Benchmark document: rabies and rabies-related initiatives in ASEAN Member States (2014)

Transcription

1 Benchmark document: rabies and rabies-related initiatives in ASEAN Member States (2014) Proceedings Workshop on Relevant International Standards for Rabies Chiang Mai, Thailand June 2014

2 Benchmark document: rabies and rabies-related initiatives in ASEAN Member States (2014) Proceedings Workshop on Relevant International Standards for Rabies Chiang Mai, Thailand June 2014

3 iii This study was made possible thanks to the financial support received by the OIE through the Australian Government Department of Foreign Affairs and Trade for the implementation of the Stop Transboundary Animal Diseases and Zoonoses (STANDZ) Initiative. All OIE (World Organisation for Animal Health) publications are protected by international copyright law. Extracts may be copied, reproduced, translated, adapted or published in journals, documents, books, electronic media and any other medium destined for the public, for information, educational or commercial purposes, provided prior written permission has been granted by the OIE. The designations and denominations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the OIE concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers and boundaries. The views expressed in signed articles are solely the responsibility of the authors. The mention of specific companies or products of manufacturers, whether or not these have been patented, does not imply that these have been endorsed or recommended by the OIE in preference to others of a similar nature that are not mentioned. The cover photo is provided from the collection of Dr Mary Joy Gordoncillo. Copyright OIE 2014 Published 2018 World Organisation for Animal Health 12, rue de Prony Paris, France Tel.: 33-(0) Fax: 33-(0) DOI: Cover & design: OIE/Paloma Blandín

4 iv Abbreviations AAHL AEGCD ACIAR AHMM AMS ARES ASEAN ASWGL AusAID DA DFAT DLD DoH ELISA FAO FAORAP FAT FAVN GARC GMS HS Lao PDR NRPCC OIE OIE SRR-SEA PCR PEP PhilAHIS PhP PIDSR PVS REML SEA SEACFMD SEAFMD STANDZ USAID WAHIS WHO USD Australian Animal Health Laboratory ASEAN Expert Group for Communicable Diseases Australian Centre for International Agricultural Research ASEAN Health Ministers ASEAN Member States ASEAN Rabies Elimination Strategy Association of Southeast Asian Nations ASEAN Sector for Working Group on Livestock Australian Agency for International Development Department of Agriculture Australian Government Department of Foreign Affairs and Trade Department of Livestock Development Department of Health Enzyme-linked immunosorbent assay Food and Agriculture Organization of the UN Food and Agriculture Organisation for Asia and the Pacific Fluorescent Antibody Test Fluorescent Antibody Virus Neutralisation Global Alliance for Rabies Control Greater Mekong Sub-region Haemorrhagic Septicaemia Lao People s Democratic Republic Rabies Prevention and Control Committee World Organisation for Animal Health OIE Sub-Regional Representation for Southeast Asia Polymerase Chain Reaction Post exposure prophylaxis Philippine Animal Health Information System Philippine Peso Philippine Integrated Disease Surveillance and Response Performance of Veterinary Services Restricted maximum likelihood Southeast Asia Southeast Asia and China Food and Mouth Disease Southeast Asia and Food and Mouth Disease Stop Transboundary Animal Diseases and Zoonoses United States Agency for International Development World Animal Health Information System World Health Organization United States Dollar

5 v Contents Abbreviations iv Contents v Background 1 Participants 1 The Workshop 1 Objectives 2 Output 2 Recommendations 2 Introduction 3 Rabies situation in ASEAN Member States 3 Part 1. Current status of compliance to International Standards on Rabies 5 Rabies notifiability 5 Rabies surveillance systems 5 Rabies regulatory measures 5 Absence of indigenously acquired rabies virus infection in the last two years 6 Absence of imported case in the orders Carnivora or Chiroptera identified beyond the quarantine station for the past six months 7 Other related official practices on rabies control and prevention 7 Comments 8 Part 2. Veterinary Services, Legislation and Communication relevant to rabies control efforts in AMS 10 The Veterinary Authority and Rabies Control and Prevention in the Country 11 Rabies Plans, Committees and Legal Instruments 12 Communication 14 Part 3. Current Status of Animal Rabies Diagnosis in ASEAN Member States 16 Rabies Diagnostic Laboratories in ASEAN Member States 16 Strengthening capacity on rabies diagnosis 16

