The One-Health Approach to Rabies Elimination in Asia

The “One-Health” Approach
Towards Rabies Elimination in
Asia

S. Abdul Rahman
President, Commonwealth Veterinary Association
President, Association for Prevention and Control of Rabies in India (APCRI)
Chairman, OIE Animal Welfare Working Group
Former Dean, Bangalore Veterinary College, Bangalore

1
Paper presented at The National Dog Welfare Conference India. 27-28 Feb 2013. Chennai, India

Ignorance is the main problem..


What is One Health?

The collaborative effort of
multiple disciplines
working locally,
nationally, and globally –
to attain optimal health
for people, animals and
our environment
-American Veterinary Medical
Association, 2008


Connectivity Between Animal and Human
Disease and the Environment

- Ancient civilisations
- Middle Ages: Black Death
- Rinderpest Outbreaks
C18th Europe
- Human Conflict: American
Civil War 1861-1865,
WWI, African Context

Questions of the animal origins of human disease lie behind
the broadest pattern of human history, and behind some of
the most important issues of human health today”
-Jared Diamond, in Guns, Germs and Steel

Early Pioneers of Comparative Medicine

- C19th: Hazards associated with
infected meat/milk gaining
recognition (TB and scarlet fever),
confirmation tapeworm associated
with muscular cysts in the cattle and
pigs.
- Rudolf Virchow coined the term
zoonosis to “indicate the infectious
disease links between animal and
http://www.creationism.org/books/TaylorIn
MindsMen/TaylorIMMhdRudolfVirchowM.j human health” (Cardiff et al, 2008)
pg
“Between animal and human medicine there are no dividing
lines – nor should there be. The object is different but the
experience obtained constitutes the basis of all medicine”
- Rudolph Virchow (1821-1902)

Calvin Schwabe (1927-2006)
- “Modern Advocate of One Medicine”
(Cardiff et al, 2008)
- 1984:Veterinary Medicine and Human
Health echoed the visions of integration
between human and veterinary medicine
- Advocated for the improvement of
human livelihoods through animal disease
control via examples such as CE, and
non-ZD e.g Rinderpest in EA
vetmed.ucdavis.edu

“The final objective of veterinary medicine does not lie in the
animal species that the veterinarian commonly treats. It lies very
definitely in man and above all in humanity” - Schwabe, 1984


One Health in the 21st Century
Promotion of One Health for the control of Emerging
Infectious Diseases

- 61% of human infectious diseases are of animal origin
(Taylor et al 2001), 75% of EID over the last 30 years
are zoonotic (Osburn et al et al 2009, AMVA 2008).

- Many hypotheses for this “spike” in zoonotic infectious
disease emergence worldwide; including increasing
human population , placing natural resources under
pressure and increases the contact between wildlife,
domestic animals and humans

Control of Endemic Zoonoses
for Poverty Alleviation
 2000: 6th MDG - “To Combat HIV/AIDS,
Malaria, and Other Diseases” - large scale
financial interventions addressing ID and their
contribution to poverty
 Neglected Tropical Diseases – Include WHO
recognised “NZDs” - Anthrax, BTB,
Brucellosis, Cysticercosis/NCC, CE, Rabies
and HAT (WHO, 2009c)
 Poverty, reliance on livestock, close proximity
between animals and people all favour the
spread of ZD
 Livestock productivity losses/death from ZD
places even greater strain on poor
communities


Moving Forwards with One Health in
Developing Countries
 Several high profile meetings to promote policy and
advocacy for the NZDs - Integrated Control of Neglected
Zoonoses in Africa (ICONZ) - EC funded project
involving 21 partners - collaborative project to address
knowledge “gaps” currently existing on NZD burdens –
www.iconzafrica.org
 “By simultaneously saving lives and securing livelihoods,
the control of neglected zoonotic diseases offers a real
and highly cost-effective opportunity for alleviating
poverty, especially in remote rural communities”
 WHO Meeting Report “Integrated Control of Neglected
Zoonoses in Africa” Nairobi, 2007

