Control and Prevention of Rabies through Dog Vaccination Campaigns, Public Awareness Creation and Dog Population Control Habtamu TM*, Abrha BH, Yohannes TA, Abreha TG, Yisehak TR, Guesh NH and Berihu GT Mekelle University College of Veterinary Medicine, P.O.Box: 2084, Mekelle, Ethiopia; *Corresponding Author: Habtamu TM, e-mail: habtamutaddele@yahoo.com ABSTRACT Rabies virus claims an estimated 55,000 lives each year, with the majority of fatalities in Asia and Africa. One person dies every ten minutes worldwide due to rabies, even though it is 100% preventable. In Tigray region, Northern Ethiopia, 4729 human rabies cases and 44 deaths were reported from 2009 2012. Therefore, the objectives of the current intervention were to initiate vaccination campaigns against Rabies and create awareness to the community. Mekelle University College of Veterinary Medicine have started organizing events during the celebration of the World Rabies Day to create awareness to the community particularly to school children, organize panel discussion forums with concerned stakeholders and conduct vaccination campaigns. In addition dog population control was conducted in Mekelle city in partnership with various stakeholders. From 2010 to 2013, an awareness creation was conducted to 7050 school children from five schools. A total of 4734 dogs were vaccinated, 3550 ownerless dogs depopulated and 388 dogs neutered. Four panel discussion forums were conducted at regional level with concerned stakeholders to initiate a collaborative and integrated control measures against the disease. The awareness creation is still continuing using regular airtime with local media namely FM Mekelle (104.4), Fana Broadcasting Mekelle (94.8) and DWT FM (102.2) radios that reached to the larger community. After the college started the awareness creation programs, the awareness of the community changed significantly. Therefore, intensifying the awareness creation programs and vaccination campaigns, and dissemination of best practices are believed to be alternative areas of intervention for rabies control. Key words: Awareness, Prevention, Rabies, School children, Vaccination INTRODUCTION Rabies claims an estimated 55,000 lives each year, with the majority of fatalities occurring in Asia and Africa (www.rabiesalliance.org). Many of the victims are children, often young boys who are more likely to try playing with or approaching free roaming dogs. The health impact of rabies in East African region is high while it remains neglected by governments. The disease incidence is increasing yearly and this is mainly associated with the increasing number of free roaming dogs in urban centers. Rabies is an endemic disease in Ethiopia claiming thousands of lives each year. It is a serious challenge in Tigray region, Northern Ethiopia, both in humans and animals. A report from Tigray Bureau of Health indicates an estimated 4729 dog bite cases and 44 deaths from 2009-2012 in the region (TBoH, 2012). Fatality rate of rabid dog bites with no Post Exposure Prophylaxis (PEP) is up to 100%. About 99% of rabies in humans arises due to bites from free roaming dogs (WHO, 2005). 9
About 99% of rabies deaths occur in developing countries (WHO, 2005); 55% in Asia and 44% in Africa. Rabies mortality ranges from 0.001 per hundred thousand in the United States to 18 per hundred thousand in Ethiopia, with mortality levels of 0.01 in South Africa, 0.47 in Thailand and Vietnam, 0.57 in Sri Lanka, 1.75 in Bangalesh, and 2 4 in India (Haupt, 1999). Many studies on free-roaming dogs have been undertaken in different countries in order to implement a rabies control program (Brown, 2001; Jackman and Rowan, 2007; Totton et al., 2010; Villa et al., 2010; Massei and Miller, 2013; WHO, 2013; Morters et al., 2014). These studies highlight the importance of dogs particularly free roaming dogs in the transmission of rabies to humans. According to WHO s recommendation, vaccinating 70% of the dog population helps to prevent and control rabies and thus prevent the rabies virus from circulating amongst susceptible animals (WHO, 2005). However, the exponential increase in the population of free roaming dogs is a serious challenge to this strategy in Eastern African countries like Ethiopia. In addition, community awareness on rabies (Knowledge, attitude and practices) with major emphasis on dog ownership, impact of rabies in humans, transmission of the diseases and precautions to be taken are important components in reducing the incidence of the disease (Dodet, 2008). Canine rabies can be eliminated, as has been demonstrated in North America, Western Europe, Japan and many areas in South America. During the last two decades, a significant reduction in human rabies associated with dog rabies has been achieved in Mexico, South America and the Caribbean by the programme for the elimination of canine rabies initiated and coordinated by the Pan American Health Organization/WHO Regional Office for the Americas. In contrast, over the past two decades rabies has been increasing in parts of sub- Saharan Africa and Asia, attributed to rapidly growing dog populations and increasing urbanization thereby leading to large proportion of free roaming dogs, density and mobility of