6 Content vi Part 4. Current Status of Rabies Vaccines and Vaccination in ASEAN Member States 22 Rabies vaccines in ASEAN Member States 22 Rabies post-vaccination monitoring in ASEAN Member States Part 5. Current Status of Stray Dog Population Management in ASEAN Member States 26 Responsible Pet Ownership in ASEAN Member States 26 Stray Dog Population Control and Management in ASEAN Member States 27 Control Measures in Stray Dog Population Control 28 Part 6. Current Status of Rabies Surveillance Activities in ASEAN Member States 31 Rabies Surveillance in ASEAN Member States 32 Dog Population in ASEAN Member States 33 Rabies Data Sharing within and between ASEAN Member States 33 Annexes A-35 Annex 1. Meeting concept note A-36 Annex 2. Meeting agenda A-37 Annex 3. Meeting participant list A-39

7 1 Background 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 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 costeffective means to strategically address and eliminate rabies in the region. 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, 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 SRR-SEA 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. Participants All the ten 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 including FAORAP and GARC. 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 SRR-SEA in Bangkok. Overall, there were a total of 36 participants. A complete list and details of these participants can be found in Annex 3. 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 selfassessing rabies freedom which includes recommendations for importation of different animals from countries with and without rabies (Chapter 8.11 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

8 Background 2 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. 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. 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 ARES, to serve as a resource material for its monitoring and evaluation. Recommendations 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.

9 3 Introduction Rabies situation in ASEAN Member States Globally, rabies infection causes about 55,000 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, moral, 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 sociocultural, 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 20 th 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, intersectoral 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 21 st 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 is 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 reportedly claimed 3,337 human lives and 7,922 animal lives (note: still need to add updated data from Thailand, Vietnam) in the region - not including the many other undiagnosed cases of this heavily under-reported disease, estimated to be in thousands. 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. Table 1. Rabies situation in ASEAN Member States, ASEAN Member State Brunei Darussalam Cambodia Year 2009 No. of animal bites reported No. of postexposure treatment No. of human rabies cases No. of animals tested for rabies No. of animals positive for rabies Rabies has never been reported ,475* 6* 61* ,475* 6* 61* ,475* 6* 61* ,475* 6* 61* ,475* 6* 61*

10 Introduction 4 ASEAN Member State Indonesia Lao PDR Malaysia Myanmar Philippines Singapore Thailand Vietnam Year No. of animal bites reported No. of postexposure treatment No. of human rabies cases No. of animals tested for rabies No. of animals positive for rabies ,466 35, , ,574 63, , ,010 71, , ,750 74, , ,136 53, , ,515 2, ,510 4, ,944 4, No rabies cases since the year , , , ,424 1, , , , , , , , , , No rabies cases since the year , , , , , , , *Estimated annual average based on the humans and animal cases in Cambodia (Ly, et al., 2009)

11 5 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 8.11 (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. 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. 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. 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. 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, rabies vaccination and animal identification. 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).

12 Part 1: Current status of compliance to International Standards on Rabies 6 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 behavioural signs, the human health sector is also immediately notified. In both instances, the location and animal type involved is reported to the other party. DSO Human bitten SMS, CONTACT, LOCATION, ANIMAL TYPE PDSR Animal bitten or acting strangely Animal can be examined Animal not found If there are several reports to investigate PDSR will allocate priorities to determine speed of response Euthanised head sent to lab by pdsr give PEP & RIG according to wound risk Give PEP & RIG according to wound risk Highly suspect Medium suspect Not found Low suspect +VE continue PEP Under observation give PEP according to wound risk VE stop PEP Give PEP & RIG according to wound risk Humane euthanasia send head to laboratory Rabies +VE or -VE Under observation 10 Information passed between PDSR and DSO 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 report 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 are then continued for at least 6 months. 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. 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.

13 Part 1: Current status of compliance to International Standards on Rabies 7 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. 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 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 rabies-infected 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 care, (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. 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 Agrifood (DAA) and non-governmental organisations, who all meet at least once yearly. Malaysia reports to have an effective importation procedure 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.

