Lao PDR) DAH = Department of Animal Health (Vietnam) NaVRI = National Veterinary Research Institute, DAHP (Cambodia) DAHP = Department of Animal Health and Production (Cambodia) NCVD = National Center for Veterinary Diagnosis (Vietnam) DARFO = Department of Agriculture Regional Field Office (Philippines) PAHC = Philippine Animal Health Center, BAI (Philippines) DCDC = Department of Communicable Disease Control PAHPO = Provincial Animal Health and Production Office (Cambodia) DIC = Disease Investigation Centre (Indonesia) RAHOs = Regional Animal Health Offices (Vietnam) DLD = Department of Livestock Division (Thailand) RBPF= Royal Brunei Police Force DLF = Department of Livestock and Fisheries (Lao PDR) VPHO = Veterinary Public Health Office, DAHP (Cambodia) DOH = Department of Health (Myanmar, Philippines) DLD, MoPH DAH and LAO Directors of AVA 16

17 National rabies surveillance is managed at different levels of authority in ASEAN Member States. Majority are handled by the national Veterinary Authority (Brunei, Lao PDR, Singapore and Vietnam) or a more specific unit within the veterinary authority (Malaysia, Philippines). For some, this is also a shared responsibility, either between units within the Veterinary Authority (Cambodia), or across sectors (Myanmar, Thailand). Animal rabies diagnosis is discussed in further detail in Part 3, which will show that several laboratories are involved in rabies diagnosis within a given country. The overall national management of animal rabies diagnosis, however, remains to be the responsibility of the central laboratories or offices for most countries (Brunei, Cambodia, Indonesia, Malaysia, Myanmar, Philippines and Singapore). Rapid response to rabies. In most countries, rapid response to rabies is a multi-agency responsibility (Brunei, Cambodia, Lao PDR, Philippines, Singapore, Thailand and Vietnam), some of which are even cross-sectoral (Lao PDR, Thailand). Some country examples of rapid response to rabies are described in more detail in Box 1.2. Management of rabies vaccination campaigns. In rabies-endemic countries, rabies vaccination campaign is one of the core activities for rabies control and prevention. These campaigns require good coordination and management, especially that this involves substantial number of trained persons for implementation. For many countries (Cambodia, Philippines, Thailand and Vietnam) rabies vaccination campaigns are jointly managed by several government units within and beyond the Veterinary Services. The local government units in particular, are well-tapped human resource for such campaigns in some countries (Philippines, Thailand). Rabies Public Awareness. The ASEAN Rabies Strategy recognizes that public awareness is one of the critical elements for rabies elimination and maintaining rabies freedom. As with other aspects of rabies operations, public awareness is also a shared responsibility within the Veterinary Authority (Cambodia, Lao PDR, and Philippines) and cross-sectorally (Lao PDR and Thailand). Management of stray dogs. Part 5 (Current Situation on Stray Dog Population Management) of this document deals in more detail about the management of stray dogs; Table 2.1 briefly shows, however, that in addition to the Veterinary Authorities, implementation of stray dog management has other involved players such as: the police authorities (Brunei) and the local government units (Philippines and Thailand). Animal welfare. Also integral to rabies elimination effort, is taking animal welfare into consideration. All countries reported responsible units for animal welfare, which, except for the Philippines, is handled by a single government unit. Over-all management of rabies initiatives. Overall management of rabies is being handled and led by their respective Veterinary Authority (for Malaysia however, this is specifically under a division of their DVS). For Myanmar and Thailand, this responsibility is shared by their counterparts from the human health sector. Furthermore, for Thailand, the local government unit is also involved. National rabies focal point. Brunei Darussalam, Malaysia, Myanmar, Philippines, and Vietnam identified responsible focal points for rabies. Cambodia, Indonesia, Malaysia, Singapore, and Thailand indicated that they do not have any specific focal person in-charge of rabies-related issues in the country, but for Singapore, they mentioned that all notifications go directly to the Director General and relevant Group Directors. 2.2 National Rabies Plans, Committees and Legal Instruments National Rabies Plans. Five of the 10 AMS (Malaysia, Philippines, Singapore, Thailand and Vietnam) have national rabies plans, four of which are accordingly endorsed (Malaysia, Singapore, Thailand and Vietnam). Another two (Indonesia and Lao PDR) are currently on the way. National Rabies Committees. Eight of the 10 AMS indicated they have committees that address rabies in their respective countries: Indonesia, Philippines, Singapore, and Thailand (4/10) have specific committees for rabies; while Cambodia, Lao PDR, Malaysia and Myanmar (4/10) have zoonoses committee who also covers rabies issues. All these committees, are multi-agency and include the health sector. The operations of 5 of the 8 national committees are also supported by law. At the minimum the 8 committees meet as needed; while operations functions include meeting regularly, reviewing of rabies situation in the country, monitoring rabiesrelated activities in the country, planning strategies to address rabies, and managing of resources allocated to rabies. 17

18 Table 2.2 National rabies plans, committees and rabies legal instruments Strategic Plan National Rabies Committee Legal instruments related to rabies Name of National Rabies Plan Level of endorsement Name of committee Composition Supported by law Meets Regularly Review rabies situation Monitor rabies activities Plan strategies on rabies Manage resources for rabies Brunei - - n/a - Animal Disease and Quarantine Order Cambodia - - Indonesia Lao PDR Malaysia Rabies Roadmap (in progress) National Rabies Strategy (in progress) National Rabies Control Programme - - Minister of Agriculture and Agro-based Ind. Myanmar - - Philippines Singapore Thailand Vietnam NRPCP Medium Term Plan Contingency plan for rabies Strategic plan for rabies elimination by 2020 National rabies Prevention and control program - DG of AVA DG of DLD and DDC Ministry of Agricuture and Rural Dev t National Strategy on Zoonotic Disease Rabies Coordination team National Committee on EID Inter-Ministries Comm. for Control of Zoonotic Dis s. zoonotic Disease Control Committee National Rabies Prevention and Control Comm. Rabies Working Group Rabies Elimination committee MAFF, MoH, FAO, WHO, PIC, OIE (National) MoA, MIA, MoA; (Local): prov and district/municipality established rabies coord team MoH, MAF, MICI, MES, MOI, MPC - DVS; MoH; Dept of Wildlife and National Parks; Min. of Urban Wellbeing, Housing and Local Gov t; MoE; National Insitute of Occupational Safety and Health Senior officials from LBVD, DoH, Municipal, UVS, MLF, Administrative Authorities DA-BAI, DoH-NCDPC, DILG, DepEd + DENR, NGOs, People s Org., Academe, LGU, PCMVLP Meets as needed Animal Health and Production Law Meets as needed Meets as needed Regulation No 18 (2009), President Regulation No 30 (2011), Minister Decision No (1999), Minister decision of strategic animal diseases No (2013) and various local regulations Decree in Animal Control, Movement (not specific for rabies) Animals Rule 1962, Animals (Importation) Order 1962, Animals Ordinance 1953, Sabah State Ordinance 1962, Public Health (Animals) Regulations 1962 Public Health Regulations 1976, Sarawak Vet. Health Ordinance Animal Health and Development Law 1993 Republic Act No or Anti-Rabies Act of 2007 AVA Officers* - Animals and Birds Act (Chapter 7) DLD, DDC, LAO, QSMI *Singapore has also established a One Health platform with the National Environment Agency and Ministry of Health for zoonotic diseases Rabies Act, Animal Epidemic Act, Public Health Act, Code of Law, Regulation of Local Administration Decre No 33/2005 regarding regulations to perform Veterinary Ordinance, Decree No5/2007 providing regulations for animal rabies prevention and control, Circular 48/2009 providing guidelines for animal rabies prevention and control. 18

