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In partnership with1

France

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CHARRIER Anne-Laure – CORON Noémie – HERIVAUX Anaïs

Human cases

� Last autochthonous case in Metropolitan France in 1934

� 21 imported cases (from 1970 to 2014):

� 90 % from Africa (8 in Maghreb) mainly linked to dogs’ bites

� 50 % occurred in children (3 to 10 years)

� 1st autochthonous case in French Guyana in 2008 (animal source unknown)

� No human case was reported in France in 2013

� Last imported case in France in 2014 (from Mali)

Rapport d’activité du Centre National de Référence de la Rage- Institut Pasteur – Année 2013 - H. Bourhy

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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

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0 0 Chyroptera rabies Canine rabies

France

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Animal cases (Fig1)

� Canine: Last case in 2011, dog imported from Morocco (2013: a cat, Morocco)

� Wild life: No vulpine rabies since 2001

� Chyroptera: 58 chyropteras diagnosed positive for rabies in France (1989 -2013)

Rapport sur la Rage – Juin 2014

(Fig1)

Number of animal rabies cases

in metropolitan France

(2000 - 2013)

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5000

10000

15000

20000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Total des consultants

Traités

Total of patients

Treated patients

France

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Post-exposure prophylaxis (PEP) in 2012

� 8038 patients were seen in an antirabic center after an exposure, 4064 (50,9 %) received a PEP.

� No real decreasing trend in the use of the post-exposure prophylaxis (Fig1):

� Important use after non-flying animal’s bites occurring in French territories

� Higher occurrence of chyropteras’ exposures

� Higher occurrence of exposures in enzootic areas with the rise of travels (North Africa and South East Asia)

Rapport d’activité du Centre National de Référence de la Rage- Institut Pasteur – Année 2013 - H. Bourhy

(Fig2)

Number of post-exposure

consultants and prophylaxis

from 2003 to 2012

France

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Measures implemented to control the disease

1. Efficient active surveillance network� Trained network at local, regional and national level and multidisciplinary cooperation between them +++

� Follow-up of suspect animals for different scenarios (illegal importation, biting animals, diseased animals, bats)

2. Acting on hosts and humans to prevent the resurgence of the disease

� Acting on enzootic cycle (i.e. reservoir/primary hosts):

� Red foxes (reintroduction of rabies in 1968 in France): oral vaccination = elimination of vulpine rabies in France

� Bats (primary hosts): no specific direct actions

� Acting on epizootic cycle (i.e. amplification hosts such as dogs) : +++++++

� Mandatory preventive vaccination of dogs in France

� Stringent controls at borders to limit illegal importations of animals from enzootic areas

� Well trained vets able to quickly recognize and diagnose rabies

� Efficient surveillance system with the follow-up of any suspect animal cases by trained vets

France

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� Acting on Humans: ++++

� Education of the general public

� Improvement of the detection of suspect cases by physicians (often under-diagnosed)

� Implementation of an efficient post-exposure prophylaxis

� Pre-exposure vaccination in specific indications (high-risk professions, travelers in risk areas)

Bosnia and Herzegovina MLACO Merjem

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Human cases

� Since war time (1992-1995) 2 cases

� Post-exposure prophylaxis:

1. surgical wound threatment: washing with water and soap, alcohol or povidone iodine

2. passive immunisation-(HRIG) in first 6 hours 20 IU/kg of body weight

3. active immunisation-rabies vaccine HDCV total 4 doses 0 (2x) ,7,21


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Animal cases

59 cases in 2009

� Canine (7)

� Wildlife: predominant red fox (Vulpes vulpes), wolf, badger (42)

� Chiroptera


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� according to legislation in force in B&H, the mandatory vaccination of dogs and cats against

rabies once a year

� voluntary immunisation of farm animals, mainly cows

� eradication campaigns through oral vaccination against fox rabies since 2011

Greece BALLAS Panagiotis

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Human cases

� Greece was a rabies-free country from 1987 until 2012 when the first cases of the disease

reoccurred in a red fox

� But as all the neighbourhood countries were constantly having cases in the past years, it is

possible that it occurred due to animals migration.


