Mission Rabies Sri Lanka

Mission Rabies Sri Lanka 10 th to 24 t September 2016 Contents Page Background. 2 Partnership and staffing. 2 Location. 3 Program. 4 Data.. 5 Experiences on the ground.. 11 Health and Safety 12 International guests.. 12 Future work 13 Photographs.. 14 References.. 15 1

Background Rabies is one of the deadliest viruses in the world, with an estimated 59,000 human deaths each year 1. Despite this it is 100% preventable through vaccination. As over 98% of human rabies cases are a result of exposure through dog bites 2 vaccinating dogs against rabies will significantly reduce the number of human rabies deaths. Vaccinating at least 70% of the canine population creates herd immunity against rabies and effectively eliminates it from the canine population 3 ; this has a knock on effect improving the welfare of both dogs and people. Mission Rabies was set up in 2012 to help eliminate canine rabies from the world. With support from the Dogs Trust and Worldwide Veterinary Services it is hoped that this goal can be achieved by 2030. After the success and great results from working in India since 2013 Mission Rabies has expanded its work to other parts of Asia and Africa. Mission Rabies conducts yearlong vaccination campaigns in Goa, India; Ranchi, India; and Blantyre, Malawi. There are smaller campaigns in Zomba and Chiradzulu, Malawi and annual vaccination campaigns in Tanzania, Uganda and Sri Lanka. In January 2015 the first Mission Rabies Dogstar Foundation (Dogstar) partnered vaccination drive was conducted in Negombo, Sri Lanka. The drive was repeated in 2016 and was opened up to International Guests (volunteers). This report details the 2016 vaccination campaign. Mission Rabies employs four concepts in its work to reduce human rabies cases 1) Mass Canine Vaccination, targeting at least 70% of the dog population 2) Humane Canine Population Control 3) Community Rabies Education and Awareness 4) Canine Rabies Surveillance Prior to the mass canine mobile vaccination program in Negombo, Dogstar partnered with the Negombo Municipal Council (NMC) to hold 137 static point vaccination sites throughout Negombo. These were held between June and September 2016. Prior to and during the mobile vaccination drive Dogstar undertook a period of community sensitisation. Dogstar run year round humane canine population control programmes and have sterilised over 4,000 dogs since March 2015. During 2017 Dogstar will be discussing introducing Canine rabies survalince with the NMC under the guidance of Mission Rabies. Partnerships and Staffing Mission Rabies has partnered with Dogstar to work in Negombo, Sri Lanka, where Dogstar are based. Dogstar was established by Mark and Sam Green in 2006, initially providing animal adoption, veterinary care and preventive care to animals in the Kegalle region. Since 2014 the main focus of Dogstar s work moved to Negombo Municipal Area. Dogstar primarily runs a combination of outreach sterilisation campaigns, but also works towards canine rabies elimination through surveillance and vaccination, under the guidance of Mission Rabies, and animal welfare education periodically in schools and communities. 2