19 Box 2.1 Some Examples of national committees on rabies In the Philippines, rabies is handled by the National Rabies Prevention and Control Committee (NRPCC). The committee is composed of the Department of Agriculture-Bureau of Animal Industry (Chair) the National center for Disease Prevention and Control of the Department of Health (DOH-NCDPC) (Vice-chair), and representatives from DA, DoH, Department of Interior and Local Government, and the Department of Education. Members of the Committee includes: Department of Environmental and Natural Resources, Non-Government Organisatoins, People s organisations, Academe, Local Government Units, Provincial, City and Municipal Veterinarians League of the Philippines (PCMVLP). In Malaysia, there are two existing Committees on zoonoses that include rabies: The Inter-Ministries Committeee for Control of Zoonotic Diseases (JKAKPZ) and the Inter-Sectoral Technical Working Group Committee for Control of Zoonotic Diseases (JKTPZ). The Inter-Ministerial Committee is comprised of: Ministry of Agriculture and Agro-based Industries (Department of Veterinary Services, Ministry of Health Malaysia, Department of Wildlife and National Parks Malaysia, Ministry of Urban well-being, Housing and Local Government, Ministry of Education Malaysia, and the National Institute of Occupational Safety and Health. These committees regularly meet, share surveillance information, and discuss on zoonoses. 2.3 Communication Five of the 10 AMS (Indonesia, Singapore, Malaysia, Thailand, Vietnam) have communication strategy for rabies, all of which have an action or operational plan. Majority of these are activities towards rabies awareness and responsible pet ownership. Table 2.3 shows the summary on rabies communication strategies among ASEAN Member States. In Indonesia, activities under this strategic plan include pilot projects in some areas to promote responsible pet ownership, which reportedly improved awareness of the community regarding rabies control and its impact. In Malaysia, activities include (1) annual celebration of the National World Rabies Day, (2) rabies awareness campaign at state level, (3) registration of pet which they implement as pet passport, and (4) vaccination and licensing campaign. As outcomes, Malaysia reports that rabies awareness of the public and animal owners have increased, as well as responsible pet ownership. It also helped in the control of animal movement, and in part is attributed to the present rabies freedom the country enjoys. In Singapore, AVA s field officers and communication group raises awareness through (1) Responsible Pet Ownership campaign; (2) Q&A in the AVA website; (3) through veterinary conferences and seminars, as well as (4) celebration of the WRD. As a result of these efforts, traceability of animals is enhanced as more people license their dogs. Awareness of staff of AVA has also reportedly improved. In Thailand, their communication strategy includes (1) development of risk communication plan, (2) production of model of communication media and materials; (3) public awareness campaign; (4) development of website for public awareness; and (5) risk communication research. These activities led to improved awareness and understanding of people regarding rabies and how to prevent it. In Vietnam, training workshops for rabies awareness enhancement were held, as well as rabies communication on public media. At this point, the actual outcomes of these rather recent efforts are yet to be determined. 19

20 Table 2.3 Rabies and Communication BR CA IN LA MA MY PH SI TH VN Have communication strategy for rabies Have an action/operational plan for the strategy Government unit responsible for implementation Responsible personnel have skills to carry out their functions effectively - *** *** DVPH A - ZVPH B - - AVA s field officers and corporate communication group MoPH, DLD, LAO C - *** A Directorate of Veterinary Public Health B Zoonosis and Veterinary Public Health Section, Biosecurity and SPS Management Division, Department of Veterinary Services, Malaysia C Ministry of Public Health, Department of Livestock Development and Local Administration Organization D Department of Animal Health, Vietnam *** No information at the time of reporting D DAH, Sub- DAH, Media agencies, Associations 20

21 Part 3 Current Status of Animal Rabies Diagnosis in ASEAN Member States Rabies is a major zoonosis for which diagnostic techniques have been standardized internationally. With dogs continuing to be the main source of nearly all human rabies cases, prompt and accurate diagnosis of dog rabies is considered as one of the keys to efficiently and effectively eliminate rabies in endemic countries or maintain freedom in rabies-free countries. As no clinical sign or gross post-mortem lesion can be considered pathognomonic in domestic or wild animals, accurate diagnosis of rabies in a country critically relies on their capacity for quality laboratory testing of rabies. The workshop session on Rabies Diagnosis reviewed the current status of the laboratory capacity for rabies diagnosis in AMS, and identified areas of improvement to further strengthen and progress towards rabies elimination. Reference for this session was Chapter of the OIE Terrestrial Manual, which outlines the testing recommendations for the identification of the rabies agent and serological testing, 3.1 Rabies Diagnostic Laboratories in ASEAN Member States Access to laboratory is critical to early detection and surveillance of rabies. Presently, all ten ASEAN Member States report to have the capacity to diagnose rabies. In the case of historically-free Brunei, however, this is not a routine operation and suspected samples are instead sent out to reference laboratories abroad. Access to rabies diagnostic laboratories in AMS. In total, there are currently 65 rabies diagnostic laboratories operating in the region: (Cambodia =2; Indonesia = 25; Lao PDR = 2; Malaysia = 1; Myanmar =2; Philippines = 19; Singapore = 1; Thailand = 10; Vietnam = 3). Details of these are summarised in Table 3.1 below. Rabies-free countries (Malaysia and Singapore) each reported to having one national laboratory, which help support maintenance of freedom. Among the rabies-endemic countries, Indonesia, Philippines and Thailand - who consistently report hundreds of animal rabies cases annually - have 25, 19, and 10 laboratories, respectively. On the other hand, rabies-endemic countries like Cambodia, Lao PDR, and Myanmar, who all reported comparatively lower numbers of animal rabies annually, have 2 laboratories each. In the case of Cambodia and Lao, both laboratories are also located in their respective capital cities. This may suggest that there could be limitations to accessibility of laboratories, and consequently, under-reporting of rabies cases in these countries. Rabies diagnostic tests in AMS. Fluorescent antibody test (FAT), the gold-standard for rabies diagnosis, is available in all rabies-endemic ASEAN Member States (Cambodia, Indonesia, Lao PDR, Myanmar, Philippines, Thailand, Vietnam), with 58/65 (89.2%) laboratories in the region offering this. Other commonly available rabies diagnostic tests in the region are histology-based test (28/65 or 43.1%) and mouse inoculation test (27/65 or 41.5%), perhaps owing to the relative costs of these tests. A total of 15 (22.7%) of these laboratories report to being able to perform molecular testing for rabies, and 14 (21.2%) are able to test for antibodies against rabies using ELISA. All prescribed tests for rabies are being performed in the region, but only one laboratory (Vietnam) performs FAVN. 21

22 Table 3.1 Rabies Diagnostic Laboratories in ASEAN Member States Country Name of laboratory Type Location FAT IT AgE RIT CC MIT Mol Hist FAVN RFFIT VN AbE Notes Brunei All rabies diagnostic labs (n=1) Sends out samples Veterinary Laboratory Services National Barc, Kilanas, B.S.Begawan Cambodia All rabies diagnostic labs (n=2) National Animal Vet Research Institute National Phnom Penh Institut Pasteur du Cambodge Private Phnom Penh Indonesia All rabies diagnostic labs (n=25) Balivet/IRCVS National Bogor, West Java DIC Medan Regional Medan, North Sumatra DIC Bukittinggi Regional Bukittinggi, West Sumatra Also performs RIAD DIC Lampung Regional Lampung, Lampung DIC Wates Regional Wates, Central Java DIC Denpasar Regional Denpasar, Bali DIC Maros Regional Maros, West Sulawesi DIC Banjar Baru Regional Banjar Baru, South Kilamantan DIC Subang Regional Subang, West Java Jambi Provincial Vet Lab Provincial Jambi, Jambi Riau Provincial Vet Lab Provincial Pekanbaru, Riau North Sulawesi Provincial Vet Lab Provincial Manado, North Sulawesi South East Sulawesi Provincial Vet Lab Provincial Kendari, South East Sulawesi Central Sulawesi Provincial Vet Lab Provincial Palu, Central Sulawesi DKI Jakarta Provincial Vet Lab Provincial Jakarta Aceh Provincial Vet Lab Provincial Banda Aceh, Aceh South Sulawesi Provincial Vet Lab Provincial Manado, South Sulawesi West Sulawesi Provincial Vet Lab Provincial Mamuju, West Sulawesi Maluku Provincial Vet Lab Provincial Ambon, Maluku North Maluku Provincial Vet Lab Provincial Ambon, Maluku Toraja District Lab District Toraja, South Sulawesi North Toraja District Lab District North Toraja, South Sulawesi Ende District Lab District ND, Flores Island, East Nusa Tengara North Mamuku, District Lab District Mamuju, West Sulawesi North Toraja District Lab District Toraja, South Sulawesi 22

23 Country Name of laboratory Type Location FAT IT AgE RIT CC MIT Mol Hist FAVN RFFIT VN AbE Others Lao PDR All rabies diagnostic labs (n=2) National Animal Health Laboratory National Vientiane Capital NCLE National Vientiane Capital Malaysia All rabies diagnostic labs (n=1) Veterinary Research Institute National Ipoh, Perak, Malaysia Myanmar All rabies diagnostic labs (n = 2) Yangon Veterinary Diagnostic Lab National Yangon Mandalay Veterinary Diagnostic Lab Regional Mandalay Philippines All rabies diagnostic labs (n=19) Philippine Animal Health Center National Visayas Avenue, Diliman, QC Research Institute for Trop Med National Corporate Ave, Alabang, Muntinlupa Regional Animal Dis Diagnostic Lab 1 Regional Tebag, Sta. Barbara, Pangasinan Regional Animal Dis Diagnostic Lab 2 Regional Tuguegarao, Cagayan Regional Animal Dis Diagnostic Lab 3 Regional San Fernando City, Pampanga Regional Animal Dis Diagnostic Lab 4 Regional Marawoy, Lipa City, Batangas Regional Animal Dis Diagnostic Lab 5 Regional Cabangan, Camalig, Albay Regional Animal Dis Diagnostic Lab 7 Regional M. Velez Street, Cebu City Regional Animal Dis Diagnostic Lab 9 Regional Tumaga, Zamboanga City Regional Animal Dis Diagnostic Lab 10 Regional A Luna St., Cagayan de Oro City Regional Animal Dis Diagnostic Lab 11 Regional Bago Oshiro, Davao City Regional Animal Dis Diagnostic Lab 12 Regional Cotabato City Regional Animal Dis Diagnostic Lab 13 Regional Agusan City Regional Animal Dis Diagnostic Lab CAR Regional Guisad, Baguio City Aklan State University Academe Banga-Libacao Highway, Aklan Provincial Veterinary Office LGU Gomburza St, Laoag, Ilocos Norte Provincial Veterinary Office LGU Bacolod City Provincial Veterinary Office LGU Dumaguete City City Veterinary Office LGU Puerto Princesa City Singapore All rabies diagnostic labs (n=1) Animal Health Laboratory National 6 Perahu Road, Singapore 23

