Major roadblocks for complete elimination of rabies

Despite the establishment of policies to control rabies, experts from the Asean region identified logistics, sociocultural factors, and resources as major roadblocks to completely eliminate the deadly disease by 2020.

During the recently concluded 10th annual meeting of the Asian Rabies Expert Bureau (Areb), experts from the region called on all countries involved to implement effective surveillance for human and animal rabies, stressing that the data that will be gathered are crucial to document the progress of the disease, to help design and direct control efforts and to monitor the effectiveness of rabies control programs.

In a statement, Areb members have agreed that elimination of dog-transmitted human rabies relies on the collaboration of several stakeholders such as veterinarians and physicians; Ministries of Health, Education and Agriculture; local authorities; the private sector; the community; international organizations and nongovernment organizations.

The meeting, organized by Areb and Sanofi Pasteur Philippines, was attended by rabies experts of both human and animal health sectors from seven Asean countries (Cambodia, Indonesia, Laos, Myanmar, Thailand, Vietnam and the Philippines). Representatives from the Global Alliance for Rabies Control (Garc), the World Health Organization (WHO) and the World Organization for Animal Health (OIE) also came.

10 million dogs

Health Assistant  Secretary Eric Tayag, who formally opened the meeting, said the department is currently coordinating with the Department of Agriculture, particularly its Bureau of Animal Industry, to carry out the vaccination drive that would target around 10 million dogs.

Tayag said:  “The campaign will focus on the vaccination of dogs since they compose most of the reported rabies cases in hospitals. It is estimated that for every 10 Filipinos, there is a dog, which makes their numbers roughly at around 10 million. That is our target.”

Dog vaccination campaigns are just one of the rabies control programs initiated in the Philippines and in the Asean region. Other initiatives include getting pre-exposure rabies vaccination  (recommended if one is traveling or living in a location where exposure to rabid and potentially rabid animals is likely), the treatment of bite victims through post-exposure prophylaxis (PEP). While some countries only have Animal Bite Treatment Centers (ABTCs) in major cities, close proximity to ABTC was identified by Areb members as key to saving lives.

In the case of the Philippines, access to PEP significantly improved with the systematic establishment of additional ABTCs: from 257 centers before the Anti-Rabies Act of 2007 to the current 410.

The goal is to set up 1,000 centers by the end of 2016.

5,000 cases

In a separate interview Tayag shared that the 5,000 cases of rabid dog bites reported by the DOH at the San Lazaro Public Hospital in Manila last month remained almost the same as that of January 2013 figures.

Administration of PEP is crucial right after a bite or scratch from a suspected animal (dog or cat) as this could save a patient’s life. One should be reminded that rabies is incurable once a person starts showing symptoms of the disease, which may be any time from one to three months (although in rare cases a person might notice the symptoms as early as one week or as late as one year).

Current data suggest that more than 95 percent of human rabies cases are due to dog bites, particularly in developing countries in Asia and Africa.

Tayag stressed the importance of immediate and extensive washing of the wound with soap and water, followed by immunization with a safe and effective vaccine and, if necessary, local administration of rabies immunoglobulin.

He said: “Continuous information campaign could make a difference: The necessity to apply appropriate wound care and to consult the nearest rabies prevention center as soon as possible can save lives.”

‘One Health’ approach

International organizations such as the WHO, OIE and the Food and Agriculture Organization, through their joint collaboration, are establishing lead mechanisms for a “One Health” approach and are providing practical guidelines to implement this strategy at the country level.

Thailand was one of the first Areb countries to thoroughly implement a One Health approach to rabies control, and has succeeded in reducing the number of annual human rabies deaths to currently less than 10 (about 500,000 people in Thailand are vaccinated against rabies each year).

Rabies is perhaps the most deadly of all human diseases, since once clinical symptoms appear it is almost 100 percent fatal. WHO estimates that approximately 50,000 people die of rabies annually, and that about 40 percent of the victims are children.