Issue-01 September 2010

BARA NEWS A Newsletter of BARA

An Official Organ of the

Bangladesh Anti Rabies Alliance [BARA]

Suit No.18 (3rd Floor), Green Super Market

Green Road, Dhaka-1205

Phone : 88-02-8115646

Message from Chairman of BARA

Bangladesh Anti Rabies Alliance (BARA), as the name implies, is a platform of doctors, scientists, professors of reputed academic institutions, and members of various other organizations of Bangladesh who have the ambition to free our country from neglected tropical diseases, specially Rabies. Rabies mainly affect the health of poor children of Bangladesh who live in remote rural areas with limited access to health facilities. Children from 5 to 15 years are the victims of animal bite followed by Rabies. More than 80% of animal bite cases are due to dog bite.

The Ministry of Health & Family Welfare, Government of Bangladesh has stated its goals for control of Rabies. But it must be shared by everyone in the society and other relevant ministry as Ministry of Live stock and Local Government. The members of BARA are committed to make their best efforts to reduce the sufferings of the people inflicted with Rabies and animal bite by conducting research, raising social awareness and by forming partnerships with the stakeholders who are devoted to achieve the same goals of rabies control in human by using TCV and replacing NTV and in animal through animal vaccination and animal birth control etc. As Chairman of BARA, it is my great privilege to offer a hearty welcome to the participants of 2nd International Conference of Climate Change and Neglected Tropical Diseases (ICCCNTDs) whose kind presence will greatly inspire everyone involved with the control of Rabies in Bangladesh. Bangladesh being a country under grave risks of climate change, will immensely benefit from the knowledge and practice we hope to share from the distinguished participants of this conference. I would like to sincerely thank the organizers and the sponsors of 2nd ICCCNTD on behalf of BARA and wish great success of this international conference in Bangladesh.

Prof. Dr. Moazzem Hossain

Chairman, BARA

BARA NEWS A Newsletter of

Bangladesh Anti Rabies Alliance No: 1, August 2010

Background:

Rabies is one of the oldest recognized zoonotic disease affecting human and is considered as a major public health problem in Bangladesh. Rabies is a viral infection of mammals. It is an ancient disease known to mankind. As mentioned in Greek Mythology rabies known to occur in man & animal from 4000 years back. It is 100% fatal but 100% preventable through proper scientific management There is no medication once the disease develops. A historic development occurred for its prevention with the discovery of Anti Rabies Vaccine by the scientist Louis Pasteur in 1885.

Rabies is widely distributed across the globe. More than 55,000 people die of rabies each year but more than 95% of human deaths occur in developing countries of Asia and Africa because of inadequate control of rabies in domesticated animals, and about 30,000 deaths is contributed by India alone.

Introduction: Rabies is endemic in Bangladesh . It is almost uniformly distributed throughout the country. Dog is the main vector but cat, jackal are also encountered. The main victims are the poorest of poor rural people, children and young adults. Most victims do not have the access of proper treatment, ignorant about the fate of animal bite, does know about the primary measures after animal exposure and is dependant on traditional healers. Burden of disease (Facts and figures) No base line data or statistics of rabies in human or animal is available in Bangladesh. It is estimated that more than 2000 people die of rabies and more than 3,00,000 people are bitten by animal annually and take post-exposure treatment with NTV mainly . A great number is unaware of rabies and treatment. Government supplies the nerve tissue vaccine (NTV) with a subsidized rate of Tk. 40.25 ( US$ 0.60 ).Tissue culture vaccine(TCV) are imported at private sectors with cost of US$ 7.5 / vial, Total cost per patient is US$ 37.5 for 5 doses by Intra muscular route , which is beyond the capacity of the victims. Large number of livestock die of rabies every year, where also the poor are the victims to loss their livestock.

Epidemiological situation (Human and animal)

Age & sex wise distribution of Rabies cases attended at IDH, Dhaka in 2006

In Bangladesh the source of infection is mainly dog and few are cat. Wild animals like Jackal and Mongoose also contribute to infection. Dog bite increases during the breeding season mainly September to November. Rabies control activities and achievements There is no rabies control Program or Project under Ministry of Health & Family Welfare or no coordinated effort . But few arrangements like post-exposure vaccination to dog bite victims by locally produced Nerve Tissue vaccine and elimination of stray dogs occasionally done by City Corporation and Pourashava (Local government organizations). Pet dog registration and vaccination is very limited. Nerve tissue vaccine is neurotoxic and its production is also scanty and not available in Health care centers adequately. Some people use cell culture vaccine with high price from the market. Recently, in May 2010 Prof. Dr. Moazzem Hossain Director, Disease Control, Directorate General of Health Services (DGHS) took the initiative for the first time for Rabies elimination as a separate program in Directorate of Health Services . Conducted a series of workshop with the stakeholders from different Ministries and NGOs including BARA etc. A National Steering Committee headed by Hon’ble Health Minister and Technical Working Group headed by Director Disease control have been formed with the involvement of Ministry of Health, LGRD & Livestock . A “National Guideline, strategy and action plan” and “National Guideline for post exposure treatment with I/D vaccination with cell culture vaccine ” was prepared by TWG and approved on 11 August 2010 by National Steering Committee (NSC) . Training of health staff ( doctors and nurses ) on ID regimen was started from 11 July 2010 with TCV at ID Hospital (IDH) , Dhaka . This was a milestone for Bangladesh for rabies elimination activity in 2010. A total of more than 300 patients are attending at IDH daily. ID vaccination will soon be started to other divisions and districts soon gradually. NSC also decided to phase out the NTV production and use and to replace the TCV as soon as