human populations. About 75% of the worldwide dogs, often referred to as stray, are free to roam and reproduce uncontrolled (WHO, 1999). In general free roaming dogs are threats to the community because of their impacts to the society and livestock that include diseases transmitted to livestock and humans, predation on livestock, bites, road traffic accidents, and nuisance behavior such as barking and soiling (WHO, 2010; Macpherson et al., 2013). In Ethiopia looking dogs freely roaming on streets of urban areas and these free roaming dogs are believed to take the greater share of bites in humans and livestock. September 28 is designated as World Rabies Day by the Alliance for Rabies Control and the Centers for Disease Control and Prevention. The campaign began in 2007 as an opportunity to spread information and prevention methods. Since then, World Rabies Day events have educated 150 million people in 135 countries, and vaccinated millions of dogs (www.rabiesalliance.org). Celebration of World Rabies Day at Mekelle University, College of Veterinary Medicine was started in 2008 by conducting several activities to contribute its share in the control and prevention of the disease. The college has strengthened its activities towards rabies control and prevention since 2010. Therefore, this paper highlights the contribution of Mekelle University, College of Veterinary Medicine in the control and Prevention of rabies through public awareness creation, mass dog vaccination and dog population control. 10
MATERIALS AND METHODS Project Area The project site was Mekelle city and its surroundings. Mekelle is the capital city of Tigray National Regional State and is located at 783 km north of Addis Ababa at 38.5 east longitude and 13.5 north latitude and an altitude of 2,200 m above sea level. The mean annual rainfall of the area is 628.8 mm. The annual minimum and maximum temperature is 11.8 and 29.94 C, respectively. The estimated human population of the city is 300, 000. The estimated dog population of Mekelle city is about 20, 000. This includes both owned and ownerless dogs. Tigray National Regional State takes the first rank in Ethiopia in the utilization of rabies post exposure prophylaxis and most of this post exposure prophylactic treatment is given in referral hospitals of Mekelle city. It is very common to see free-roaming dogs on the streets of the city and this could play a significant role in the widespread of rabies in humans and other animals. Activities School education: This was one of the major activities targeted by the college. Students from five schools in Mekelle city were targeted for the awareness creation programs (2010-2013). Leaflets, brochures and posters were prepared local language to deliver the awareness creation program on rabies. Awareness campaigns were held in the schools and the trainings were given in the local languages. As part of the awareness creation program, competition among students was conducted on issues related to rabies. The prepared leaflets and brochures were distributed to students. In addition, posters were used as training materials for long term sensitization by posting at different sites of the city. Rabies vaccination and awareness campaigns: Four rabies vaccination campaigns were conducted to owned dogs yearly from 2010-2013 in Mekelle city and its surroundings. At the same time awareness creation forums were held to dog owners on rabies and its associated impacts. In addition, posters were prepared in the local language and distributed to different veterinary and human health posts as part of the awareness creation program. Student races were also prepared with the theme of Run for Rabies Awareness to disseminate information to the wider community. The dog vaccination campaigns have been continued by graduates of the college where they got organized and provide regular door-to-door rabies vaccination in and outside Mekelle, as business. Panel discussion forum: Several panel discussion forums were held among concerned stakeholders about rabies. These panel discussions were conducted with the objective of strengthening the collaborative effort of the stakeholders involved in rabies control and prevention. Use of mass media for dissemination of information: Radio: Fana Broadcasting Mekelle (94.8), Mekelle FM (104.4), DWT FM (102.2) and Ethiopian television were used to broadcast relevant information on rabies including cause of rabies, transmission of rabies, impact of rabies, measures to be taken during dog bite, and the prevention and control measures of rabies. Dog population control: Chemical applications and birth control (neutering and spaying) approaches were employed to reduce or depopulate ownerless dogs in Mekelle city and its surroundings in collaboration with Mekelle city Office of Agriculture, Tigray Bureau of Health 11