14 Part 1: Current status of compliance to International Standards on Rabies 8 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) setup 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. Table 1.1. Current status of compliance of AMS to International Standards on Rabies, in accordance with the OIE Terrestrial Animal Health Code Chapter 8.11 AMS Rabies is notifiable Has rabies surveillance systems With rabies surveillance in the past 2 years With early detection programme Import procedures ensure prevention of rabies entry into the country Domestic and wild captive mammals from RFC 1 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 No imported rabies cases outside quarantine Brunei Cambodia Indonesia Lao PDR - Malaysia Myanmar Philippines 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

15 Part 1: Current status of compliance to International Standards on Rabies 9 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 For rabies control and prevention Regulatory Measures For rabies 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 - Thailand Ministry of Agriculture and cooperatives Vietnam - N/A = Not applicable (rabies-free count

16 10 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 recognised 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. The Veterinary Authority and Rabies Control and Prevention in the Country As anywhere else in the world, 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 channelled towards this also insentiently transcends into the strengthening of One Health coordination mechanisms. Such progress in inter-sectoral collaboration in a way contributes to the joint preparedness of the AMS in addressing any future emergency zoonoses event, should this happen. rabies surveillance 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 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, remain 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,

17 Part 2. Veterinary Services, Legislation and Communication relevant to rabies control efforts in AMS 11 Table 2.1 Responsible 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 animal rabies diagnosis rapid response for rabies cases management of rabies vaccination campaigns rabies public awareness management of stray dogs DAA NaVRI/VPHO DIC DLF DAA NaVRI DIC Animal only: DAA Animal + human case: DAA + MoH DAA DAA Municipal board/ RBPF/Distr. Offices/ DAA VPHO/AHO VPHO/AHO VPHO / Extension Office animal welfare DAA VPHO management of rabies initiatives over-all national rabies focal point DAA DAHP/PAHPO DAHP Local government Directorate of Animal Health Directorate of Vet Public Health Directorate of Vet Public Health Directorate of Vet Public Health Directorate of Animal Health NAHL, DLF DLF, DCDC DLF DLF, DCDC - DLF DLF Biosecurity and SPS Mgt. Div. Biosecurity and SPS Mgt. Div. Biosecurity and SPS Mgt. Div. Biosecurity and SPS Mgt. Div. Biosecurity and SPS Mgt. Div. Biosecurity and SPS Mgt. Div. Biosecurity and SPS Mgt. Div. Biosecurity and SPS Mgt. Div. LBVD/DOH AHD AVA LBVD PAHC AVA Animal rabies: LBVD LBVD LBVD/DOH LBVD/ Municipal BAI, DARFO, LGU, Regulatory Div/Livestock div BAI, DARFOs, LGUs BAI, DARFOs, LGUs LGUs AVA AVA AVA AVA DLD and MoPH DLD and QSMI (Thai Red Cross) DLD and MoPH DLD and LAO DLD, MoPH and LAO DLD and LAO DAH NCVDs, RAHOs Steering committee for rabies prev. and control DAH, Sub-DAH DAH LBVD BAI, DARFOs AVA DLD DAH LBVD/DOH BAI AVA All notifications go direct to DG and relevant Group Directors of AVA DLD, MoPH and LAO Sub-DAH DAH AHD = Animal Health Division, BAI (Philippines) AVA = Agri-food and Veterinary Authority (Singapore) BAI = Bureau of Animal Industry (Philippines) DAA = Department of Agriculture and Agrifood (Brunei) DAH = Department of Animal Health (Vietnam) DAHP = Department of Animal Health and Production (Cambodia) DARFO = Department of Agriculture Regional Field Office (Philippines) DCDC = DIC = Disease Investigation Centre (Indonesia) DLD = Department of Livestock Division (Thailand) DLF = Department of Livestock and Fisheries (Lao PDR) DOH = Department of Health (Myanmar, Philippines) LAO = Local Administrative Office (Thailand) LBVD = Livestock Breeding and Veterinary Division (Myanmar) LGU = Local Government Unit (Philippines) MoPH = Ministry of Public Health (Thailand) NAHL = Animal Health Laboratory (Lao PDR) NaVRI = Veterinary Research Institute, DAHP (Cambodia) NCVD = Center for Veterinary Diagnosis (Vietnam) PAHC = Philiipine Animal Health Center, BAI (Philippines) PAHPO = Provincial Animal Health and Production Office (Cambodia) RAHOs = Regional Animal Health Offices (Vietnam) RBPF= Royal Brunei Police Force VPHO = Veterinary Public Health Office, DAHP (Cambodia)