24 Country Name of laboratory Type Location FAT IT AgE RIT CC MIT Mol Hist FAVN RFFIT VN AbE Others Thailand All rabies diagnostic labs (n=10) National Institute of Animal Health Upper Northern Veterinary Research and Development Center Lower Northern Veterinary Research and Development Center Upper Northeastern Veterinary Research and Development Center Lower Northeastern Veterinary Research and Development Center Eastern Veterinary Research and Development Center Western Veterinary Research and Development Center Southern Veterinary Research and Development Center Lower Southern Veterinary Research and Development Center National and Central Regional Bangkok Regional Lampang Province Regional Phitsanulok Province Regional Khonkaen Province Regional Surin Province Regional Chonburi Province Regional Ratchaburi Province Regional Nakhornrachasima Province Regional Songkhla Province Queen Saowapa Memorial Institute National Bangkok Vietnam All rabies diagnostic labs (n = 3) National Institute of Hygiene and Epidemiology National Hanoi Ho Chi Minh City Pasteur Institute National Ho Chi Minh City Ho Chi Minh City Sub-Department of Animal Health Provincial Ho Chi Minh City All AMS All rabies diagnostic labs (n = 65) FAT = Fluorescent Antibody Technique IT = Immunochemical Test AgE = Antigen ELISA RIT = Rapid Immunodiagnostic Test CC = Cell Culture for rabies virus MIT = Mouse Inoculation Test Mol = Molecular Techniques Hist = Histology-based test FAVN = Fluorescent Antibody Virus Neutralisation RRFIT = Rapid Fluorescent Focus Inhibition Test VN = Virus Neutralisation in mice AbE = Antibody ELISA 24

25 2.2 Strengthening capacity on rabies diagnosis Other than the availability and accessibility of diagnostic tests in the countries, quality of diagnosis is also important. Human resources involved in rabies diagnosis need to be provided technical and training support to be able to effectively and efficiently perform their tasks. Table 3.2 Activities of ASEAN Member States related to rabies diagnosis capacity Capacity building activities for rabies diagnosis BR CA IN LA MA MY PH SI TH VN Participation in regional proficiency testing Conducts activities for strengthening rabies diagnosis Avails assistance from OIE Reference Laboratories for rabies Proficiency testing for rabies diagnosis. In 2013, regional proficiency testing for rabies was conducted through the support of USAID IDENTIFY Programme of the FAO RAP. Facilitated by the Australian Animal Health Laboratory (AAHL) based in Geelong, Australia, this regional proficiency testing was participated by 8 of the 10 AMS (Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Thailand and Vietnam). Programmes for strengthening rabies diagnosis. Indonesia, Philippines, Singapore, Thailand, and Vietnam have all indicated having programmes to strengthen rabies diagnosis in their countries. In Indonesia, trainings on rabies diagnosis are conducted, in collaboration with experts from both the national laboratories and universities. Other than participating in regional proficiency testing, they also conduct national proficiency testing for their laboratories. The Philippines have in-house basic quality control for FAT, while Singapore attends annual training workshop organized by rabies OIE reference laboratory in South Korea (Rabies Research Laboratory at Quarantine and Inspection Agency of Korea). Thailand offers training programmes on rabies diagnosis locally, while Vietnam, under their national rabies prevention and control program also trains laboratory staff. Linkage with OIE Reference Labororatories for rabies.oie Reference Laboratories are designated to pursue all the scientific and technical problems relating to a named disease or specific topic. The Expert, responsible to the OIE and its Member Countries with regard to these issues, are leading and active researchers helping the Reference Laboratory to provide scientific and technical assistance and expert advice on topics linked to surveillance and control of the disease for which the Reference Laboratory is responsible. Reference Laboratories may also provide scientific and technical training for personnel from Member Countries, and coordinate scientific and technical studies in collaboration with other laboratories or organisations. There are 10 OIE Reference Laboratories for rabies globally, two of which are in Asia: the Changchun Veterinary Research Institute (CVRI) in Changchun, China, and the Rabies Research Laboratory in South Korea. Indonesia, Singapore, and Vietnam reported tapping this scientific resource for rabies diagnosis. Indonesia also reports linking up with the Australian Animal Health Laboratory to increase the capacity of their laboratory, particularly in the validation of RIAD, RFFIT, PCR and rtpcr for rabies diagnosis. Singapore requested protocols for rabies rtpcr and qrt-pcr from the Nancy Laboratory for rabies and wildlife in France. They also requested antibodies for immunohistochemistry from the Centre of Expertise for Rabies CFIA/ACIA, Ottawa Laboratory Fallow field, Animal Disease Research Institute in Canada. They also procured positive paraffinized tissues from the Rabies and Wildlife Zoonoses Group from the Veterinary Laboratories Agency in UK. 25

26 26

27 Part 4 Current Status of Rabies Vaccines and Vaccination in ASEAN Member States OIE s policy on rabies control recognizes that controlling rabies in domestic animals is key to preventing human deaths. With only 10% of the financial resources for PEP in humans needed, eradicating rabies at source is certainly more cost-effective. Vaccination of animals using high quality vaccines and with an effective coverage of at least 70% of the susceptible population, is therefore critical in controlling and eliminating rabies, along with accompanying essential measures such as effective surveillance and diagnostic capabilities, dog population management, public awareness, and other related initiatives. Rabies vaccines are defined as a standardised formulation containing defined amounts of either inactivated (killed), live-attenuated or biotechnology-derived rabies immunogens. The principal rationale for the use of injectable vaccine is to protect human health through the prevention and control of rabies in animals, particularly dogs. Licensed vaccines for the parenteral vaccination of domestic animals and oral vaccines for the immunization of wild animals are available, while oral vaccines for dogs remains to be in the experimental stage. The minimum requirements for conventional and oral vaccines are found in the Chapter (Rabies) of the OIE Terrestrial Manual for Diagnostic Tests and Vaccines. Relevant hygiene precautions and vaccination are found under Chapter 4.15 of the OIE Terrestrial Code. The first OIE regional rabies vaccine bank for Asia was launched in early 2012 under the HPED programme funded by the European Union. To date, 2,690,400 doses of rabies vaccines have been supplied free of charge to ten eligible countries in Asia, and additional 300,000 doses were purchased through the STANDZ programme funded by Australia. The workshop session on rabies vaccines and vaccination familiarized AMS on the minimum requirement for conventional and oral rabies vaccines, and also provided venue for discussions on vaccine quality and vaccination strategies. 4.1 Rabies vaccines in ASEAN Member States Sources of rabies vaccines for AMS. Of the 10 ASEAN Member States, only Indonesia produces rabies vaccines. Myanmar also reported that they used to produce lyophilized ARV, but this was discontinued in All AMS, however, import rabies vaccines. Among the reported vaccines imported into the region were: Rabisin (Merial), Rapigenmono (France), Rabivac (Intervac), Novovac Rabies and Rabvac 3TF (Fort Dodge), Rakshavac (India), Biocan R and Bayovac R (Bioveta, Czech Republic), Canvac R (Dyntec, Czech Republic), Defensor (Zoetis, USA), Nobivac Rabies (Intervet International, The Netherlands), Rabigen Mono (Virbac Laboratories, France), Raksharab (Indian immunologi-cals, India). Types of rabies vaccines in use in AMS. Majority (8/10) use killed rabies vaccines. Cambodia reports using live attenuated vaccine provided by an international donor, while Malaysia reports using inactivated vaccines. Rabies vaccine use in AMS. Most countries did not have information on the number of total doses of rabies vaccines that entered into their countries. Cambodia, Lao, Malaysia, and Philippines reported these figures, but for the most part are limited to what was imported (and distributed) by the government. Likewise, available information on the actual vaccine use/distribution in all AMS was also very limited, except for Malaysia and Singapore which are rabies-free countries using very small number of vaccine doses against rabies. Annual budget on rabies vaccines. Indonesia Malaysia, and the Philippines reported the total budget allocated by their respective governments towards rabies vaccines. The Philippines further added that from , the annual budget averaged at about USD 220,000, but in 2014, improved to about USD 950,000 with a quarter of this allocated for operations. 27