possible with a target for Elimination of Rabies by 2020. Major constraints: 1. Political Commitment 2. Trained professionals (Human and Veterinary side) 3. Coordination among stake holders 4. Fund 5. Awareness

History of BARA:

Though Rabies is 100% fatal and 100% preventable but in Bangladesh no study was done to give the complete situation of rabies in both human and animal. Rabies was recognized by the Government of Bangladesh as neglected disease. The doctors and veterinarians were involved in analysis of rabies situation and its control. But they were working individually. Keeping the situation in mind, we the philanthropists and social scientists who were involved in research activities on rabies for years decided to form an alliance named as Bangladesh Anti rabies Alliance (BARA). Institute of Allergy and Clinical Immunology of Bangladesh (IACIB) will act as the coordinator of BARA. BARA was formed on 1st July 2009 with the following objectives:

BARA members at official meeting on July 1, 2009

Objectives of BARA:

a) To strengthen local and National capacity. b) To improve the effectiveness of the programme management with a focus on policy, planning

and regulation. c) To promote early and appropriate post-exposure treatment to human with TCV. d) To plan and implement selective and suitable preventive measures for the reduction of

incidence of human and animal rabies e) To conduct basic and operational research and surveillance for rabies elimination.

f) To reduce the risk of transmission of Rabies.

g) To improves the management of rabies patient

h) To raise awareness about Rabies control and prevention. i) To raise strong voice both nationally and internationally for rabies control.

Members of BARA:

1. Prof. Dr. Moazzem Hossain (Director Disease Control, DGHS) - Chairman 2. Md. Anwarul Hoque (ED, IACIB) 3. Prof. AKM Samsuzzaman (Prof. of Microbiology, Sahahid Suhrawardy Medical College) 4. Prof. Shireen Akhter ( Director NIPSOM) 5. Md. Mustafizur Rahman ( LEPRA Bangladesh) 6. Md. Abu Saeed (Wild life and environment consultant) 7. Prof. Dr. Hamida Khan (Dept. of Zoology, Dhaka University) 8. Dr. Farida Begum (Ex- DPM Kala-Azar, DGHS) 9. Dr. Tania Bulbul (Lecturer Biochemistry, Enam Medical College) 10. Nasima Akhter ( Chairman IACIB) 11. Dr. Ziauddin Ahmad (Rabbies in Asia Foundation) 12. Dr. Kazi Jamil ( Associate scientist ICDDR,B) 13. Dr. Sohrab Hossain (Ministry of LGRD- Tangi Pouroshova)

Activities of BARA :

1. BARA observed the 3rd the world Rabies day on 8th September 2009 . 2. BARA is member of TWG of GOB. 3. Members of BARA played vital role in development of “National guideline for rabies

control in Bangladesh” and “National guidelines for Intra-dermal vaccination” . 4. BARA will take active part in upcoming World Rabies Day 28 Sep 2010. 5. BARA is involved in different activities for Rabies control with GOB.

BARA’s activities with GOB:

The experts of BARA contribute and share updated knowledge and skills for rabies control in the 

country. Some of the activities where BARA closely worked with the GOB are as follows: 

 

1. National Guideline development: BARA played active role in developing National Guidelines 

and strategies for rabies control in the country. The experts of BARA took part in a series of 

workshops in developing National guidelines: Strategy, Prevention and Control of Rabies. 

     

 

   

Honorable Minister, Ministry of Health and Family Welfare with other GOB officials and BARA members in the first National Steering Committee meeting, held on August 11, 2010 at Conference room, Ministry of Health and Family Welfare.    

BARA also took part in development of Intra‐dermal Vaccination guideline using TCV . Both 

the guidelines are approved by the National Steering Committee (NSC) in its first meeting 

held on 11 August 2010 at conference room of Ministry of Health and Family Welfare, 

presided over by Honorable Minister, Ministry of Health and Family Welfare. 

 

2. Training on  I/D vaccination:  DGHS, GOB  has introduced  Intra‐dermal Tissue Culture 

Vaccine (TCV) for the first time at Infectious Disease Hospital, Mohakhali, Dhaka on  11 July 

2010  and simultaneously (TOT) training for doctors and nurses on rabies control and ID TCV 

vaccination has also been started.  The experts of BARA members participated and conducted 

the training as resource persons/ master trainer along with other resource persons of GOB. 