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Animal cases

From 19.12.2012 to 9.5.2014, 48 cases were recorded:

� 40 in red foxes

� 5 in dogs

� 2 in (farmed) bovines

� 1 in a stray cat


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� The vaccination of the domestic cats and dogs is obligatory by law.

� Imported pets from other countries must be accompanied by the vaccination

certificates, in case that is not possible a quarantine is proposed.

� At the last two years, 215 doses of Post-exposure Prophylaxis (vaccine+antibodies) were

administrated to people who probably came in contact with a rabies-suspected animal,

most of the cases were hunters or sheepherders.

� Per Os vaccination program for the red foxes with the use of a bait that contains live

attenuated rabies virus (usually of the strain SAG2)

Pakistan RIZVI Hina-Ambreen

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Introduction

� Rabies is endemic in Pakistan

� The most common lyssavirus present is genotype 1 (rabies virus, RABV)

� There is no national coordinated response to the disease and its surveillance


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Human cases

� Human rabies is not a notifiable disease in Pakistan

� Human infections are mostly due to dog bites

� Dog bites and rabies are under-reported

� An estimated 2000 to 5000 human cases of rabies occur per year (WHO)


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Animal cases

� The main reservoir for rabies is the domestic dog

� In 2010, there was a rabies outbreak in mules and 12 animals died

� There is no information available about the presence of lyssaviruses in bats


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Management

During July 2009 to June 2013, the following control measures

were taken (OIE data):

1. Rabies was classified as a notifiable disease in

domestic animals (but not in humans or wild animals).

2. General surveillance and routine vaccinations were

done in dogs.

Number of Annual

Rabies Vaccinations in

Dogs (OIE data)

2009 10,252

2010 10,259

2011 8,751

2012 10,419

2013 5,032 Diagnostic Tests (for domestic & farm animals) Price / Test

ELISA for detection of rabies antibodies € 5.23

PCR for diagnosis of rabies virus € 21.78


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Post-exposure prophylasis

� The use of nerve tissue vaccine was discontinued in 2014

� Cell culture vaccines are used (Verorab®, Abhayrab®, Rabipur® and Lyssavac®)

� Patients also receive rabies immunoglobulin


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WHO's Strategy for Rabies Control in Pakistan

� Mass awareness about rabies transmission, prevention and self-protection

� Establishment of rabies treatment centres

� Ensuring the most cost-effective and efficacious vaccines

� Enforcement of laws relating to vaccination of pet animals

� Mechanisms to decrease the stray dog population using bait vaccination and dog elimination


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WHO's Strategy for Rabies Control in Pakistan

� Development of a surveillance system to monitor dog bites, dog rabies and human rabies

� Close collaboration between the three government departments involved in the control of

rabies

� Research on animal rabies and the development of animal and human rabies vaccines

Myanmar BALA Khun, THUZAR Ma

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Human cases

In 2012 (Source: Ministry of Health, Myanmar)

� Number of dog bite patients – 11,424

� Number of rabid dog bite patients – 455

� Number of patients who were administrated the vaccine – 1,794

Estimated data from WHO, OIE

� 50,000 dog bite patients / year

� 1,000 deaths caused by human rabies


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Animal cases

� Cannot access data source

� It is estimated that 75 % of stray dogs might have the rabies virus

From 2004 to 2011:

� Laboratory report – 45 animal rabies cases:

� 39 dogs

� 3 cats

� 1 bovine

� 1 equine

� 1 porcine


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Management measures to implement to fight the disease

� National surveillance by Ministry of Health (MOH)

� MOH – provides 30,000 vaccines to public hospitals, in urbanized area, with easy access to the

vaccines

� Participated in “Southeast Asia Rabies Elimination Strategy 2020” supported by WHO & OIE

� Advocacy about rabies – through public communication (radio, newspaper, TV, ..)