28 Box 4.1 Some examples of quality control of rabies vaccines in ASEAN Member States Seven of the 10 AMS (Brunei, Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam) shared their standard quality control procedures for importation of rabies vaccines. Brunei only imports and does not produce rabies vaccines locally. For quality control of imported rabies vaccines, relevant licenses must be acquired from the Ministry of Health prior to importation. MoH will then refer this to the Department of Agriculture and Agri-food. In Indonesia which produces local rabies vaccines, the standard process are followed, including dossier check and final product test. Manufactured vaccines are also sampled and tested in the field. In Malaysia, imported vaccines need to secure the Technical Advisory Committee Biologic endorsement. In the Philippines, routine standardization tests for rabies vaccines are done annually. This includes sterility test and safety test. The potency test which is also included in this routine testing, is not performed however. In Singapore, all vaccines that are imported must be approved by the Biologics Evaluation Committee from AVA. Each batch of vaccine in each consignment must be accompanied by a quality control certificate. Each batch of vaccine is also subject to sampling at the AVA lab. For Thailand, imported vaccines need to be registered and approved by Food and Drug Authority (FDA) Thailand, while in Vietnam vaccines are experimentally checked by the Veterinary Drug Inspection Centers and registered with the Department of Animal Health for license. Table 4.1 Rabies vaccine utility in ASEAN Member States Rabies vaccines BR CA IN LA MA MY PH SI TH VN Source of vaccines A. Locally produced A B. Imported Type of dog rabies vaccines currently available for use A. Killed B. Live attenuated vaccines C. Biotechnology-derived vector vaccines D. Inactivated vaccines Vaccine use (2012) A. Total doses of imported n/i 3,500 n/i 128, n/i 1,861,526 3,000 n/i < 3M B. Total doses imported, utilised n/i 3,500 n/i 128, n/i 896,690 1,902 n/i n/i C. Total doses of locally produced , D. Total doses utilised M Vaccine use (2013) A. Total doses of imported n/i n/i n/i n/i n/i 1,818,471 5,400 n/i < 3M B. Total doses imported, utilised n/i n/i n/i n/i n/i 727,180 1,182 n/i n/i C. Total doses of locally produced - - 1,020, D. Total doses utilised M Annual budget from Government A. Vaccines n/i n/i USD 1.5 M none RM 50,000 n/i PHP 40 M B n/i n/i n/i B. Operational expenses n/i n/i n/i n/i n/i n/i PHP 10 M n/i n/i n/i n/i = no information A Lyophilised ARV by LBVD, but at present not available B Annual budget averaged about PhP 10,000,000 (approx. USD 228,838) for the last 5 years ( ) but in 2014, this has improved to PhP 40,000,000 with PhP 10,000,000 allotted for operational expenses. 28

29 4.2 Rabies vaccination in ASEAN Member States National rabies vaccination plans in AMS. Six of the 10 AMS (Indonesia, Malaysia, Myanmar, Philipines, Thailand, and Vietnam) have rabies vaccination strategies in their countries. Box 4.1 Some examples of National Rabies Vaccination Plans and Strategies In Malaysia, a rabies-free country, vaccination against rabies is prerequisite to licensing and is also compulsory in the immune belt area a km width along the Thai border. In Peninsular Malaysia, dogs and cats imported from rabies-infected countries are vaccinated upon arrival and quarantined for a minimum period of thirty days. Young pets are detained until they reach the vaccination age of 3 months when they are then vaccinated and further quarantined for thirty days thereafter. Rabies vaccination, however, is currently not practiced in Sabah and Sarawak. For the Philippines, rabies vaccination is accordingly guided by the National Rabies Prevention and Control Program Manual of Operations This document outlines the general guidelines for mass vaccination, the approaches for vaccination, vaccination strategies, target population, animal vaccines against rabies, the conduct of dog vaccination, personnel involved in the vaccination, and estimation of dog populations. According to this manual, a single strategy or a combination of strategies can be used for domestic dog vaccination and should be selected on the basis of the setting or known socio-cultural factors. Rabies vaccination strategies in AMS. This can be any, or a combination of the following: (1) continual vaccination at fixed vaccination posts in well-recognized sites within the community where dog owners could take their dogs/cats for anti-rabies immunization; (2) Mobile teams in temporary vaccination points at a central location within individual villages or cities conveniently located for dog owners; (3) house-to-house campaigns; and (4) synchronized campaigns done within a short period of time. Table 4.2 summarises the strategies employed by the different Member States where mass vaccination is implemented, showing that in Indonesia, Philippines and Thailand, a combination of all strategies are used. In rabies-endemic areas, rabies vaccination for dogs is only compulsory in 5 of the 7 AMS (Indonesia, Lao PDR, Philippines, Thailand, and Vietnam), and in 4 of the 7 AMS (Lao PDR, Philippines, Thailand, and Vietnam) for cats. For all the 10 AMS, rabies vaccination is neither compulsory nor routinely practiced in livestock and wildlife. 29

30 Table 4.2Rabies vaccination in ASEAN Member States Rabies vaccines BR CA IN LA MA MY PH SI TH VN Vaccination strategies A. Continual vaccination at fixed points * * B. Vaccination by mobile teams - countrywide * * C. Vaccination by mobile teams temp. vacc n points * * D. house-to-house campaigns * * E. Others * * Rabies vaccination in dogs A. Yes, compulsory for the whole country B. Yes, compulsory in select areas only C. No, but practiced routinely in the whole country D. No, but practiced routinely in select areas E. No, it is neither compulsory nor routinely practiced Rabies vaccination in cats A. Yes, compulsory for the whole country B. Yes, compulsory in select areas only C. No, but practiced routinely in the whole country D. No, but practiced routinely in select areas E. No, it is neither compulsory nor routinely practiced Rabies vaccination in livestock A. Yes, compulsory for the whole country B. Yes, compulsory in select areas only C. No, but practiced routinely in the whole country D. No, but practiced routinely in select areas E. No, it is neither compulsory nor routinely practiced Rabies vaccination in wildlife A. Yes, compulsory for the whole country B. Yes, compulsory in select areas only C. No, but practiced routinely in the whole country D. No, but practiced routinely in select areas E. No, it is neither compulsory nor routinely practiced * Mass vaccination is not done 4.3 Rabies post-vaccination monitoring in ASEAN Member States Post vaccination activities in AMS. Three of the 10 AMS (Indonesia, Philippines, Thailand) have postvaccination monitoring activities for the vaccinated population. In Indonesia, rabies vaccination monitoring is conducted through a evaluation of antibody titer among dogs with collar (vaccinated) where rabies elimination program is implemented. In the Philippines, their Manual of Operations describes an assessment of dog immunization coverage using cluster survey. Here, post-vaccination questionnaire surveys are used to determine the proportion of vaccinated to unvaccinated dogs in households. During these surveys, dog owners are supposed to be asked to produce vaccination 30

31 certificates to identify vaccinated dogs. In Thailand, PVM for rabies is not routinely done, but conducted as a research project. Vaccination reporting mechanisms. For rabies vaccination reporting, Cambodia uses the existing report system for HPAI. The diagram below (Fig 4.1) shows the vaccination reporting mechanism in Indonesia: Fig 4.1 Vaccination Reporting Mechanism for Indonesia For Malaysia, vaccination data from the district office is relayed to the state office, which then relays it to the headquarters at Biosecurity and SPS Management Division, DVS. In the Philippines, vaccinators collect and duly accomplish the report on the summary of vaccination, and submit this immediately to the coordinator, with copy to BRCCC chairman and the Animal Health Division of BAI. Vaccinated animals and other details of the animal and their owner are also recorded in the Philippines Animal Health Information System (Phil AHIS) database. In Singapore, private veterinarians vaccinate owned pets against rabies to meet the import requirements of the importing country. These private veterinarians are required to fill out a sheet and send these records to AVA. In Thailand, rabies vaccination data during annual rabies campaign are reported (using the reporting forms) from livestock provincial office to the central office (Bureau of Disease Control and Veterinary Services) via . Mandatory reporting mechanism is also in place for provinces given vaccine allocation, who reported this through e-operation database of the planning division DLD. In Vietnam, the Sub-DAH is responsible to report rabies vaccination to DAH, Ministry of Agriculture and Rural Development. System for identification of vaccinated animals. In Malaysia, dogs vaccinated against rabies are identified with metal tags, while Myanmar uses red collar or ribbon. In the Philippines dog tags are used to identify vaccinated animals from the non-vaccinated animals, while vaccination records are used by Singapore. Thailand uses both rabies tags and vaccination certificate to identify vaccinated animals. 31