Challenges of Implementing a One Health
Approach in Developing Countries

 Advocacy and public
awareness for NZD

 Constraints to the
diagnosis (prioritisation)
of zoonotic disease

 Who Pays? National
funding “falls between
the cracks” of MoH/MoA

Rabies
 3.1 billion people live in 15 countries in Asia that are
endemic for dog rabies
 Rabies kills 55 000 people every year and also has the
highest case-fatality ratio of infectious diseases.
 Approximately 31000 (90% ) occur in Asia
 99% of deaths occur in Asia where Rabies is endemic in
dog population


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


Rabies
 Rabies is a vaccine preventable disease. The most cost
effective strategy for preventing rabies in people is by
eliminating rabies in dogs through vaccination
~ World Health Organization (WHO) 2010

 The control and elimination of rabies in dogs through
vaccination remains the only cost effective way to
sustainably protect humans from contracting the disease.
~ World Organisation for Animal Health (OIE) 2011

 Vaccinating dogs against rabies is the key to stopping this
terrifying disease. It protects the dogs from rabies and
creates a barrier between the disease and the people
~ Global Alliance for Rabies Control (GARC) 2012

Why Do People Still Die of Rabies?
 Lack of awareness on all levels about
 Responsible pet ownership – vaccinating pets
 Need for post-exposure prophylaxis (PEP)
 Primary wound care
 Rabies immunoglobulin (RIG) not available
 Rabies vaccines not available
 Greater cost of travel
 Increased risk of rabies onset
 Rabies vaccines are too expensive
 Likelihood of giving up
 Delays because of need to raise money
 Control of Dog Reservoir
Slide courtesy of Dr Katie Hampson, University of Glasgow

14

Human Rabies in Asia, 2010

Rabies-free
Up to 150 cases
151-300
301-2000
2001-10 000


Afghanistan

40 in 2010
(37) 150-200
2000-2500 1-4

20 000
Urban:24%
2000-2500
Rural: 76%

Rabies Free

Rabies Free
58 (2009)


Rabies Situation in Asia
 WHO estimation of rabies deaths in 2005 in Asia was
32,000 as compared to 41,000 in 2001 and it could still
be less now. This is mainly due to:
 Implementation of comprehensive rabies control programs
 Phasing out of Nerve tissue vaccine from all Asian
countries except Pakistan and Mongolia
 Availability of tissue culture vaccines and immunoglobulins
 Awareness programmes especially with World Rabies Day
 Role of International and Regional Organisations such as
WHO,OIE,FAO,GARC,RIA etc.


Adoption and implementation of OIE
Recommendations and Standards
 Rabies should be considered as a priority by all
governments
 Public awareness and education on rabies
 Active contribution of Veterinary Services to the goal of
eliminating human rabies at the animal source with the
appropriate financial support (public budget/Ministries of
Health)
 Design and implementation of comprehensive and
sustainable national programmes for rabies elimination,
 Harmonisation of control/ elimination programme
strategies between neighbouring countries until rabies
has been successfully eliminated.

Rabies Control Initiatives In Asia
 2004  2007
 1st AREB Meeting, Cebu  4th AREB Meeting,
Island, Philippines Bangkok,Thailand
 2005  First Rabies in Asia Conference
(RIACON 1) Bangalore, India
 2nd AREB Meeting, Shanghai,
China
 OIE/WHO/EU Intl conf Towards
the Elimination of Rabies in
 2006 Eurasia
 3rd AREB Meeting, New Delhi,  First World Rabies Day
India  The Philippines enact into law
 Establishment of the Rabies in the Anti-Rabies Act
Asia Foundation  Vietnam: Decree Enacts a
 Establishment of the Alliance Rabies elimination program
for Rabies Control (ARC)