� City Development Committee in urban areas – control the population of stray dogs

Vietnam NGUYEN Thi Thanh Ha

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Animal cases

� Rabies has been a notifiable disease in Vietnam for more than 20 years

� Rabies is endemic in Vietnam. The most common lyssavirus present is Genotype 1 (Rabies

virus, RABV) in the canine population. There is no information available on the presence of

lyssaviruses in bats

Dogs;

89,2

Cats; 8,7

Contact;

1,6

Other;

0,5

Animal species

exposure resulting in

human rabies


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Human cases

� From 1991 to 2010, there were 3,523 fatal human rabies cases. The majority of whom were

under 15 years of age (>40%)

According to the OIE, in 2013, Vietnam reported 102 cases of rabies in humans. A recent study

estimates that around 230 people die from rabies every year in Vietnam


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Rabies vectors

� The main vector for rabies in Vietnam is the domestic dog

� In Vietnam, the proportion of vaccinated dogs was 40% that is around 12 million pet

dogs.

� According to OIE, in 2013, 105 dog rabies cases and 10,895 ring vaccinations were

reported

� Rabies post-exposure prophylaxis (PEP) is available in urban areas

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Number of vaccinated peopleDeath cases


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Vietnam Collaborative Response to Fight Rabies

� In 2011, The Ministry of Agriculture and Rural Development (MARDS) endorsed the

National programme on Rabies control and elimination for the period 2011-2015; Ministry

of Health allocated USD 15 million for communication, training, vaccination workshops and

awareness of people on rabies.

� Vietnam government supports research works on rabies vaccines in human cell.

� With the support from international organizations (WHO / FAO / OIE), Vietnam government

committed to eliminating rabies in 2020.

Madagascar ANDRIANIAINA Mirana Marie Stéphanie

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Epidemiological situation (2005-2011)

38/111 districts sampled: rabies

circulation was confirmed in 34 districts

(Antananarivo +++)

RABV strains belonging to cosmopolitan

lineage ++

Laboratory Surveillance of Rabies in Humans, Domestic Animals, and Bats in Madagascar

from 2005 to 2010 Advances in Preventive Medicine


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Animal cases

� Non-flying animal cases, Madagascar (LNR Institut Pasteur de Madagascar)

Species Received Tested positive (%)

Dog 353 185 (54)

Cat 56 13 (24)

Cattle 26 21 (81)

Pig 3 2 (67)

Laboratory Surveillance of Rabies in Humans, Domestic Animals, and Bats in Madagascar

from 2005 to 2010 Advances in Preventive Medicine


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Animal cases

� No Lyssavirus RNA detected in 1,983 bats specimens, BUT 18 Malagasy fruit bats were tested

positive for the detection of antibodies against LBV, EBLV-1 and LBV

Surveillance and control of rabies in La Reunion, Mayotte, and Madagascar. Veterinary Research 2013

Human cases

22 human specimens were received by the NLR and 20 were tested positive.


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Post-Exposure Prophylaxis (PEP)

� Since the use of PVRV "purified Vero cell rabies vaccine" in 2006 � fluctuation of consultation

at the ARMC-IPM (24,946 patients , 0-97 years old); 97,2% received PEP (free of charge)

� Rabies post-exposure prophylaxis center: in only 26 of the 111 administrative districts of

Madagascar



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Management measures to fight against the disease

� Official texts exist:

� 1963: measures to fight against rabies

� 1978: official text for the creation of inter-ministerial committee to fight against rabies

BUT their application were frequently not effective (text not published).

� Since 1996 and in accordance with a WHO resolution known as AFR/RC43/R7, the Integrated

Diseases Surveillance and Response (IDSR) system is operational; human rabies is one of the

main diseases under surveillance.

� National Laboratory Reference for the diagnosis of rabies : Institut Pasteur de Madagascar

rabies surveillance and notification is a national program.