and Mekelle city Municipality. Different anesthetic agents, formalin, magnesium sulphate and other chemicals were used to humanely remove the ownerless dogs from the city. RESULTS School education: A total of 7,050 students were involved in the awareness campaigns from five schools starting from 2010 and this activity is continuing (Fig 1a & b). Table 1 summarizes the number of students from each school involved in the awareness creation programs. Rabies vaccination and dog population control: A total of 4734 dogs were vaccinated through organized vaccination campaigns, 3550 number of ownerless dogs depopulated and 388 numbers of dogs neutered (Table 2, Fig 2). In addition in 2012, rabies pre-exposure vaccination was given to professionals who are potentially exposed to rabies. During the vaccination campaigns, an awareness creation was conducted to the dog owners by the veterinary professionals of the college. Panel discussion forum: Four panel discussion forums were organized by the college of veterinary medicine of Mekelle University from 2010 2013. Stakeholders involved in rabies control and prevention were parts of the panel discussion (Table 3). Use of media for dissemination of information: Public media (FM Mekelle, Mekelle Fana Broadcasting, DWT FM) were used to disseminate awareness creation programs based on the different events conducted (school education, dog vaccination campaigns, panel discussion forums, etc.). Starting from February 2013 series of programs were broadcasted through FM Mekelle on several issues related to rabies. This broadcasting is a continuing program and currently organized by the college extension and consultancy services office. In addition, Mekelle Fana FM and DWT FM were used on seasonal basis to broadcast information related to rabies. All the media programs were delivered with the local language (Tigrigna). DISCUSSION Rabies is one of the major examples of a neglected tropical disease that mostly affects communities suffering from inequitable health care (WHO, 2010). The false perception that rabies impacts on society are low is due to case under-reporting and limited awareness of the disease burden (Dodet et al., 2008; Lembo et al., 2010). With this regard, there were fragmented activities in Tigray region, which are not sufficient to control the disease. However, since 2008, Mekelle University College of Veterinary Medicine took the initiative to contribute its share in the control and prevention of rabies in humans and animals. Among these initiatives, school education about rabies, mass vaccination of dogs, use of public media to disseminate information and ownerless dog population control through chemical and surgical methods were the major once. The Global Alliance for Rabies Control (www.rabiesalliance.org) and other organizations working on rabies control and prevention recommend public awareness as one of the major tools to reduce the incidence of rabies in human and animals. Mass dog vaccinations and educating the public about the risks associated with rabies and how infection can be prevented are key elements to keeping the spread of rabies. In the last five years the college delivered awareness creation to more than 7,000 students in different schools. The project members strongly believe that by educating school children, it is 12
possible to disseminate information to the wider community as these students are parts of the community. The feedback from the students was encouraging and efforts to establish clubs on rabies were also attempted. In the panel discussion fora detailed discussions were conducted and responsibility sharing between the various stakeholders was addressed. The major output of the panel discussion fora was establishment of a Regional Working Committee of Rabies involving several stakeholders involved in rabies control and prevention. Lembo and partners for rabies prevention (2012) developed a toolkit for rabies control based on the seven principles. Among these principles the following were in line with the activities accomplished by our college: 1) create a multi-disciplinary working group combining all disciplines/ institutions required for formulating comprehensive guidelines for a One Health approach to controlling rabies (Lembo et al., 2011); 2) follow a question-and-answer approach, reflecting the most frequently asked questions on rabies prevention and control; 3) use language that is understandable by a wide range of users, including professionals and field personnel. The first approach was achieved through the regularly organized panel discussion fora. The second and third approaches were addressed through school education and public media based awareness creation programs. The depopulation of dogs using chemical method is not recommended because of its environmental impact. However, due to the increasing population of stray dogs and the economic status of the country the team is forced to use this approach. Moreover, the animal birth control approach has been used to control dog population as an alternative option to depopulation method. Mekelle University, College of Veterinary Medicine considered rabies as one of the major diseases affecting human and animals in the region. The college took the initiative to contribute its share in the control and prevention of rabies. Since the college started the awareness creation campaigns, the awareness of the community on rabies has improved. The college has also played a significant role in the establishment of a private sector who are graduates of the college and currently they are providing regular door-to-door rabies vaccination in major