18 Part 2. Veterinary Services, Legislation and Communication relevant to rabies control efforts in AMS 12 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 recognises 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 quickly 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. 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. Rabies Plans, committees and Legal Instruments 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. 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, except for Singapore, are multi-agency and include the health sector. The operations of 5 of the 8 national committees are also Box 2.1 Some Examples of national committees on rabies In the Philippines, rabies is handled by the Rabies Prevention and Control Committee (NRPCC). The committee is composed of the Department of Agriculture-Bureau of Animal Industry (Chair) the Centre 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 Committee 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 Parks Malaysia, Ministry of Urban well-being, Housing and Local Government, Ministry of Education Mlaaysia, and the Institute of Occupational Safety and Health. These committees regularly meet, share surveillance information, and discuss on zoonoses.

19 Part 2. Veterinary Services, Legislation and Communication relevant to rabies control efforts in AMS 13 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 rabies-related activities in the country, planning strategies to address rabies, and managing of resources allocated to rabies. Table 2.2 rabies plans, committees and rabies legal instruments Name of Rabies Plan Strategic Plan Level of endorsement Name of committee Composition Brunei n/a Cambodia Indonesia Lao PDR Malaysia Rabies Roadmap (in progress) Rabies Strategy (in progress) Rabies Control Programme Minister of Agriculture and Agrobased Ind. Myanmar Philippines Singapore NRPCP Medium Term Plan Contingency plan for rabies DG of AVA Strategy on Zoonotic Disease Rabies Coordination team Committee on EID Inter- Ministries Comm. for Control of Zoonotic Dis s. Nat l zoonotic Disease Control Committee Rabies Prevention and Control Comm. Rabies Working Group MAFF, MoH, FAO, WHO, PIC, OIE () MoA, MIA, MoA; (Local): prov and district/ municipality established rabies coord team MoH, MAF, MICI, MES, MOI, MPC DVS; MoH; Dept of Wildlife and Parks; Min. of Urban Well-being, Housing and Local Gov t; MoE; 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 Supported by law Rabies Committee Meets Regularly Meets as needed Review rabies situation Monitor rabies activities Plan strategies on rabies Manage resources for rabies Meets as needed Meets as needed AVA Officers Legal instruments related to rabies Animal Disease and Quarantine Order Animal Health and Production Law 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 1999 Animal Health and Development Law 1993 Republic Act No or Anti-Rabies Act of 2007 Animals and Birds Act (Chapter 7)

20 Part 2. Veterinary Services, Legislation and Communication relevant to rabies control efforts in AMS 14 Strategic Plan Rabies Committee Legal instruments related to rabies Name of 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 Thailand Strategic plan for rabies elimination by 2020 DG of DLD and DDC Rabies Elimination committee DLD, DDC, LAO, QSMI Rabies Act, Animal Epidemic Act, Public Health Act, Code of Law, Regulation of Local Administration Vietnam rabies Prevention and control program Ministry of Agricuture and Rural Dev t 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. 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 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 have 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. 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? DVPH A ZVPH B AVA s field officers and corporate communication group MoPH, DLD, LAO C DAH D, Sub- DAH, Media agencies, Associations

21 Part 2. Veterinary Services, Legislation and Communication relevant to rabies control efforts in AMS 15 BR CA IN LA MA MY PH SI TH VN Responsible personnel have skills to carry out their functions effectively? 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

22 16 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 postmortem 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. 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 66 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 = 4). Details of these are summarised in Table 3.1 below. Rabies-free countries (Brunei, 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, rabiesendemic 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 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 58/66 (87.9%) laboratories in the region offering this. Other commonly available rabies diagnostic tests in the region are histology-based test (28/66 or 42.4%) and mouse inoculation test (26/66 or 39.4%), perhaps owing to the relative cost 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, except for FAVN, is being performed in the region. 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 Participation in regional proficiency testing Conducts activities for strengthening rabies diagnosis Avails assistance from OIE Reference Laboratories for rabies BR CA IN LA MA MY PH SI TH VN