32 32

33 Part 5 Current Status of Stray Dog Population Management in ASEAN Member States Dog population management is an important part of a rabies control plan and is often purposively integrated into national programmes. While OIE well-recognises its critical role in achieving rabies freedom, it likewise continues to uphold the importance of controlling dog populations without causing unnecessary animal suffering. An important area of emphasis therefore, as the region progress towards dog rabies elimination, needs to be also placed on animal welfare. In principle, responsible dog ownership can significantly reduce the numbers of stray dogs and the incidence of rabies. With dog ecology heavily linked with human activities, the control of dog populations need to also be reinforced by changes in human behavior. Recommendations for Animal Welfare in general may be found in Chapter 7.1 of the OIE Terrestrial Animal Health Code, while that for the Stray Dog Population Control is under Chapter 7.7. The workshop session reviewed international standards on stray dog population control, discussed animal welfare considerations in rabies control programmes in South-East Asia, and also covered discussions on estimating stray dog population. 5.1 Responsible Pet Ownership in ASEAN Member States Seven of the 10 AMS confirmed that they have ongoing campaigns on responsible ownership. These are Brunei (2013), Indonesia (2012), Malaysia (2010), Myanmar (2004), Philippines (estimated to have started in the 1980s), Singapore (2004) and Thailand (1993). Except for Brunei which never had a case of human or animal rabies reported, all were linked to the National Rabies Programme. Malaysia, Philippines, Singapore and Thailand also reports that these campaigns are nationwide, while Brunei, Indonesia, and Myanmar indicated these are only in select pilot areas. In Brunei, the campaign activities include promotion of awareness of responsible pet ownership to encourage pet owners to continuously improve and maintain good health status of their pets. NGOs also have talks on issues of strays. In Indonesia, the campaign has actually been initiated many years back, but had only been found effective in big cities. An example of this is the Capital city Jakarta, which has a local regulation on responsible ownership. Its implementation has been successful, contributing to the maintenance of rabies freedom in Jakarta.Since 2012, an intensive community awareness program was launched under the zoonotic diesease and animal welfare program to improve community awareness on zoonotic disease and pet ownership. However due to limited budget allocation, only selectareas were covered with plans of progressively being replicated to other areas. In 2013 the pilot started in Kepulauan Riau and North Sumatra Province. In 2014 the program was replicated in Bali, Riau, NTT and Banten. In 2015 the program will be replicated in West Kalimantan, DKI Jakarta, West Java, Papua, East Java and North Sulawesi. Moreover, animal welfare program has been enhanced, and improvement in animal welfare in general is expected, including pet ownership. Malaysia has an animal registration campaign through the Pet Passport program, which has been successfully carried out nationwide. The campaign is managed by the Department of Veterinary Services Malaysia, with the help of accredited Veterinarians. In Myanmar, responsible dog ownership program was initiated by the Municipal City Development Council through dog registration in Yangon and Mandalay, accompanied by vaccination of owned dogs. However, this is deemed not applicable nationwide, as an estimated >80% of dog population are strays. Myanmar considers responsible pet ownership campaign along with mass vaccination campaign and rabies awareness as needed, and can be implemented in pilot areas. They consider that because of the present lack of infrastructure, technical and funding support is needed. 33

34 In the Philippines, the Encouragement of the practice of responsible pet ownership (Joint Administrative Order No. 01, series of 2008 Implementing Rules and Regulations of Republic Act 9482, Section 4. Rule 4.2.7) states that: (a) all NRPCC members tasked to implement the NRPCP shall undertake activities in promoting Responsible Pet Ownership (RPO); (b) concerned citizens shall report to the proper authorities the presence of stray or abandoned dogs, instances of abuse or irresponsible action of dog owners such as but not limited to neglect and infliction of harm; and (c) pet owners shall be provided information on RPO such as grooming, health care, proper nutrition, shelter, and others during registration and vaccination events. As a champion for animal welfare, Singapore s AVA has been actively promoting responsible pet ownership to equip existing and potential owners with knowledge on the care and responsibility that comes with owning a pet. As part of our educational efforts, AVA has been reaching out to students to inculcate a sense of responsible pet ownership through talks at schools since 2001.In 2004, AVA intensified its responsible pet ownership public education efforts with the official launch of its Responsible Pet Ownership Public Education Programme. With the advent of the Responsible Pet Ownership Public Education Programme, AVA paved the way towards a society that cares for the welfare of its animals. Expanding its public education efforts beyond talks at schools, AVA adopted a multi-prong approach to spread the message of 'A Pet Is For Life' to the public. These included the organization of responsible pet ownership events and roadshows and mass media efforts such as advertorials, radio advertisements and television commercials. In addition, a Responsible Pet Ownership Icon was also developed. AVA will continue to work closely with animal welfare organizations and other like-minded organizations to create greater awareness on animal welfare. Thailand has four main activities: dog population survey and registration, mass vaccination campaign, dog population control and public relation and parade campaign. Local Administration Organizations are motivated to integrate multiple sectors in the campaign, such as schools and NGOs in local areas. Table 5.1 Responsible pet ownership in ASEAN Member States Responsible Pet Ownershiip BR CA IN LA MA MY PH SI TH VN With responsible pet ownership (RPO) campaign Year started B 1980s? RPO is linked to the rabies national programme Extent of RPO Campaign Select areas - Select areas - Select areas Nationwide Nationwide Nationwide Nationwide - RPO Campaign is initiated by Govt - Govt - Govt Govt Govt Govt Govt - RPO Campaign is managed by Govt - Prov&Dis t - Govt A Govt Govt C Govt Govt E - RPO Campaign is funded by Govt - Govt - Govt Govt Govt D Govt Govt F - A Campaign is managed by the National Government, together with accredited veterinarian B Stated 10 years ago, but limited to 2 cities only; not applicable nationwide as approximately >80% are strays C Campaign is managed by the National Government, together with the Local Government Units (LGUs) D Campaign is funded by the National Government, shared by the LGUs and the Department of Agriculture Regional Field Offices (DARFOs) E Campaign is managed by the National Government, shared by human health sectors, university, Thai Red Cross society, and Local Administration Organization F Campaign is funded by the National Government, shared by human health sectors, university, Thai Red Cross society, and mainly from the Local Administration Orgamization 34

35 5.2Stray Dog Population Control and Management in ASEAN Member States Stray Dog Population Control and Management Programmes. As shown in Table 5.2 below, 8 of the 10 AMS have programmes on stray dog population control and management: Brunei (estimated to have started in 1984), Indonesia (2010), Malaysia (1952), Myanmar (1994), Philippines (2009), Singapore (1953), Thailand (1993, but became a national strategy in 2013), and Vietnam (2009). As with the responsible pet ownership, all are linked to the national rabies programme, except for rabies-free Brunei. It is nationwide in 6 of the 8 AMS (Brunei, Malaysia, Philippines, Singapore, Thailand and Vietnam). Programme Initiation, Management and Funding. Although almost all identified that their National Government initiated, manages, and funds the stray dog population program, some countries reported that this is shared with other agencies or groups in their respective countries. For example, in Myanmar the stray dog population control program was initiated by the government together with the Veterinary Association, and in Thailand, with NGOs and the local authority. The programme is also managed together with the NGOs (Brunei) and mainly by the local authority and NGOs (Thailand). Funding programmes are also mostly by the National Government, although in some instances, it the Local Government (Philippines, Thailand) or NGOs (Thailand) cover this completely or in part. Table 5.2Stray dog population control/management in ASEAN Member States Stray dog population control/management BR CA IN LA MA MY PH SI TH VN With stray dog population control programme Year started 1984? ? 1993 C 2009 Linked to the rabies national programme - - Extent of stray dog population control programme Nationwide - Select areas - Select areas Nationwide Nationwide Nationwide Nationwide Nationwide Programme was initiated by Govt - Govt - Govt Govt B Govt Govt Govt D - Programme is managed by Govt A - Govt - Govt Govt Govt Govt Govt E - Programme is funded by Govt - Govt - A Programme is managed together with NGO B Programme was initiated by the National Government together with Myanmar Veterinary Association (MVA) C Programme started in 1993 but became a national strategy since 2013 D Programme was initiated by the National Government together with LAO, NGO E Programme is managed by the National Government but mainly by LAO, NGO F Programme is funded by the National Government but mainly by LAO, NGO Govt Govt LGU Govt Govt F Others Programme Stakeholders. Table 5.3 below shows that multiple stakeholders are involved in stray dog population control and management in ASEAN Member States where it exists. Most commonly involved are the countries Veterinary Authority (8/8) and other Government Agencies (8/8). NGOs were also commonly identified (7/8), followed by local government authorities and dog owners (6/8), and private sector veterinarians (5/8). Other sectors identified as role-players in some countries were: the academe and educators, and private contractors. Some of the identified roles of Veterinary Authorities include: euthanasia when necessary, extension work and collaboration with technical support, rounding up of stray dogs throughout public areas, and castration, spaying and vaccination. Other government agencies are seen to play roles in: capturing and impounding, 35