Rabies Control Initiatives In Asia
 2008  2011
 Creation of the Partner for Rabies  OIE Global Conference on Rabies
Prevention group Incheon, Korea
 Resolution of eliminating rabies by  Third Rabies in Asia Conference
2020 adopted by the ASEAN Plus (RIACON 3) Colombo, Sri Lanka
Three Countries  8th AREB Meeting, Bangkok,
 5th AREB Meeting, Ho Chi Minh City, Thailand
Vietnam  Establishment of Global Alliance for
Rabies Control Asia
 2009
 6th AREB Meeting, Manila,  2012
Philippines  Ilocos Norte Philippines: 1st
 Second Rabies in Asia Conference Provincial Rabies Summit and
(RIACON 2) Hanoi, Vietnam CARE Project Launch
 Creation of a National Rabies
 2010 Control Programme in 12 Five Year
 7th AREB Meeting, Goa, India Plan Govt. of India
 9th AREB Meeting, Yogyakarta
Indonesia

Rabies Control Programme in
Asia
 Recent positive developments in South Asia and
South-East Asia towards rabies elimination need
to be enforced and supported through
international partnerships and funding.

 Political commitment, development and
execution of comprehensive rabies elimination
programmes and community participation are
prerequisites for successful rabies elimination


Asia
 Necessary tools and methods for control and
prevention of dog and human rabies are
available, and human rabies elimination has
been demonstrated in Europe, America and
some countries of Asia.

 Coordination among major stake -holders,
international partnerships, political commitment
and regional cooperation are major challenges


Asia
 The ASEAN Secretariat has taken a bold
decision to eliminate rabies by 2020; while
SAARC is also trying to
 move towards human rabies elimination. Though
many international non-government and humanitarian
organizations are involved in animal birth control and
rabies vaccination activities in urban areas in some
countries, a strong international
 partnership will be needed to execute a
comprehensive rabies elimination programme in the
South-East Asia region.
 OIE and WHO has been providing technical support to
member countries to launch such a programme

Asia
New projects with international funding

 WHO-coordinated Bill & Melinda Gates Project for
Dog Rabies Elimination (Visayas Islands) : 10m US$
funding

 Bohol Rabies Prevention and Eradication Program
(ARC, Bohol Provincial Gvt, Private Swiss Foundation)
Rabies retained in the final list of GAVI investment case


The Need for a One-Health
Approach
 In the fight against rabies, the priority is to safeguard
human welfare but it should not be at the unnecessary
expense of dogs

 One health approach will provide good animal welfare
which will have direct benefit to human health

 To ensure sustainability, dog vaccination programmes
will need political support and will need to integrate
public health, veterinary, livestock and animal welfare
agencies


Examples of “One Health” Initiatives
for Rabies Control in Asia
India : 1. Adopt a Village Programme
2. Pilot Project on Prevention and Control of
Human Rabies
3. Proposed National Rabies Control Programme
in 12th Plan
Indonesia: Indonesian Project –The Bali Case Study
Bangladesh: WSPA’s Red Collar Campaign in Cox’s Bazar
Philippines – Bohol Project
The CARE Project in Ilocos Norte, Sorsogon and Metro Manila
in Philippines and Nias in Indonesia
WHO – Bill & Melinda Gates Foundation Project in The
Philippines (Visayas)


INDIA
1. Adopt a Village Programme
 Ten villages surrounding Bangalore and Pune,
India have benefited from a programme aimed
at reducing the incidence of human and animal
rabies through improved educational awareness
and mass vaccination of dogs.
 A large number of medical and veterinary
partners worked together in the target villages to
educate people in their own language with
sensitivity to their customs.


Model Rabies Prevention Programme:
(Based on one health experiment )

Medical Veterinary

Messenger: Medium:

•Primary health care Behavioral •Rabies video film
volunteers Change •Rabies Calendar
•School children & Communication
•Posters
Teacher
•Wall paintings
•Local leaders
•Snake & ladder game
•Rabies rally
Rabies •Book labels
Awareness
•Folk Media

Post exposure prophylaxis Animal Welfare Activities
Laboratory Diagnosis by dRIT
& • Responsible pet ownership
Pre exposure vaccination • Anti rabies vaccination of
by ID route dogs
• Deworming

Rabies prevention

N
Bangalor
Subjects and Methods: e
Ramohall
y Bhimanakup S
e Project Villages
Vinayak
nagara
India