A pilot vaccination campaign was held in January 2015 to demonstrate the effectiveness of Mission Rabies working protocols and to establish the feasibility of transferring these to working outside of India. Mission Rabies had been working in India for over a year and had established effective working practices there. This project was the first to be held outside of India and aimed to test the ability for the established practices to work in alternate locations. A 5,000 dog vaccination drive was opted for to act as a proof of concept. A total of 5,327 dogs were vaccinated over 20 days of mobile door-to-door vaccinations. This was estimated to be over 75% of the canine population, sufficient to create herd immunity against rabies. Dogstar strives to work closely with the NMC, which run annual vaccination campaigns in Negombo. Dogstar have informed the government that we will be working in Negombo for 3 years, in order to create a Rabies Free Negombo, then the responsibility will fall with the NMC to maintain this status. To help build relationships with the NMC, Dogstar partnered with them during their annual vaccination campaign between June and September 2016, providing quality vaccines and data collection. Over this time 137 static point vaccination sites were held. This was done under the guidance of Mission Rabies. Following on from this Mission Rabies and Dogstar conducted a mobile, door-to-door vaccination campaign over three weeks in September in order to establish the effectiveness of the static point vaccination sites. Dogstar undertook most of the in country preparatory work for the mobile vaccination campaign, under the guidance of the Mission Rabies team in the UK. There were a total of 6 Mission Rabies volunteers in addition to Dogstar and Best Care staff and one Mission Rabies staff member. The local hotel association in Negombo were in support of the project, advertised our project and donated drinking water and one hotel donated the use of their pool for the volunteers. Location Vaccinations took place in Negombo, a tourist destination on the west coast of Sri Lanka. This area was originally chosen to support the excellent work being carried out by Dogstar in this region. The urban area of Negombo covers an area of 30 Km 2 4 and Negombo Municipal Council comprises 33 wards. A 2001 census for Negombo places the human population at approximately 128,000 4. Since the first vaccination campaign in Negombo no suspect rabies cases have been reported in this area, though one case was confirmed in the neighbouring area at the boarder of the previous year s vaccination campaign. 3

Image 1. Negombo, 1a, Location of Negombo in Sri Lanka. 1b, 1c, 33 working wards of Negombo. Program It is estimated that Negombo has a population of approximately 7,500 dogs. To achieve 70% vaccination coverage of the canine population we would need to vaccinate approximately 5,000 dogs. Dogstar worked with NMC between June and September prior to the start of the mobile door-todoor vaccination campaign vaccinating over 4000 dogs at 137 static point vaccination sites. Turn out to the static point vaccination sites was greater than expected though the door-to-door vaccination campaign was vital to determine what proportion of owned dogs were presented at the static point vaccination sites, what proportion didn t attend and to increase the vaccination coverage above 70%. Mission Rabies International Veterinary Projects Manager, Jordana, was present for the duration of the door-to-door vaccination campaign. All staff and volunteers were briefed before the start of the vaccination campaign. The briefing contained information about the history of Mission Rabies; the pathophysiology and epidemiology of rabies; exposure and post exposure protocols; how the vaccination campaign would run so that all team members were fully aware of their roles and responsibilities; and health and safety. All participants signed to say they had been present and understood the briefing. This was followed up with a practical brief introducing all volunteers to the Mission Rabies App. The door-to-door programme was initially planned to run from 12 th to 23 rd September for 10working days. This year vaccinations took place in more wards than in 2015 and more dogs were encountered than anticipated meaning the programme ran for 15 days between 12 th and 28 th September 2016, though volunteers were only present for 10 days. There were 3 teams working in separate wards each day apart from in large open areas, typically fish markets, when all 3 teams worked together to increase the number of dogs caught. Traditionally Mission Rabies focuses on canine vaccination since dogs are the main reservoir and vector of rabies, with over 99% of human 4

rabies cases occurring as a result of a rabid dog bite. During the NMC partnered static point vaccination campaign cats were also vaccinated, since these are both common pet species. As people brought their cats to the static point vaccination campaign it was agreed that Mission Rabies would vaccinate cats in addition to dogs in the door-to-door campaign. Image 2. Static point vaccination sites in Negombo, between June 2016 and September 2016. To help establish vaccination coverage and to help improve on prior population estimates surveyors visited completed wards the next day. Survey teams worked from tuk tuk s travelling along every passable road in each ward. All dogs visible from the tuk tuk were recorded indicating whether they had a paint mark or a collar so that vaccination percentages could be calculated from this. A paint mark was applied to all vaccinated animals and where possible a quick release collar was put around the dog s neck, either was an indication of a vaccinated dog. Different colours were used to identify a dog that had been vaccinated previously at a static point vaccination site or by a private vet (yellow collar, red paint) from those that were vaccinated at the door-to-door campaign (blue collar, yellow paint). Data A total of 4,327 dogs and 632 cats were vaccinated at the static point vaccination sites. The door-todoor campaign saw an additional 3,494 dogs and a staggering 786 cats vaccinated. In total 9,239 animals were vaccinated, of which 7,821 were dogs. This is phenomenal and exceeds the original canine population estimate. Whilst it is possible some dogs were vaccinated twice, at both the static 5