36 garbage management (to control stray dogs), assisting in rounding up of strays, and local administration. Non- Governmental Organisations manage shelters, participate in logistic support, and render services such as rehoming of strays, castration, spaying and vaccination. Local Government Authorities has a role in law enforcement, assist in rounding up of stray dogs, coordination, castration, spaying, vaccination, implementation, public relation, and funding. The important role of dog owners are mostly seen as related to responsible pet ownership. Additional sectors identified were the educators/academe for their role in the development of curriculum for rabies prevention, training, clean market project, and temple dog registration. Private contractors engaged by government were also identified for their role in rounding up of stray dogs. Table 5.3 Stakeholders in the stray dog population control/management in ASEAN Member States AMS Veterinary Authority Other Gov t Agencies Private Sector Vets NGOs Local Gov t Authorities Dog Owners Brunei Others Cambodia Indonesia - Lao PDR Malaysia - Myanmar Philippines Singapore Thailand Vietnam Control Measures in Stray Dog Population Control Article of the OIE Terrestrial Animal Health Code identifies the following control measures that could be implemented according to the national context and local circumstances: (1) education and legislation for responsible pet ownership; (2) registration and identification of dogs or licensing; (3) reproductive control; (4) removal or handling; (5) capture and return, rehoming or release; (6) environmental controls; (7) control of dog movements international; (8) control of dog movements within country; (9) regulation of commercial dog dealers; (10) reduction in dog bite incidence; and (11) euthanasia. These measures may be used in combination. Table 5.4 shows the measures implemented in dog population management in ASEAN Member States, both at the national and local levels. At the national level, control of international dog movement is the most commonly practiced measure in the region (8/10), followed by education and legislation for responsible pet ownership (6/10). The least practiced measures is removal in handling (1/10). Euthanasia of dogs, used alone, is not an effective control measure. If used, it should be done humanely (see point 11 of Article ) and in combination with other measures to achieve effective long term control. It is also important that authorities gain an understanding of people s attitudes towards dog ownership so that they can develop a cooperative approach to the control of dog populations. Four of the 10 AMS perform euthanasia, with further details on methodology shown in Table 5.5 below. 36

37 ary Table 5.4 Measures implemented in dog population management in ASEAN Member States AMS Education and Legislation for RPO Registration & identification of dogs Reproductive control Removal and handling Capture, return, rehoming, release Environmental controls Control of dog movements (international) Control of dog movements (w/in country) Regulation of commercial dog dealers / breeders Reduction in dog bite incidence Euthanasia National Local National Local National Local National Local National Local National Local National Local National Local National Local National Local National Local Brunei Cambodia Indonesia Lao PDR Malaysia Myanmar Philippines Singapore * Thailand Vietnam *Rehoming only 37

38 5.5 Methods involved in dog euthanasia in ASEAN Member States AMS Method of restraint Method of euthanasia Method to confirm death Method for carcass disposal Brunei Manual/Cage Barbiturate Absence of vital signs Ground burial Cambodia Indonesia Lao PDR Malaysia Manual restraint/motorized squeeze cage Injectable using drug intra-cardia/intra-venous Cessation of vital signs Incinerator Myanmar Philippines Use of pole nets; humane/animal friendly nets; traps; snare/catch pole an or in combination with nets; tranquilizer gun; tranquilizer blow darts Phenobarbital injection overdose (IV,IP) inhalant anaesthetics, other injectables (MgSo4, KCl, neuromuscular blocking agents) however, dog must be in a deep plane of anesthesia prior to this; tiletamine with zolazepam or ketamine with diazepam or other sedative combinations; firearms with no less than caliber.22with no expansive bullets (target area: head or heart); carbon monoxide from car exhausts using gasoline engines Absence of vital signs Dispose the carcass by burying or burning in a pit. Disinfect the working area with 10% household bleach (Chlorox) or 3% Lysol. Discourage eating of the meat of the biting animal. Singapore Manual restraint using squeeze cage Barbiturates Veterinarian confirmation Incineration Thailand Trap, food offer, sedative bait and net include blow darts Nembutal over dose Respiratory, heartbeat, pupil Bury or burn Vietnam

39 Part 6 Current Status of Rabies Surveillance Activities in ASEAN Member States A timely, concise, and regular regional exchange of rabies situation between ASEAN Member States will be a critical tool to achieve the goals of rabies-free ASEAN Fortunately, an effective platform is already in place and can be efficiently utilised for this purpose - the World Animal Health Information System (WAHIS). WAHIS is an internet-based computer system that processes data on reportable animal diseases (including rabies) with the purpose of sharing the reported information with the international community. Access to this secure site is only available to authorised users, namely the Delegates of OIE Member Countries and their authorised representatives, who use WAHIS to notify the OIE of relevant animal disease information. The OIE has been collecting data on domestic and wild animals on a six-monthly basis. Moreover, countries provide information on human cases on a yearly basis. The national depot for rabies surveillance data should therefore be accordingly linked with the WAHIS focal points, and the reporting channels appropriately streamlined. The OIE also has various facets of disseminating this information, including through disease alerts, bulletins and through access to information about specific diseases and events through the World Animal Health Information Database (WAHID). Additionally, the region also has the ASEAN Regional Animal Health Information System (ARAHIS). This has been developed with the cooperation of the ASEAN Sectoral Working Group on Livestock (ASWGL), and with support from the Australian Government, OIE, and ACIL. The system builds on and extends the functions of existing regional animal health information systems, covering the five priority diseases of ASEAN namely: footand-mouth disease (FMD), classical swine fever (CSF), highly pathogenic avian influenza (HPAI), Newcastle Disease (ND), and Rabies. The session on surveillance reviewed the current national surveillance and reporting mechanism of countries for rabies. The role of the OIE Focal Point for Animal Health Information, and its link to the national rabies surveillance data was also covered, as well as a review on WAHIS data entry and its regional and global relevance to rabies elimination. 6.1 National Rabies Surveillance in ASEAN Member States Brunei Darussalam is the only country among ASEAN Member States that is considered to be historically free from rabies. Presently there is no ongoing system for rabies surveillance, although it is recognized that the Department of Agriculture and Agri-food is in-charge of collating rabies information from the field and laboratory, should the need arise. Cambodia presently does not have a rabies surveillance system in place. There is no organized body of information regarding number of dog rabies cases, however, Ly and co-workers (2009) reported that from 1998 through 2007, the Institut Pasteur Cambodge (IPC) received 1,255 animal heads. Of these, 1,213 (96.7%) were from dogs and 42 were from cats, cattle, and monkeys. The laboratory confirmed rabies in a total of 596 cases in dogs, coming from 17 of the 24 Cambodia provinces. The authors noted however, that 95% of them were located within the 200 km radius from Phnom Penh where the IPC is located. Rabies in domestic and wild animals has been reported to the OIE as a suspected status since the second half of 2001 and 2013, respectively. Indonesia has a rabies surveillance system in place since The Directorate of Animal Health is in charge of collating all rabies data, coming from the field and their laboratories. Surveillance activities include: disease reporting or notification, control programmes or health schemes, laboratory investigation records and field observations. Indonesia notes however, that although the integrated bite case management (IBCM) is in order in areas with eradication programs, coordination between animal and human health sectors is not yet established in all areas. First exceptional epidemiological event was reported in Bali in December 2008 to the OIE. In 2011, the country was officially declared rabies endemic. 39

40 Lao PDR does not have an ongoing system for rabies surveillance. Passive information from the field observations and the laboratory records are managed by the DVS and NAHL. Rabies has been reported to the OIE as present in domestic animals since Malaysia has implemented rabies surveillance system in Presently there are two types of surveillance: (1) In the immune belt area (50-80 km width around the Thai border), all dog bite cases are brought to the attention of the Veterinary Department. The dog is detained and observed for a period of two weeks. If the dog shows signs of rabies, a necropsy is performed. (2) Per district, a random sample of 30 stray dogs destroyed in the immune belt area and 15 from the non-immune belt area are also subjected to rabies testing. For reporting, information from the district office is brought to the state office, and finally to the headquarters of the Biosecurity and SPS Management Division of the Department of Veterinary Services, the government unit in Malaysia who is responsible for collating rabies data for the country. Rabies has been reported to the OIE as present in domestic animals since Rabies has been reported to the OIE as absent in domestic animals since At present, Myanmar does not have an on-going system for rabies surveillance. Rabies-related information in animals however,are collated from the field and the laboratory by the Epidemiology Unit of the Disease Control and Research Division of the Livestock Breeding and Veterinary Department (LBVD) of Myanmar. Myanmar identifies lack of awareness and a formal system for rabies reporting as some of the country s major problem in rabies reporting. Rabies has been reported to the OIE as present in domestic animals since 2005 except for the second semester 2008 and first semester The Philippines has an ongoing rabies surveillance system (Fig. 6.1), which is estimated to have commenced in the 1990s. The detailed guideline for animal rabies surveillance in the Philippines is detailed in pages of the NRPCP Manual of Procedures (2012). Briefly, the diagnostic laboratories are required to furnish the DA and DoH Provincial Coordinators of the results of testing to serve as guide in the institution of appropriate control measures. Likewise, they are also to inform the AHD-BAI immediately of all specimens examined positive for rabies. They will also collate all DA-BAI-DOH Form I using the standardized DA-BAI-DOH Form two (2) and should submit the filled-up forms to AHD-BAI on or before the 7th day of the succeeding month. The Philippines note that some of the major problems encountered in rabies reporting in country include: timely submission of reports from the RADDLs and the RITM, accounting of unreported cases due to distance from rabies laboratories, and availability of diagnostic services for the poor and the indigent. Fig 6.1 Animal rabies surveillance in the Philippines 40