Cameroon SANDEU TEMOLE Alix Florent

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Human cases

� Between January and September 2013, there were 137 cases of dogs bites for 19 deaths

(communicated by the ministry of public health- MINSANTE) in Cameroon with 48 cases for 1

death in the west

� Out of the 137 cases 118 persons got vaccinated (by VERORAB) after the dog bites and in the

western region, 47 persons had post-exposure prophylaxis

cameroon-info.net - article by MICHEL FERDINAND – 31th October 2013


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Animal cases

� Dogs represent almost 99% of mortal cases of human rabies in Cameroon, with 137 dogs

contaminated by rabies from January to September 2013

� For Chiroptera and in the wildlife, there are no real studies done for now to evaluate the cases



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Management Measures to fight rabies

� The Ministry of Livestock, Fisheries and Animal Industries (MINEPIA), has launched a rabies

vaccination (by RABISIN) campaign throughout the western region

The aim being to improve the immunisation coverage of pets while ensuring proper

monitoring of rabies


Benin BOSSOU Marc

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Introduction

There are no reliable data on rabies. The problem

was and still is cosmopolitan in Benin and the

people most affected by the disease are the poor

and the children.

Some epidemiological data encountered in 2012

(AfroREB, 2013)

It is difficult to make serious analyzes to determine

the prevalence and the incidence of rabies, the

number of people bitten, their fate, the percentage

of vaccinated dogs. The cases of biting dogs under

observation are rarely listed.

Africa Rabies Expert Bureau, 2013, Journée Mondiale contre la rage

Benin BOSSOU Marc

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Human cases

� Number of bites (around the seashore): 115

� Number of deaths due to rabies (clinical): 1

� Number of deaths due to rabies confirmed by worklab: 0

� Compulsory report: yes (Decree 2005-637 of 13.10.2005)

� Laboratory of human rabies diagnosis: no


Benin BOSSOU Marc

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Animal cases

� Number of vaccinated dog: The dog population is unknown

� Number of animal rabies cases

� Unknown

� Coastal areas + Borgou: 42

� Laboratory for human rabies diagnosis: No


Benin BOSSOU Marc

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PEP

� Protocol: Essen

� Type of vaccine: Verorab

� Number of people who received PEP: 115 (in the coastal areas)

� Funded vaccine: No

� Nb. of antirabic centres: 0


Benin BOSSOU Marc

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Bite management

In case of a dog bite, the biting animal is put under observation for 15 days by the

veterinary services and given first aid if the animal dies before the end of 15 days following

the bite of rabies treatments.

Prevention

In Benin, the prevention of rabies is done through vaccination of dogs and other cats once a

year and by raising public awareness about the dangers of this disease.

Conclusion

Canine rabies remains confined in Benin. Its important to find appropriate strategies for

eradication.


Senegal CISSOKHO Penda

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Human cases

� 40 cases per year

� 1000 consultations/year at the national reference center after dog bites

� Underestimation of the total cases

� Children (5-15 years) are the most affected

NODJIMADJI R. , « Contribution à l’étude de l’épidémiologie de la rage au Sénégal:

cas de la région de Fatick au cours de la période 1998-2007 », 2008


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Human cases

� Post exposure prophylaxie:

� Vaccination with the Verorab * manufactured by Sanofi-Pasteur Lyon. This is an inactivated rabies

vaccine, purified, prepared on Vero cells.

� Immunisation protocol used: Zagreb

� 2 doses on day 0

� 1 dose on day 7

� 1 dose at day 21

� Most of the cases are not reported (so no post exposure prophylaxis)




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Animal cases

� Canine: 80 % of cases due mainly to stray dogs

� Wildlife (mainly caused by jackal and Chiroptera): No recent epidemiological data found




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Management measures implemented

� Lack of epidemiological data

� Existence of a national reference center for rabies inside the Institut Pasteur of Dakar

� Ragestanbio and diagnostic intra – vitam: 2 projects aiming at diagnosing and monitoring

rabies

� Stop Rage: Surveillance of the zoonotic disease

� National Program for fighting rabies launched in 2014 by the government



Jamaica BROWN Ayinka-Asahkee

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Situation

� Jamaica is considered to be rabies–free

� Status based on absence of clinical suspected cases

� Status theoretically preserved by prohibition of importation of animals from anywhere

except the UK and Ireland (also rabies-free)

� Exception: “service dogs”

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