point sites and the mobile door-to-door sites further work is needed to improve on the estimated dog population of Negombo. During the door-to-door vaccination 1,679 dogs were recorded as having had been vaccinated previously, of which 1,032 were vaccinated at the static point locations. Only 23.8% of dogs vaccinated at the static-point vaccination sites were re-seen. Ward ID Static Point Cat Static Point Dog Door to Door Dog Door to Door Cat Door to Door Roaming Dogs Door to door Owned Dogs % of dogs roaming at D2D %of dogs owned at D2D % Static Point % Door to Door Total Cats Total Dogs 1 11 144 181 25 66 115 36.46 63.54 44.31 55.69 36 325 2 14 72 72 13 11 61 15.28 84.72 50.00 50.00 27 144 3 2 26 136 21 25 111 18.38 81.62 16.05 83.95 23 162 4 17 130 70 5 18 52 25.71 74.29 65.00 35.00 22 200 5 10 46 88 15 11 77 12.50 87.50 34.33 65.67 25 134 6 16 54 56 14 18 38 32.14 67.86 49.09 50.91 30 110 7 6 80 226 16 118 108 52.21 47.79 26.14 73.86 22 306 8 4 30 183 32 22 161 12.02 87.98 14.08 85.92 36 213 9 30 212 21 1 1 20 4.76 95.24 90.99 9.01 31 233 10 17 162 91 8 28 63 30.77 69.23 64.03 35.97 25 253 11 14 128 89 9 22 67 24.72 75.28 58.99 41.01 23 217 12 19 195 102 22 13 89 12.75 87.25 65.66 34.34 41 297 13 5 37 36 10 11 25 30.56 69.44 50.68 49.32 15 73 14 40 349 202 37 45 157 22.28 77.72 63.34 36.66 77 551 15 4 67 45 9 16 29 35.56 64.44 59.82 40.18 13 112 16 25 88 108 15 35 73 32.41 67.59 44.90 55.10 40 196 17 16 132 149 46 11 138 7.38 92.62 46.98 53.02 62 281 18 34 121 65 39 3 62 4.62 95.38 65.05 34.95 73 186 19 35 239 172 31 20 152 11.63 88.37 58.15 41.85 66 411 20 40 280 191 68 7 184 3.66 96.34 59.45 40.55 108 471 22 14 68 99 17 12 87 12.12 87.88 40.72 59.28 31 167 23 25 214 100 18 20 80 20.00 80.00 68.15 31.85 43 314 24 38 151 105 14 6 99 5.71 94.29 58.98 41.02 52 256 25 0 0 47 11 9 38 19.15 80.85 0.00 100.00 11 47 26 23 63 40 5 17 23 42.50 57.50 61.17 38.83 28 103 27 4 43 77 18 35 42 45.45 54.55 35.83 64.17 22 120 28 15 91 61 11 17 44 27.87 72.13 59.87 40.13 26 152 29 5 41 82 38 4 78 4.88 95.12 33.33 66.67 43 123 30 13 117 48 22 20 28 41.67 58.33 70.91 29.09 35 165 31 31 189 79 24 25 54 31.65 68.35 70.52 29.48 55 268 32 11 173 72 25 8 64 11.11 88.89 70.61 29.39 36 245 33 53 432 143 47 52 91 36.36 63.64 75.13 24.87 100 575 34 32 245 257 99 60 197 23.35 76.65 48.80 51.20 131 502 Extra* 0 0 1 1 0 1 0.00 100.00 0.00 100.00 1 1 Totals 623 4419 3494 786 786 2708 22.50 77.50 55.84 44.16 1409 7913 Table 1, Static point and Door to Door numbers combined. 6