Control Gerupaly
Villages a
Rabies deaths in Animals
Village name 09 08 07
Kumbalgodu
A A A Study
Ramohally 1 1 - Villages
Bhimanakupe 1 - 1
Vinayak nagara 1 - 1
Tagachgup
* No Human Rabies death
e
Rabies Death in Human & Animals
Location of
Project Villages Bangalore
Village name 09 08 07 06 05 04
H A H A H A H A H A H A
Gerupalya - 1 - 1 - 1 - NA - NA - NA
Kumbalgodu - 2 - 2 1 2 - NA - NA 1 NA
Tagachgupe - 2 - 2 - 2 - NA - NA 29 - NA
H=Human
29
Mysore
A=Animal

INDIA
1. Adopt a Village Programme
 Empowering local
communities to take
action against rabies
 Building partnerships
& providing expertise
 Using existing
networks to improve
public health
 Human, veterinary &
animal welfare

Rabies Awareness Activities
Wall Paintings – Wall Paintings –
Objectives of the project Calendar for the Year 2011
Rabies education

Rabies Volunteer educating the Snake & ladder game for rabies
community Painting Competition education


Poster on Post Exposure Poster on responsible pet
Prophylaxis ownership Rabies public awareness video in
Kannada

FGD with rabies volunteers
Rabies Awareness - Jatha
& SHGs members


Laboratory Methods in Rabies Diagnosis & Hands
on training in Direct Rapid Immunohistochemistry
Test (dRIT)
Dr. S Abdul Rahman -Addressing the Dr. S N Madhusudana , NIMHANS –
participants -Auditorium, Government Discussion on dRIT .
Veterinary College, Bangalore.

Brain sample for
dRIT

Ms. Lillian Orciari, CDC, Atlanta
Rabid cow explaining about dRIT procedure

Results
Animal bite/Exposure - Incidence
Incidence in 1 year Baseline End line Z P

Study villages (N=1735) 47 (2.7) 33 (1.9) 2.05 0.0398

Control villages (N=1080) 31 (2.8) 27 (2.5) 0.59 0.5501

Note: Overall there was 30% reduction in incidence of animal bite /exposures in study villages.

 Human rabies Incidence: There was no case of human rabies
reported in study and control village.
 Animal Rabies Incidence: There were six cases from study village
and one case from control village of animal rabies confirmed by
dRIT

Results Summary
 Significant improvement in the KAP of people in the
study villages following implementation of rabies
prevention strategies.
 Incidence of animal bite/exposure reduced by 30 % in
study villages when compared to control villages.
 Post exposure prophylaxis was provided to all animal
bite/cases in the study villages. Dog, particularly pet dog
was found to be the most common biting animal and
majority of the cases were category III exposures.
 Pre exposure vaccination by Intradermal route to school
children & other risk groups using PCECV was safe &
immunogenic.

Results Summary
 There were no human rabies cases in project villages
during the two year project period.
 Laboratory diagnosis of animal rabies using direct rapid
immunohistochemical test (dRIT) was feasible at field
conditions.
 The animal welfare activity involving collar, anti rabies
vaccination & deworming was well accepted by the
community in study villages. Adequate RVNA titer in
dogs was observed with annual booster dose of rabies
vaccine.


Notifiability and Education Project

 Rabies is not a notifiable disease in
India but only Reportable
 Mass information campaign to
sensitize 545 Members of Parliament
with translation of Rabies information
in 12 different Indian languages
 Media campaign to highlight the need
for making Rabies a notifiable disease


Pilot Education Project in Karnataka State
 TACTICAL OBJECTIVE/GOAL
To relieve the burden of Rabies in animal
population especially in dogs in India and
eliminate human rabies deaths.

 Project is based on the premise that children are
best medium to adopt the concept of responsible
pet ownership Furthermore up to 60% of all
people who die of rabies are children.

 Target beneficiaries: 54,529 primary schools
with 252,875 teachers and 8.495 million
students. 9,498 secondary schools with 92,287
teachers and 1.384 million students
 Goal: Incorporation of rabies education into
54,529 primary schools by 2013 and 9498
secondary schools in Karnataka state by 2015.