41 Singapore, where rabies has been reported to the OIE as absent in domestic and wild species since 1953, has started rabies surveillance in the 1950s. Presently, this includes (1) passive surveillance based on reporting by public/veterinary clinics, and (2) active surveillance in the form of necropsy and testing of brain tissue on all animals that die in post-arrival quarantine, on arrival and transshipped animals. For the rabies reporting mechanism, members of the public or veterinarians may call AVA s hotline to report a suspicion; AVA will then respond to conduct an investigation. All rabies-related data from the field and the laboratory are managed and collated by the national authority, the Agri-Food and Veterinary Authority. Thailand has started rabies surveillance more than 25 years ago. Samples from suspect animals are sent by village volunteers (livestock or public health) to the district livestock office, who then transfers this to the provincial livestock office and to the regional laboratory. Results are then reported via mail, line, phone, or formal document. Field and laboratory data are collated by the district livestock/health officer, provincial livestock/health officer, regional livestock/health officer, Bureau of Animal Health Service and zoonosis. Thailand also allocates a small amount of budget (100 Baht/sample) to cover the cost of submission, in order to stimulate the Local Administration Organization. Samples come from suspected animals with clinical signs, unidentified dead mammals, mammal road kills, and stray dogs. Sample heads are cut, and sent to the laboratory for diagnosis using IFA method and confirmed by mouse inoculation test and/or PCR to confirm negative samples. Thailand obtains surveillance data from disease reporting or notification, control programmes or health schemes, targeted testing or screening, laboratory investigation records, field observations, and wildlife disease data. They also conduct annual active surveillance, six-month post-outbreak surveillance, One Health network, university, human health, and the zoo. All these information are collated and recorded in Rabies has been present in domestic animals since Vietnam started their rabies surveillance in However, rabies has been reported to the OIE as present in domestic animals since Overall, five countries (Indonesia, Myanmar, Philippines, Thailand and Vietnam) have provided quantitative information through the WAHIS. Since 2005 up to 2013, 92% of cases were reported in dogs. In addition, was highlighted that it is very important to collect information on wildlife due to potential reservoirs. However, 4 countries (Myanmar, Lao PDR, Philippines and Vietnam) did not provide information on wild animals to the OIE. Rabies in wildlife has been reported as absent in four countries [Brunei Darussalam (never reported in the country); Malaysia (since 1999), Singapore (last occurrence unknown) and Thailand (since 2007)]. Indonesia (from 2009 and 2011) and Cambodia reported that the disease is present or suspected respectively. Table 6.1 National Rabies Surveillance in ASEAN Member States A BR CA IN LA MA MY PH SI TH VN With an ongoing system for rabies surveillance Year rabies surveillance was implemented s 1950s 1980s B 2012 Government unit in charge of rabies information DAA - DAH Sources of rabies data Dog population Field, Lab - No info No info Field, Lab 3,307,272 DVS, NAHL Field, Lab No info Biosecurity and SPS MgtDiv, DVS Field, Lab Epi Unit Field, Lab,Do H BAI Field, Lab AVA Field, Lab Several* agencies Field, Lab Field, Lab 300,000 4,000,000 9,987, ,500 8,090,528 >10 M A Please refer to the narrative for acronyms and other details B Thailand indicated >25 years 6.2 Dog Population in ASEAN Member States Seven of the 10 AMS (Indonesia, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam) provided estimates of the dog population in their respective countries. These were obtained via different methods. Indonesia estimates its dog population at 3,307,272. This information was obtained from the livestock officers at the district level. Some of these come from conducted surveys particularly in areas with eradication 41

42 program such as Bali Province, where capture re-capture methods is implemented. Some are based on estimates. Myanmar s estimate of 4 million dogs was based on a conducted survey by DoH in 2003, which estimated the population then at 3.8 million. The Philippines estimate of 9,987,426 used a dog-to-human ratio of 1:10 (10%) of the human population, and based the calculation on the DoH Memorandum no dated 8 January 2014 regarding Population use for CY to estimate the dog population. In Singapore, the estimated 104,500 dogs came from a combination of licensing records of registered dogs, and a stray dog population estimate obtained using the line transect methodology in 2010 by an independent researcher. The population of owned dogs is based on AVA s licensing records, which is updated every time a license is approved (all dogs above 3 months of age must be licensed by AVA). In Thailand, the estimated 8,090,528 dogs include 7,493,800 owned dogs and 596,728 public dogs. This does not include cat population of 2,345,040 owned cats and 335,992 public cats (2,681,032 cats). This data was obtained through the 77 provincial livestock offices who are responsible to enforce the 888 districts to promote 7,902 sub-district administration organizations to empower the village volunteers to conduct household surveys and in the public areas. In Vietnam, the estimated >10 million heads of dogs were obtained from the sub-department of Animal Health, who estimates the dog population for vaccine supply purposes. 6.3 Rabies Data Sharing within and between ASEAN Member States Almost all countries identified regional meetings and workshops as venue for sharing rabies information to other AMS. Nine of the 10 AMS (Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam) reported sharing official information to other Member States either through ARAHIS or WAHIS, or both. Two countries (Cambodia and Singapore) report to ARAHIS only, while 4 countries (Brunei, Indonesia, Malaysia, Philippines) report to WAHIS only. Four countries (Lao PDR, Myanmar, Thailand and Vietnam) share official rabies information via both platforms. Seven of the 10 AMS (Indonesia, Lao PDR, Malaysia, Philippines, Singapore, Thailand and Vietnam) confirms that national rabies surveillance data reaches the OIE National Focal Point for Animal Disease Notification. In Indonesia, the same focal point maintains the surveillance database; in Philippines and Thailand, rabies data reaches the focal point as it is entered into WAHIS. Singapore reports that since both responsible personnel are both from AVA, there is internal data sharing within the organization. In Vietnam, the National focal point is a veterinary officer of Epidemiology Division of DAH, where all disease information from provinces are coursed through. Table 6.2 Sharing of rabies information among the ASEAN Member States BR CA IN LA MA MY PH SI TH VN Currently shares rabies information with other ASEAN Member States Means of sharing rabies information - ARAHIS WAHIS WAHIS, ARAHIS ASWGL WAHIS, ARAHIS WAHIS ARAHIS WAHIS, ARAHIS WAHIS, ARAHIS Government unit maintaining national rabies surveillance database (animals) DAA - MoA DLF DVS Epi Unit LBVD AHD, BAI AVA DLD DAH Rabies information reaches the OIE National Focal Point for Animal Disease Notification - - Rabies information is reported to ARAHIS Rabies information is reported to WAHIS 42

43 WORKSHOP ON RELEVANT INTERNATIONAL STANDARDS FOR DOG RABIES Chiang Mai, Thailand, June

44 WORKSHOP ON RELEVANT INTERNATIONAL STANDARDS FOR DOG RABIES Chiang Mai, Thailand June 2014 Annex 1: CONCEPT NOTE Rabies is a widespread, neglected and under-reported zoonosis with an almost 100% case fatality rate in animals and humans. It remains endemic in the canine population of several South-East Asian countries where nearly all human rabies infections are transmitted via rabid dog bites. Controlling the disease in dogs, therefore, would be the most effective and cheaper way to prevent rabies in humans. The OIE continues to pursue its commitment to the global fight against rabies. Consistent with its long-standing support to the 2008 ASEAN Call for Action towards the Elimination of Rabies by 2020 in the ASEAN Member States plus three countries (China, Japan, and Korea), the OIE SRR SEA will be holding a workshop on international standards relevant to dog rabies elimination. As the entire region collectively work towards regional rabies freedom by 2020 through the implementation of each of the member countries national rabies control programs as guided by the ASEAN Rabies Elimination Strategy ARES, this workshop will timely seek to ground these plans on international standards to further strengthen these respective plans and their quality at implementation. In addition to an introductory session and country updates, the workshop will focus on the following areas of international standards relevant to rabies: (1) international guidelines pertaining to rabies, (2) veterinary services, (3) diagnostic techniques, (4) vaccines and vaccination, (5) stray dog population control, and (6) surveillance. Briefly, the session on international standards pertaining to rabies will cover considerations to be taken for assessing rabies freedom and recommendations for importation of different animals from countries with and without rabies (Chapter 8.12 of the OIE Terrestrial Animal Health Code) ; the session on veterinary services will include discussions on communication as an integral part of all the activities of the veterinary services (Chapter 3.3 of the OIE Terrestrial Animal Health Code), as well as discussions on how good governance in the veterinary services can be strengthened through legislation (Chapter 3.4 of the OIE Terrestrial Animal Health Code) and participation in the PVS pathway, and how these relate to rabies elimination efforts; the session on diagnostic techniques will cover discussions on international standards for sample collection, transport and processing (Chapter of the OIE Terrestrial Manual) and the roles of Regional Reference Laboratories. The session on vaccines and vaccination will cover international standards on minimum requirements for rabies vaccines (Chapter of the OIE Terrestrial Manual), rabies vaccine bank, and guidelines on vaccination. The session on stray dog population control will cover international recommendations for control measures and methods for estimating the size of the dog population (Chapter 7.7 of the OIE Terrestrial Animal Health Code). Lastly, the session on surveillance will include discussions on rabies notification and epidemiological information (Chapter 1.1 of the OIE Terrestrial Animal Health Code) as well as WAHIS reporting requirements. Each session will start with a presentation by designated teams of OIE resource persons to be followed by a workshop which will be guided by a prepared worksheet on the relevant 44