Ward Cat Dog New Not vacc vacc Prev vacc Dog Total Grand Total 1 25 181 8 69 258 283 2 13 72 12 36 120 133 3 21 136 18 58 212 233 4 5 70 2 10 82 87 5 15 88 1 29 118 133 6 14 56 5 45 106 120 7 16 226 13 42 281 298 8 32 183 0 38 221 253 9 1 21 0 10 31 32 10 8 91 0 20 111 119 11 9 89 4 23 116 125 12 22 102 1 74 177 199 13 10 36 0 9 45 55 14 37 202 0 80 282 319 15 9 45 0 3 48 57 16 15 108 25 119 252 267 17 46 149 22 107 278 324 18 39 65 1 59 125 164 19 31 172 0 77 249 280 20 68 191 4 182 377 445 22 17 99 2 53 154 171 23 18 100 0 34 134 152 24 14 105 0 30 135 149 25 11 47 0 15 62 73 26 5 40 0 9 49 54 27 18 77 0 15 92 110 28 11 61 0 15 76 87 29 38 82 0 44 126 164 30 22 48 0 32 80 102 31 24 79 0 27 106 130 32 25 72 0 82 154 179 33 47 143 0 88 231 278 34 99 257 0 145 402 501 Grand Total 785 3493 118 1679 5290 6076 Table 2. Door-to-door vaccinations. New vac = vaccine given at the time; Not vaccd = no vaccine given now or within the past year; Prev vac = vaccine not given now but has been vaccinated in the past year The majority of the ward surveys came back with at least 70% vaccination coverage, with multiple achieving over 80% vaccination coverage (Table 2). Where a survey came back with less than 70% vaccination coverage (highlighted in orange) the vaccination teams went back to that ward and 7

surveys subsequently repeated. Where this happened the second survey came back at over 70% vaccination coverage (highlighted in green). Unfortunately the surveys conducted over the last two days came back with low vaccination percentages. At that time Sam and Mark were not in Sri Lanka to oversee the work and it is thought that the surveyor started surveying differently as there was a large increase in the number of confined dogs noted in his surveys at this time. Despite this the overall percentage vaccination coverage exceeds the minimum required to eliminate rabies from an area at 71.69%. This programme shows how you can successfully use static point vaccination sites in combination with door-to-door vaccinations in Sri Lanka. There were many dogs that would not have been vaccinated in the door-to-door campaign that were vaccinated at the static point campaign and vice versa. Date Vaccinated Grand Ward No Yes Total 13/09/2016 % vaccinated 1 40 97 137 70.80 14/09/2016 29 94 123 76.42 2 15 37 52 71.15 4 14 57 71 80.28 15/09/2016 18 61 79 77.22 3 18 61 79 77.22 16/09/2016 35 76 111 68.47 7 32 91 123 73.98 17 4 19 23 82.61 17/09/2016 19 105 124 84.68 16 18 71 89 79.78 18/09/2016 15 82 97 84.54 5 9 34 43 79.07 6 6 48 54 88.89 19/09/2016 39 174 213 81.69 9 36 152 188 80.85 15 3 22 25 88.00 20/09/2016 42 100 142 70.42 20 42 100 142 70.42 21/09/2016 47 147 194 75.77 18 12 39 51 76.47 19 28 74 102 72.55 23 7 34 41 82.93 22/09/2016 107 198 305 64.92 8 55 72 127 56.69 10 4 33 37 89.19 11 26 37 63 58.73 8