Project On Evaluation Of Neutralizing Activity
Monoclonal Antibody Combination Against Rabies

 For reasons of safety and availability, alternative
products to HRIG and ERIG are advocated, and the
development of rabies virus-specific monoclonal
antibodies has been recommended by WHO
 Genotypic characterisation of Rabies virus from different
geographical locations in India
 The aim of the project in India will be to provide an
alternative therapy to rabies immune globulins (RIGs) by
developing a human monoclonal antibody (mAb) cocktail
for Post Exposure Prophylaxis


INDIA
2. Pilot project on Prevention and Control of
Human Rabies
 Objectives
 Prevention of human deaths due to rabies.
 Sensitization of veterinary and animal husbandry departments for reducing the
transmission of disease in animals.
 Strategy
 Enhancing awareness regarding timely and appropriate Post exposure treatment
 Ensure availability vaccines and anti-sera
 Training health professionals
 Operationalise ID route in selected centres
 Strengthen diagnostic capabilities
 Interface with animal husbandry department
 Involvement of NGOs and Community
 Pilot Project Cities
 Ahmedabad
 Bangalore
 Delhi
 Pune
 Madurai


Challenges faced in Surveillance and
Intersectoral coordination

• No single administrative unit
thus collection and collation
of data from all the agencies
involved in animal bite
management is a challenge
• Involvement of Intra-city
multiple stakeholders

• Continues to remain a
disease of low priority with
Dept of Animal Husbandry


INDIA
3. Proposed National Rabies Control Programme
in 12th Plan of Government of India
 Components:
 Human Health : to reduce mortality due to rabies
 Animal Health : to cut down transmission of disease
 Strengthening Intersectoral coordination
 Maintaining rabies -free areas as rabies -free


Coordination of Rabies control
Activities in India
NGO’s
WHO FAO OIE APCRI RIA ARC

Ministry of Ministry of
Health
Mun Corp Agriculture Dept. of
Vet
Services

AWBI -Min. of
Envr. Forest &
Anim. Welfare

Rabies Control
Programmes


World Rabies Day Programmes

 Education campaign
involving Media and
Celebrities such as
Film Stars and Sport
persons (Cricket)


Vietnam Government’s
Commitment
 Instruction No.92/TTg signed by Prime Minister
on 07/12/1996;

 Ordinance on Animal Health was adopted by the
National Assembly in 2004;

 Decree No.05/2007/ND-CP signed by Prime
Minister on 09/01/2007.


INDONESIA
Indonesian Project –The Bali Case Study

 In 2010, the Bali Animal Welfare Association (BAWA),
funded by the World Society for the Protection of
Animals (WSPA) and the Australian Agency for
International Development (AusAID), initiated island-
wide mass vaccination campaigns for free, targeting the
outside dog population.
 The result was a marked decline in the new reports of
rabies infections in humans. The Indonesian Directorate
of Animal Health, seeing the concrete results, reached
out to FAO for technical support to maintain the
momentum and build upon the lessons learned battling
the rabies virus in Bali.

INDONESIA

FAO's Assistance
 In early 2011, the FAO began working with the
veterinary services to develop a targeted strategy to
combat rabies, coordinating at various levels: local,
provincial and with central authorities in Jakarta.
 In addition, human health services, local NGOs and
animal welfare groups have also been involved in
mounting a united front against rabies.
 FAO supported the government by helping to bring all
sides to the table to launch an effective control
programme against rabies.


INDONESIA

Island wide mass vaccination programme
commences.
 In the first round of vaccinations
implemented by BAWA, some 239,000 dogs
were vaccinated.
 During the second round, coordinated by
the Bali Province Livestock Service and the
central government's Directorate of Animal
Health, with funding from FAO, Australia
and United States, another 235,000 dogs
were vaccinated within four months.
 A third round of vaccination is ongoing now
and will cover another 250 000 dogs.