45 international standard for each session, as it applies in the participating countries. A discussion on the session outputs will follow, and where feasible, a summary of all responses on the current state of the countries relevant to these international standards will also be presented. The expected outcome of the workshop is that participants will have a sound knowledge of OIE international standards and approaches as they apply to rabies, and a good understanding of the rabies situation in countries participating in the meeting. Objectives: This workshop aims to provide: 1. A good understanding of the rabies situation in countries participating in the meeting 2. A sound knowledge of the OIE international standards and approaches relevant to rabies Target group: The target group consists of rabies focal persons in ASEAN Member States (Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand and Viet Nam). Partners working on rabies in the region - FAO RAP, GARC and WSPA will also be participating. The meeting will be facilitated by resource persons from OIE Headquarters, OIE Regional Representation for Asia and the Pacific, OIE Sub-Regional Representation for South- East Asia, and the OIE Reference Laboratory for Rabies. 45

46 WORKSHOP ON RELEVANT INTERNATIONAL STANDARDS FOR DOG RABIES Chiang Mai, Thailand June 2014 Annex 2: AGENDA Day 1: June 11, :30 09:00 Registration 09:00 10:00 Opening Program Welcome Remarks DLD Thailand OIE Introduction of participants Group Photo 10:00 10:30 Coffee Break 10:30 12:00 12:00 13:30 Lunch Break 13:30 14:00 Country Presentations Plenary session on country rabies situations (Moderator: Dr Mary Joy Gordoncillo) Country Presentations Plenary session on country rabies situations (Moderator: Dr Mary Joy Gordoncillo) Introduction to the OIE and OIE international standards (Moderator: Dr Tikiri Wijayathilaka) OIE Mandate and missions Governance Structure of the OIE The OIE Terrestrial Animal Health Code 14:00 15:00 The OIE Terrestrial Manual The FAO-OIE-WHO Tripartite and the One Health Concept OIE initiatives on rabies Introduction to the workshop Question and answer 15:00 15:30 Coffee Break Introduction to Session 1 (Moderator: Dr Gardner Murray) International standards on rabies Chapter of the OIE Terrestrial Animal Health Code Control of rabies in dogs Rabies freedom 15:30 17:00 Recommendations for importation Workshop for Session 1 Reviewing the current status of control of rabies in dogs in the countries Plenary session: Goal setting and action plan on applying international standards on rabies in South-East Asia 19:00 Hosted Dinner (OIE) Cambodia, Indonesia, Lao PDR, Myanmar, Philippines, Thailand, Vietnam Brunei Darussalam, Malaysia, Singapore Dr Ronello Abila Dr Gardner Murray Dr Gregorio Torres Dr Mary Joy Gordoncillo 46

47 Day 2: June 12, :30 10:00 Introduction to Session 2 (Moderator: Dr Mary Joy Gordoncillo) International standards for veterinary services, communication and legislation Chapter 3.1 of the OIE Terrestrial Animal Health Code (Veterinary Services) Chapter 3.3 of the OIE Terrestrial Animal Health Code (Communication) Chapter 3.4 of the OIE Terrestrial Animal Health Code (Legislation) Workshop for Session 2 Reviewing the line of command, coordination mechanism, and staff capacity in rabies control. Also discuss public awareness and communication plan for rabies and community mobilization and discuss status of country legislations to support rabies control 10:00 10:30 Coffee Break Introduction to Session 3 (Moderator: Dr Ronello Abila) International standards for rabies diagnosis Chapter of the OIE Terrestrial Manual Basic and advanced techniques 10:30 12:00 OIE Rabies Reference Laboratories Workshop for Session 3 Reviewing the current status of rabies diagnosis in the countries Plenary session: Goal setting and action plan on improving rabies diagnosis in South-East Asia 12:00 13:30 Lunch Break Introduction to Session 4 (Moderator: Dr Gardner Murray) Minimum standards on rabies vaccines and other vaccine-related standards Chapter of the OIE Terrestrial Manual 13:30 15:00 The OIE Vaccine Bank: Concept and Activities Workshop for Session 4 Reviewing the current status of rabies vaccination in the countries Plenary session: Goal setting and action plan on improving rabies vaccination in South-East Asia 15:00 15:30 Coffee Break Introduction to Session 5 (Moderator: Dr Agnès Poirier) International standards related to stray dog population control Chapter 7.7 of the OIE Terrestrial Animal Health Code International recommendations for stray dog population control 15:30 17:00 Estimating the size of the dog population Workshop for Session 5 Reviewing the current status of stray dog population control in the countries Plenary session: Goal setting and action plan on improving the management of the stray dog population in South-East Asia Plenary session: Goal setting and action plan on improving rabies surveillance in South-East Asia 19:00 Hosted Dinner (DLD Thailand) Dr Ronello Abila Dr Agnès Poirier Dr Gregorio Torres Dr Dong-Kun Yang Dr Agnès Poirier Dr Dong-Kun Yang Dr Rastislav Kolesar Dr Gardner Murray 47

48 Day 3: June 13, 2014 Introduction to Session 6 (Moderator: Dr Ronello Abila) Relevant international standards on surveillance Chapter 1.1 of the OIE Terrestrial Animal Health Code Rabies notification 08:30 10:00 Rabies reporting obligations WAHIS and ARAHIS Workshop for Session 6 Reviewing the current rabies surveillance mechanisms in the countries 10:00 10:30 Coffee Break Dr Paula Cáceres Soto Dr Tikiri Wijayathilaka 10:30 12:00 Workshop synthesis 12:00 13:30 Lunch Break Partners forum (Moderator: Dr Ronello Abila) Food and Agriculture Organization of the United Nations Regional Office for Asia and the Pacific 13:30 15:00 Global Alliance for Rabies Control Dr Carolyn Benigno Dr Louis Hendrik Nel World Animal Protection Dr Jennifer Ford 15:00 15:30 Coffee Break 15:30 17:00 Recommendations, summary and conclusions, closing ceremony Dr Gardner Murray 48

49 WORKSHOP ON RELEVANT INTERNATIONAL STANDARDS FOR DOG RABIES Chiang Mai, Thailand June 2014 Annex 3: LIST OF PARTICIPANTS Brunei Darussalam Dr Hamsiah MohdSaat (Ms) Livestock Husbandry Officer Department of Agriculture and Agri-food Veterinary Laboratory Services Division of Livestock Industry BRUNEI DARUSSALAM Phone: , Dr Juwairiyah Jali (Ms) Veterinary Officer Department of Agriculture and Agri-food, Ministry of Industry and Primary Resources, Old Airport Road, Bandar Seri Begawan BB3510BRUNEI DARUSSALAM Phone: Cambodia Dr Bunnary Seng (Ms) Staff of Viro/Serology, Department of Animal Health and Production Phum Trea, Str.371, Sangkat Steung Mean Chey, Khan Mean Chey, Phnom Penh CAMBODIA Phone: (855) Dr Morany Heng (Ms) Acting Chief of VPH, Department of Animal Health and Production Phum Trea, Str.371, Sangkat Steung Mean Chey, Khan Mean Chey, Phnom Penh CAMBODIA Phone: (855) , (855) Indonesia Dr Yuni Yupiana (Ms) Head of Animal Diseases Eradication Section, Directorate of animal health, Ministry of Agriculture Komplek BBPMSOH No.D24 Gunungsindur, Bogor West Java, Jakarta INDONESIA Phone: , Dr Martdeliza Hanfiah (Ms) Laboratory staff, DIC Bukitinggi Jl. RayaBukitinggi-Payakumbuh KM 14 Baso Bukittinggi, Sumbar INDONESIA Phone: , Lao PDR Dr Thongphoun Theungphachanh (Ms) Deputy Chief of Division of Veterinary Service, Department of Livestock and Fisheries Ministry of Agriculture and Forestry, Souphanouvong road, Vientiane LAO PDR Phone: Dr Phouth Inthavong (Mr) Deputy Director, National Animal Health Laboratory Department of Livestock and Fisheries Souphanouvong road km2 Bansithanneua, Sikhottabong district, Vientiane LAO PDR Phone: , ,