22 22 56 78 71.79 23/09/2016 37 85 122 69.67 31 13 33 46 71.74 32 24 52 76 68.42 24/09/2016 21 77 98 78.57 11 4 33 37 89.19 12 17 44 61 72.13 25/09/2016 15 71 86 82.56 14 15 71 86 82.56 26/09/2016 31 69 100 69.00 8 1 25 26 96.15 33 30 44 74 59.46 28/09/2016 31 41 72 56.94 34 31 41 72 56.94 29/09/2016 87 54 141 38.30 13 18 14 32 43.75 24 27 6 33 18.18 25 24 6 30 20.00 26 18 28 46 60.87 Grand total 71.69 Table 3. Survey results for all wards vaccinated. Those highlighted in orange came back under 70%, those highlighted in green represent vaccination percentages after the ward was vaccinated again and survey repeated. 16.64 0.68 0.74 % NO % GC % OC % OP 81.95 Image 3. Pie chart demonstrating ownership status of dogs; NO = no owner; GC = community dog; OC = owner claimed during catching; OP = owner presented at catching 82.68% of all dogs recorded were owned, with only 16.64% not having any owner of care giver. The majority of owned dogs were confined at the time of presentation (Image 3). Image 4 and 5 illustrate the GPS data points collected for each animal recorded during the door-to-door vaccination campaign. 9

Image 4. Data points for door-to-door vaccination campaign 10

Image 5. Close up view of part of the data points for door-to-door vaccination campaign Experiences on the ground Dogstar have an amazing and dedicated team, who are supported by the local hotel industry and by a private veterinary practice, Best Care. In addition they are especially organised and motivated towards the aim to eliminate rabies from Negombo. Consequently the programme was a great success and the volunteers enjoyed their time working with the teams. All members of the team were punctual, responsible and worked as a team. There was great support from the people of Negombo, people were ready to cooperate and provide proof of vaccination. Dogs and cats of all ages were brought for vaccination. Whilst there is often concern amongst people over vaccinating young animals this didn t seem to be a feature in Negombo meaning that we were able to vaccinate a greater proportion of the canine population and protecting all ages of dogs with ease. During the door to door drive difficulties were experienced with GPS on the mobile phones leading to some erratic data recording. The working method evolved as we worked. Originally we knocked on every door we saw to ask people if their dogs had been vaccinated. This significantly slowed down the work and so the methodology was changed so that a tuk tuk went ahead of the team announcing the presence of the vaccination team and for owners to present their dogs for vaccination or their vaccination cards to prove their dogs had already been vaccinated. This allowed the teams to cover the areas much 11

quicker, though coverage would not be as thorough compared with the door-to-door method. This didn t have any effect on our overall vaccination percentages since the overall percentage still exceeded 70%. One problem we suspect happened was that owners would wash off the paint and take off the collars from the dogs. Blue collars were put on dogs to represent a previous vaccination and yellow collars represented a new vaccination. Dogs were also given vaccination collars at the static point vaccination sites. Whilst a few dogs were seen with these collars on many had either lost their collar or their owner had removed them. Many owners presented the collars to us along with their vaccination card. If this pattern was followed and owners removed collars after the door-to-door vaccination campaign it may affect our surveys negatively. Health and Safety Mission Rabies prides itself on running safe and efficient vaccination campaigns. An important aspect of this is ensuring health and safety of staff, volunteers and members of the public. All participants were briefed prior to the start of the project about rabies, exposures, rabies prevention and the working methods used. Only one post exposure course was needed during the programme, for one of the volunteers due to a cat bite. Any person who was potentially exposed, via a category 2 or 3 exposure, were instructed to wash the affected area for 15minutes using soap or iodine and water. All members of the public were advised to seek medical attention and that they would require post exposure prophylaxis, especially if their dog or cat became sick or died within the following 10days. Vehicles were an additional health and safety concern. There has been a move within Mission Rabies to ensure that every team has a vehicle in case of an emergency. This project used 3 Best care vans donated for the duration of the project and 3 tuk tuks, two owned by Dogstar and one rented. In general the IGs travelled by Tuk tuk, as space was limited in the trucks. All team phones had the local ambulance phone number stored in the contacts. Drivers were never far from the teams. Tuk tuks were fine for IG travel in this project as roads were not too busy or congested and the vehicles were quite secure, although one IG was travelling after the end of the project in a tuk tuk that capsided, so this may need to be considered in the future. Finances would be a limiting factor to using alternative vehicles. Unfortunately scheduling prior to the start of the vaccination drive didn t allow for additional first aid training of team leaders. This needs to be corrected for next year. Jordana was with one team during the majority of the project and was always available by phone in case of emergencies. There were no emergencies during this drive, and as the project is relatively low risk it isn t expected for there to be any emergencies in subsequent drives, however there is always this possibility. International Guests This year we opened up Mission Rabies Sri Lanka to volunteers. There were 7 places advertised and were filled with relative ease. Unfortunately a number of volunteers had to drop out though one person applied with short notice and was able to attend. The project ran with 6 volunteers, 2 per team. This worked well. We had volunteers from the UK, USA, Australia and Portugal. All volunteers were new to Mission Rabies programmes and had heard about Mission Rabies from a masters 12