The vaccination of dogs
Human and Dog Rabies Cases, Bali (Oct 2009 – March 2011)
STOP Dog Culling
START of 1 st mass dog
vaccination
14 90
13 13
213 176
doses 80
12 Humans 77
Human deaths

70

Dog cases
68 (70% dog pop)
10 10 62 60
8 8 8 50
7 7
6 38 6 38 40
5 5 5 5 30
4 28
4 28 4
23 22 24
3 19 3 20
2 Dogs 2 14 12 2
9 10 9 9 9 10
133 169 doses 115 326 doses
0 0
Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar-
09 09 09 10 10 10 10 10 10 10 10 10 10 10 10 11 11 11

Months


INDONESIA

Herd Immunity
 With more than 70 percent of dogs vaccinated, the
dogs have ‘herd immunity'.
 At this level of vaccination coverage, the rabies virus is
unable to spread in a dog population that has immune
protection, and it eventually dies out.
 Rabies deaths in humans have declined from 83 in
2010 to 26 in 2011. So far in 2012, just seven people
have fallen victim to rabies.


BANGLADESH
WSPA’s Red Collar Campaign in Cox’s Bazar

 WSPA’s mass vaccination project in
Bangladesh is helping to protect
thousands of dogs, as well as local
families, from rabies.
 The teams put red collars on
vaccinated dogs, or sprayed their
backs with toxin-free yellow paint, to
indicate that the animals were
protected against the deadly disease.
 Further, the teams educated the
community about the importance of
vaccination in the fight against rabies.

The Global Alliance for Rabies Control
“Striving to free people and animals from rabies”
 Collaborative programs:
 World Rabies Day Campaign
 It is a global campaign, celebrated every 28th September of the
year, to raise awareness and give a voice to people at most
risk on rabies
 Bohol Rabies Project, demonstrated that rabies can be
eliminated and children saved by:
 empowering communities to take responsibility

 mobilizing local resources

 developing & sharing adequate tools for sustainability

 working with global experts

 Other programs where we share our expertise and support
governments to monitor their rabies program
(i.e. Adopt a Village in India)

PHILLIPINES
The Bohol Project
Luzon
Luzon
 Partnership with government and the
Global Alliance for Rabies Control
Manila
Manila

PHILIPPINES
PHILIPPINES

Additional funds from WHO and other
Samar
 Panay
Samar

Panay
Cebu

NGOs
Leyte
Cebu
Ley
Palawan Bohol
Negros
Palawan Negros Bohol

Initiated in 2007
Mindanao
 Mindanao

Basilan
Basilan

Cost estimate conducted in 1991
Jolo
 Sulu
Jolo
Sulu

 Estimated $2.5 million/year in cost-
savings by eliminating dog rabies in
Philippines
 Costs would be repaid in 4 –11 years


Bohol Project Philippines:
Controlling Canine Rabies and Preventing
Human Deaths
 Community mobilization
 140 to >15,000 persons involved in program
 Vaccination
 70% of dog population
 Increased access to postexposure prophylaxis (PEP)
 New clinics
 Expanded training
 Integration of rabies education into school curriculum
 All elementary school children educated (182,000 children)
 CDC training of direct Rapid Immunohistochemical Test (dRIT)
and evaluation of diagnostics


Bohol Project Philippines:
Controlling Canine Rabies and Preventing
Human Deaths
 No human or dog rabies deaths reported since Oct
2008

 In 2 prior years, 10 cases/year reported

 Program strategy to be self-sustainable when
outside funding no longer available


Bohol Updates
Galing Pook Award 2011 for Outstanding Local
Government Program for Governance and
Innovation

 presented by the President of the Philippines and every year
recognizes 10 local governance projects for excellence
 held up as an example for other communities to emulate in their
rabies control.
 It is powerful endorsement of the project model and a step forward
in global rabies control.