               

              

        Photos:  GOB  and  BARA members  taking  part  in  the  training  session  (TOT)  for  doctors  and  nurses  and             practical use of ID TCV vaccination at IDH, Mohakhali, Dhaka. 

3. Pilot study on Rabies control:  DGHS has planned to conduct some pilot studies for Rabies 

control at some Islands and tourist spots. For this purpose initially one island has been 

designed by the CDC, DGHS in six union of Raipura Upazila under Norsingdi district. These six 

unions are surrounded by the river Meghna and where free movement of dog population 

hardly occurs. A high level team of DGHS comprising concerned officials and experts of BARA 

visited and conducted an advocacy meeting with the stakeholders of 11 unions of Raipura at   

upazila  sadar on 15 July 2010. The meeting was presided over by the Raipura Upazila 

Chairman Advocate Md. Yunush Ali Bhuyan . People of Raipura welcomed and expressed 

their full cooperation and support for success of pilot study to make the island free from 

rabies. 

   

In  the  frist picture: Dr. Aung  Swi  Prue Marma, DPM Rabies,   DGHS  and  in  the  second picture: Dr.  Ziauddin Ahmad, BARA member is seen to deliver  speech at advocacy meeting, in Raipura.  

   

Photos:  Civil  Surgeon  of  Norsingdi,  Upazila  Chairman,  Dr. Musleh  Uddin,    DPM  Emerging  &  Re‐emerging disease, DGHS and Mayor of Raipura with participants   Research  activities on Rabies:   BARA members  are  actively  involved with GOB on  various ongoing research activities on rabies.   A cross sectional study on “prevalence of rabies and animal bite cases  from  January  to December 2008  in  randomly  selected 30 Upozila  from 6 divisions” was  conducted. Another  study on  “Animal bite and  clinically diagnosed  cases of rabies, referred to Infectious Disease Hospital (IDH), Dhaka from January 2004 to December 2008” was also conducted. Both these research papers in which BARA members are involved, are  under  publication  in  the  reputed  Japanese  Journal  of  Tropical Medicine.  Some more research works are also on going with joint collaboration of GOB.  

 

4.  KAP study on rabies:  One country wide KAP study on rabies was conducted jointly by BARA 

and GOB researchers. Experts from BARA took active role in questionnaire development, 

finalization, data collection from field, data analysis and report writing. The paper will be 

published timely. 

           

       KAP study team at Burichong, Comilla. 

         

5. Planning meeting for Rabies control: The first planning meeting for Rabies control was

held on 20 May 2010 in the Ministry of LGRD with Mr. Monjur Hossain , Secretary LGRD as

Chairman. In this meeting NSC and TWG was formed and a number of important decisions

were taken for rabies control including inclusion of BARA as a member of TWG .Another

planning meeting was held on 25th July, 2010 at EPR Conference room of DGHS with seven

divisional directors (Health), Directors of Medical college hospitals, Chief Health Officers of

City Corporations, Senior Consultants of Infectious Disease Hospitals and Metrons of Medical

College Hospitals organized by Disease Control unit, DGHS for expansion of TCV in

divisional level . BARA members were also took part and contributed in both the planning

meetings by sharing their expertise, knowledge and skills for Rabies control . 

 

                

 

         

GOB officials with BARA members at planning meeting 

6. Participation in Press Briefing on Rabies: GOB with the cooperation of BARA organized

a Press Briefing with Electronic and Print media on 25th July, 2010 at IDH, Mohakhali,

Dhaka. BARA members played active and contributory roles in the press conference and

shared their expert ideas with media personnel. 

            

   

GOB officials and BARA members taking part in press briefing 

7. World Rabies Day observation: Every year BARA has been observing “World Rabies Day on 28 September”. BARA is committed to observe the 4th World Rabies day in this year jointly with cooperation of GOB in a befitting manner. 

IACIB ( Coordinator of BARA) organized rally at Saidpur, Nilphamari on 3rd WRD

8. Animal Birth Control: BARA has organized jointly with Directorate General of Health Services a 2 days workshop on practical training (TOT) on 19- 20 September 2010 on Animal Birth Control (ABC) using non surgical sterilant called EsterilSol with technical support from Alliance for Contraception in Cats and Dogs (ACC&D) , USA for the first time in Bangladesh.

      

Practical Training (TOT) on Animal Birth Control (ABC),  

Banani, Dhaka

Editors: Prof. (Dr.) Moazzem Hossain Email : directodcbd@gmail.com 

Dr. Aung Swi Prue Marma E-mail: draungsprue@yahoo.com

Official address: Room 18 (3rd Floor), Green Super Market, Green Road, Dhaka- 1205, Bangladesh. Phone: 880-2-8115646, Email: iacib1995@gmail.com