course they were doing (International Animal Welfare, Ethics and Law; Edinburgh University), from friends or internet searches. All volunteers appeared to enjoy the project and many expressed a wish to participate in either this project next year or a different Mission Rabies project. The volunteers adapted quickly to their environment and worked well together and with their vaccination teams. All volunteers have been asked to fill out a post-project survey that covers all aspects of the volunteer experience, including accommodation, by Mission Rabies. The data shall be analysed once participants have completed the survey and details can be obtained at a later date, if desired. A tour had been arranged by Sam and Mark through a contact. This left on the evening after finishing work and was for two nights, returning in the evening before work started the next day. The trip took volunteers to Sigiriya Rock Fortress ( UNESCO World Hertage Site ), Minneriya National park to see wild elephants, to Dambulla Rock cave Temple and the Temple of the Tooth in Kandy. The trip cost approximately 200 each (for 5 people) excluding meals and drinks. It was enjoyed by all and worth the money. The guide was nice and friendly, he did add in an alternative optional part to the trip, a village tour, which is not recommended for future trips. Overall it is believed the volunteers enjoyed the experience and that the project is suitable for volunteers. Future work The volunteers are asked to fundraise 350 pounds each which will be used to expand the work being carried out in Sri Lanka by Dogstar and Mission Rabies. The total amount raised at the time of writing is 2413.18. The plan is to introduce the Mission Rabies education programme to Negombo, a proposal has been made. The project ran well and is a suitable project for volunteers. Therefore it is possible to run the same project next year in a similar manner. I had no contact with government officials so am not in a position to say whether they would be able to provide any financial assistance. Dogstar do have contact with local NMC and have already started plans for how to hand over the project to them after 2017. This is work in progress and will be followed up over time. The NMC worked with Dogstar on static point vaccinations this year, and opted not to be involved in the door-to-door work. The government charged 50 Sri Lankan Rupees for registration of owner dogs, making the programme more appealing to the NMC. Dogstar have plans to discuss ideas with the NMC about making the project financially viable for them so that rabies vaccination and surveillance can continue in Negombo beyond 2017. Further work is needed to improve on the estimated dog population of Negombo. A lot of data has been collected during this vaccination campaign which can be used to help create an improved population estimate, including neutered status and whether the dogs were microchipped or not (Dogstar have microchipped all dogs they have sterilised since mid 2015). Alongside this information it may be necessary to discuss alternate ways to survey the area s to avoid missing owner dogs, 13

perhaps using a technique similar to that of Goa where the surveyors will talk to owners about the vaccination status of their dogs and not only relying on the presence of a paint mark. Photographs from the vaccination drive Volunteer vaccinating an owner dog whilst another is helped to data collect by a team mate 14

Vaccinating an owner dog In search of dogs to vaccinate note the Balinese style catching nets 15

References 1. Hampson, et al (2015) PLOS 9 (4) 1-20 2. Canine Rabies Blueprint 3. WHO, http://www.who.int/rabies/about/en/ 4. https://en.wikipedia.org/wiki/negombo 16