23 Part 3. Current Status of Animal Rabies Diagnosis in ASEAN Member States 17 Table 3.1 Rabies Diagnostic Laboratories in ASEAN Member States Country Brunei Cambodia Indonesia Name of laboratory All rabies diagnostic labs (n=1) Veterinary Laboratory Services All rabies diagnostic labs (n=2) Animal Vet Research Institute Institut Pasteur du Cambodge All rabies diagnostic labs (n=25) Balivet/IRCVS DIC Medan DIC Bukittinggi DIC Lampung DIC Wates Type Location FAT IT AgE RIT CC MIT Mol Hist FAVN RFFIT VN AbE Notes Barc, Kilanas, B.S.Begawan Phnom Penh Private Phnom Penh Regional Regional Regional Regional Bogor, West Java Medan, North Sumatra Bukittinggi, West Sumatra Lampung, Lampung Wates, Central Java DIC Denpasar Regional Denpasar, Bali DIC Maros DIC Banjar Baru DIC Subang Jambi Provincial Vet Lab Riau Provincial Vet Lab North Sulawesi Provincial Vet Lab South East Sulawesi Provincial Vet Lab Central Sulawesi Provincial Vet Lab DKI Jakarta Provincial Vet Lab Regional Regional Regional Maros, West Sulawesi Banjar Baru, South Kilamantan Subang, West Java Provincial Jambi, Jambi Provincial Provincial Provincial Provincial Pekanbaru, Riau Manado, North Sulawesi Kendari, South East Sulawesi Palu, Central Sulawesi Provincial Jakarta Sends out samples Also performs RIAD

24 Part 3. Current Status of Animal Rabies Diagnosis in ASEAN Member States 18 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 Country Name of laboratory Type Location FAT IT AgE RIT CC MIT Mol Hist FAVN RFFIT VN AbE Others Lao PDR Malaysia Myanmar Philippines All rabies diagnostic labs (n=2) Animal Health Laboratory NCLE All rabies diagnostic labs (n=1) Veterinary Research Institute All rabies diagnostic labs (n = 2) Yangon Veterinary Diagnostic Lab Mandalay Veterinary Diagnostic Lab All rabies diagnostic labs (n=19) Philippine Animal Health Center Research Institute for Trop Med Regional Animal Dis Diagnostic Lab 1 Vientiane Capital Vientiane Capital Ipoh, Perak, Malaysia Yangon Regional Mandalay Regional Visayas Avenue, Diliman, QC Corporate Ave, Alabang, Muntinlupa Tebag, Sta. Barbara, Pangasinan

25 Part 3. Current Status of Animal Rabies Diagnosis in ASEAN Member States 19 Singapore Regional Animal Dis Diagnostic Lab 2 Regional Animal Dis Diagnostic Lab 3 Regional Animal Dis Diagnostic Lab 4 Regional Animal Dis Diagnostic Lab 5 Regional Animal Dis Diagnostic Lab 7 Regional Animal Dis Diagnostic Lab 9 Regional Animal Dis Diagnostic Lab 10 Regional Animal Dis Diagnostic Lab 11 Regional Animal Dis Diagnostic Lab 12 Regional Animal Dis Diagnostic Lab 13 Regional Animal Dis Diagnostic Lab CAR Aklan State University Provincial Veterinary Office Regional Regional Regional Regional Regional Regional Regional Regional Regional Tuguegarao, Cagayan San Fernando City, Pampanga Marawoy, Lipa City, Batangas Cabangan, Camalig, Albay M. Velez Street, Cebu City Tumaga, Zamboanga City A Luna St., Cagayan de Oro City Bago Oshiro, Davao City Cotabato City Regional Agusan City Regional Academe LGU Guisad, Baguio City Banga- Libacao Highway, Aklan Gomburza St, Laoag, Ilocos Norte Provincial Veterinary Office LGU Bacolod City Provincial Veterinary Office City Veterinary Office All rabies diagnostic labs (n=1) Animal Health Laboratory LGU LGU Dumaguete City Puerto Princesa City 6 Perahu Road, Singapore Country Name of laboratory Type Location FAT IT AgE RIT CC MIT Mol Hist FAVN RFFIT VN AbE Others All rabies Thailand diagnostic labs (n=10) Institute of Animal Health and Central Regional Bangkok