The CARE Project in Ilocos Norte,
Sorsogon and Metro Manila in Philippines
and Nias in Indonesia

Project Components:
 prevention of dog bites and human rabies;

 establishment of sustainable diagnostic and surveillance
systems;
 elimination of rabies in the vector species (dogs);

 community awareness and mobilization;

 integration of rabies prevention education into
elementary schools


CARE Project Sites
Indonesia and Philippines

Ilocos Norte – 547k people, 40k dogs
Sorsogon – 709k people, 64k dogs
Metro Manila – 690k people, 20k dogs
(Cross border Marikina & Cainta)

Nias
750k people
45k dogs


A One Health Example – Metro Manila
 To demonstrate the benefit of a one health approach,
WSPA and the Global Alliance for Rabies Control
(GARC) will jointly deliver a cross border dog rabies
elimination project in Metro Manila

 Objective is to eliminate canine and human rabies in 3
years

 Department of Agriculture and the Department of Health
are supportive and local veterinary and animal welfare
agencies will be brought on board


WHO – Bill & Melinda Gates Foundation
Project in The Philippines (Visayas)

 From a short-list of ten countries, sites in three
countries have been identified to demonstrate the
feasibility, cost-effectiveness and benefits for
human health of controlling and eliminating
canine rabies in five years.
 Selected countries:
 Tanzania (South Eastern part)
 South Africa (Kwa Zulu Natal) and
 The Philippines (Visayas)


Project area in the Philippines
 Visayas group of islands
covering 25% of the total
number of animal rabies cases,
28% of the total human rabies
and 27% of the animal bites in
the entire country.
 The project will serve almost 19
% of the country’s human
population (with 17 million
inhabitants in the area) and an
estimated 9 million dogs.


Challenges for Rabies Control in Asia

 Generating the political awareness and will for
large-scale control programme – Ownership
for dog rabies control

 Development and implementation of a national
rabies control strategy

 Devolving responsibility to local government
authorities

 Legislation: Registration/Licensing and
vaccination of dogs.


Government
Public
Legislative
awareness
Support -
and education
Notifiability -
on rabies
Funding

Municipality &
Community Involvement
Involvement, of Veterinary
Media and Services
Celebrities
RABIES
CONTROL
Wound
Dog
Management
Population –
and Post
Management
Exposure
and Control
Prophylaxis

Surveillance Involvement
and of Animal
Laboratory Welfare
Diagnosis Organizations


Future plans to control Rabies at
Source in Asia
General Considerations
 Prevention: Introduce cost-effective public health
intervention techniques to improve accessibility,
affordability and availability of post-exposure prophylaxis
 Promotion: Improve understanding of rabies through
advocacy, awareness, education and operational
research
 Partnership: Provide coordinated support for anti-rabies
drive with the involvement of community, civil society,
government and non-government sectors and
international partners


General Considerations
 Establish surveillance on human as well as animal side
and identify Rabies as a Notifiable disease
 Strengthen State-level coordination committees
 Identify and fill gaps in current implementation
programmes eg. Rural and peri-urban areas pose a
major threat to the success of rabies control efforts
 Document Rabies intervention as a model for replication
 Draft a blueprint that can guide the national disease
control programme to combat rabies and other zoonoses
in the country


Future plans to control Rabies at Source
in India
Specific Considerations
• Human rabies prevention is possible
through promotion of responsible dog
ownership, mass dog vaccination and
animal birth control programme with
partnership approach

 Mass vaccination campaigns targeting dogs
of all age group to develop herd immunity.

 Mass dog vaccination alone is effective but
providing additional dog population
management interventions can help
overcome the challenges


Strengthening Of Available Laboratory Facilities
For Rabies Diagnosis In Animals And Humans
Currently very few facilities for Rabies Diagnosis are
available:
For rabies diagnosis in humans:
 NIMHANS, Bangalore

 NCDC, Delhi

 NIV, Pune
For rabies diagnosis in animals
Dedicated Rabies Laboratory has
Been set up at Bangalore Vet Col
Which will be twinned under OIE
Twinning programme with CDC
: Laboratories in different states and
at Veterinary colleges

Conclusion
A Rabies Control programme focused on
mass vaccination of dogs and animal birth
control is largely justified by the future
savings in human rabies prevention.
 This is where dog owners, civic societies,
animal welfare and non-government
organizations need to play a proactive role.
 A concerted effort between the human and
animal health sectors can achieve the goals
of rabies elimination.

We are not alone!


Thank You For Your Attention

Merci de votre attention


The One-Health Approach to Rabies Elimination in Asia

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