cities of the region. For this reason, the vaccination coverage of rabies in the region has increased from 8.3% to 30.6%. However, to sustain these initiatives we strongly recommend integration between concerned stakeholders, improving the networks and communication channels, intensifying the awareness creation programs and mass dog vaccination coverage in the region, dissemination of best practices and development of policy and regulations on the prevention and control of rabies. ACKNOWLEDGEMENTS The authors are thankful to Mekelle University for provision of financial and material support for undertaking the activities. Furthermore, we acknowledge Tigray Bureau of Agriculture, Tigray Bureau of Health, Mekelle Municipality, Public media (FM Mekelle, Mekelle Fana Broadcasting and DWT FM), and the local community for their contribution in the success of the initiative. REFRENCES Brown, G. 2001. Population study of free-roaming dogs in a remote community in Central Australia. 13
Dodet, B., Bureau, A. R. E., Adjogoua, E., Aguemon, A., Amadou, O., Atipo, A., Baba, B., Ada, S. B., Boumandouki, P. & Bourhy, H. 2008. Fighting rabies in Africa: the Africa Rabies Expert Bureau (AfroREB). Vaccine, 26, 6295-6298. Global Alliance for Rabies Control: www.rabiesalliance.org Haupt, W. 1999. Rabies risk of exposure and current trends in prevention of human cases. Vaccine, 17(13), 1742-1749. Jackman, J. & Rowan, A. 2007. Free-roaming dogs in developing countries: the public health and animal welfare benefits of capture, neuter, and return programs. In: Salem D, Rowan A, (Eds). State of the animals. Washington DC: Humane Society Press; vol: 55 78. Lembo, T., Attlan, M., Bourhy, H., Cleaveland, S., Costa, P., De Balogh, K., Dodet, B., Fooks, A. R., Hiby, E. & Leanes, F. 2011. Renewed global partnerships and redesigned roadmaps for rabies prevention and control. Veterinary medicine international, 2011. Lembo, T., Hampson, K., Kaare, M. T., Ernest, E., Knobel, D., Kazwala, R. R., Haydon, D. T. & Cleaveland, S. 2010. The feasibility of canine rabies elimination in Africa: dispelling doubts with data. PLoS Neglected Tropical Diseases, 4, e626. Lembo, T. 2012. The blueprint for rabies prevention and control: a novel operational toolkit for rabies elimination. PLoS Neglected Tropical Diseases, 6(2), e1388. Macpherson, C.N.L., Meslin, F.X. & Wandeler, A.I. 2013. Dogs, zoonoses and public health, Second edition. Wallingford, UK: CABI International. Pp. Massei, G. & Miller, L. A. 2013. Nonsurgical fertility control for managing free-roaming dog populations: a review of products and criteria for field applications. Theriogenology, 80(8), 829-838. Morters, M. K., McKinley, T. J., Restif, O., Conlan, A. J., Cleaveland, S., Hampson, K., Whay, H. R., Damriyasa, I. & Wood, J. L. 2014. The demography of free roaming dog populations and applications to disease and population control. Journal of Applied Ecology 51: 1096-1106. Totton, S. C., Wandeler, A. I., Zinsstag, J., Bauch, C. T., Ribble, C. S., Rosatte, R. C. & McEwen, S. A. 2010. Stray dog population demographics in Jodhpur, India following a population control/rabies vaccination program. Preventive Veterinary Medicine, 97(1), 51-57. TBoH. 2012. Tigray National Regional State Bureau of Health Annual report, Tigray Mekelle, Ethiopia Villa, D.P., Kahn, S., Stuardo, L., Iannetti, L., Di Nardo, A. & Serpell, J. A. 2010. Free-roaming dog control among OIE-member countries. Preventive Veterinary Medicine, 97(1), 58-63. WHO. 1999. World survey of rabies: no. 33: for the year 1997: RABNET: the electronic WWW rabies data bank: 1988 to 1997. WHO. 2005. World Health Organization expert consultation on rabies: first report. WHO. 2010. Working to overcome the global impact of neglected tropical diseases: first World Health Organization report on neglected tropical diseases. WHO. 2013. World Health Organization expert consultation on rabies: second report (No. 982). World Health Organization 14
*Sectors participated: Mekelle University, Tigray Bureau of Agriculture, Tigray Bureau of Health, Tigray Bureau of Education, Tigray Police Office, Traffic Police, Mekelle Municipality, Tigray Agricultural Research Institute, Sub-city livestock and health Officers, Private groups Figure 1a and b: School children Education on Rabies Figure 2: Dog mass vaccination campaign in Mekelle, Tigray, Ethiopia 15
Table 1: Awareness creation on Rabies to school children from 2010-2013 School name Status of Total number School name students of students Atse Yohannes school Grade 1-6 900 Atse Yohannes school Aba G/michael Catholic school Grade 1-10 1,300 Aba G/michael Catholic school SOS school Grade 4-8 650 SOS school Sheba Academy Grade 4-8 750 Sheba Academy Magic Academy Grade 1-12 2,400 Magic Academy May Duba Elementary school Grade 1-8 1,050 May Duba Elementary school Table 2: Mass dog vaccination against rabies and dog population control Year No. of Dogs Vaccinated No. of depopulated dogs Birth control 2008 650 ------- --------- 2009 700 ------- --------- 2010 944 1050 214 2011 1100 800 73 2012 1340 1700 101 Total 4734 3550 388 Table 3: Panel discussion forums conducted from 2010-2013 Year No. of participants No. of sectors participated * 2010 68 5 2011 65 6 2012 64 6 2013 72 11 16