26 Part 3. Current Status of Animal Rabies Diagnosis in ASEAN Member States 20 Upper Northern Veterinary Research and Development Center Regional Lampang Province Lower Northern Veterinary Research and Development Center Regional Phitsanulok Province Upper Northeastern Veterinary Research and Development Center Lower Northeastern Veterinary Research and Development Center Eastern Veterinary Research and Development Center Regional Khonkaen Province Regional Surin Province Regional Chonburi Province Western Veterinary Research and Development Center Regional Ratchaburi Province Southern Veterinary Research and Development Center Regional Nakhornrachasima Province Vietnam All AMS Lower Southern Veterinary Research and Development Center Queen Saowapa Memorial Institute All rabies diagnostic labs (n = 4) Institute of Hygiene and Epidemiology Ho Chi Minh City Pasteur Institute Nha Trang Pasteur Institute Ho Chi Minh City Sub-Department of Animal Health All rabies diagnostic labs (n = 66) Regional Songkhla Province Bangkok Hanoi Ho Chi Minh City Khanh Hoa City Provincial Ho Chi Minh City 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 = RRFIT = VN = Virus Neutralisation in mice AbE = Antibody ELISA

27 Part 3. Current Status of Animal Rabies Diagnosis in ASEAN Member States 21 Proficiency testing for rabies diagnosis In 2013, regional proficiency testing for rabies was conducted through the support of the 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. 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 Fallowfield, Animal Disease Research Institute in Canada. They also procured positive paraffinised tissues from the Rabies and Wildlife Zoonoses Group from the Veterinary Laboratories Agency in UK. Linkage with OIE Reference Laboratories 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,

28 22 Part 4. Current Status of Rabies Vaccines and Vaccination in ASEAN Member States OIE s policy on rabies control recognises 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 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. 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, Philippines, Singapore 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. rabies vaccination plans in AMS. Six of the 10 AMS (Indonesia, Malaysia, Myanmar, Philippines, Thailand, and Vietnam) have rabies vaccination strategies in their countries. Rabies vaccination strategies in AMS This can be any, or a combination of the following: (1) continual vaccination at fixed vaccination posts in wellrecognised 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

29 Part 4. Current Status of Rabies Vaccines and Vaccination in ASEAN Member States 23 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 Agrifood. In Indonesia which produce 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 Centres 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 Locally produced A Imported Type of dog rabies vaccines currently available for use Killed Live attenuated vaccines Biotechnology-derived vector vaccines Inactivated vaccines Vaccine use (2012) Total doses of imported n/i 3,500 n/i 128, n/i 1,861,526 3,000 n/i < 3M Total doses imported, utilised n/i 3,500 n/i 128, n/i 896,690 1,902 n/i n/i Total doses of locally produced 840,000 Total doses utilised 2.3 M Vaccine use (2013) Total doses of imported n/i n/i n/i n/i n/i 1,818,471 5,400 n/i < 3M Total doses imported, utilised n/i n/i n/i n/i n/i 727,180 1,182 n/i n/i Total doses of locally produced 1,020,000 Total doses utilised 1.7 M Annual budget from Government 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 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. (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 is 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.

30 Part 4. Current Status of Rabies Vaccines and Vaccination in ASEAN Member States 24 Box 4.1 Some examples of 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 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. Table 4.2 Rabies vaccination in ASEAN Member States Rabies vaccines BR CA IN LA MA MY PH SI TH VN Vaccination strategies Continual vaccination at fixed points * * Vaccination by mobile teams - countrywide * * C. Vaccination by mobile teams temp. vacc n points * * D. house-to-house campaigns * * Others * * Rabies vaccination in dogs Yes, compulsory for the whole country 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 Yes, compulsory for the whole country 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 Yes, compulsory for the whole country 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 Yes, compulsory for the whole country 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