rabies situation in far east asia zhen f. fu department of pathology university of georgia
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Rabies situation in Far East Asia
Zhen F. Fu
Department of Pathology
University of Georgia
Africa 5000 – 15000 Cases
< 500 000 PET
North America/Europe<50 Cases < 100 000 PET
Latin America
<60 Cases
< 500 000 PET
Asia 35 - 55 000
>8 000 000 PET Rabies Incidence
40
32092490
19000
76
44
2000
1100
24
248
30
Human rabies cases (>28,000) in Far East Asia in 2006
Human Rabies and Treatments, Far East Asia,2006
Post-exposure Country Deaths Rate/million Treatment Rate/mil
India 19,000 16.7 1,800,000 1,768
Pakistan 2,490 17 69,000 469
Bangladesh 2,000 12 60,000 455
Myanmar 1,100 23 5,000 102
China 3209 2.5 8,000,000 3,959
Philippines 248 3.3 102,148 1,338
Indonesia 40 0.2 8,800 43
Sri Lanka 76 4 80,000 4,200
Thailand 24 0.41 200,000 3,178
Vietnam 30 0. 38 635,000 8,105
Nepal 44 2.17 25,000 1,085
Cambodia 2 0.80 12,000 1,071
Lao People s Democratic Republic 2 1.26 3,000 540
TOTAL 28,275 6.5 10,692,010 1,881
Rabies in the Far East Asian
Not much has changed: Rabies free countries or regions: Japan, Singapore,
HK, Taiwan. Endemic with slow increase: most of other countries
Continued and sustained improvement: Thailand
Dramatic changes: China
South Korea: No human cases, but wildlife rabies spreads.
Reported Human Rabies Deaths in Thailand
0
20
40
60
80
100
120
140
160
180
Total
Male
Female
Veera Tepsumethanon
National rabies centre,
1995
171
68
24
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 20100
1000
2000
3000
4000
5000
6000
7000N
o of
hum
an r
abie
s ca
ses
Rabies in China in the past 60 years
A neglected disease of the poor – rural areas
For example: India
Urban: 1,058 5% Rural: 18,201 95%
Characteristics of rabies in Far East Asia
Rabies: a disease of childhood •Children aged less than 15 years are
involved in 40% of the cases
70 70
60 60
50 50 C P T
40 A 40 A H M K A 30 30 B I I O C
20 S L 20 INDIA D H T A
10 I I 10 A N A N N D
0 A 0
Most of the human vaccines are locally produced and brain vaccines are still used in some countries
•HDCV: India•PVRV: India, Columbia, China•PCEC: India, Japan, Thailand, Philippines•PDEV: India•PHKC: China•SMB: Vietnam, Cambodia•Semple: India, Bangladesh, Nepal, Pakistan
Blue are WHO recognized productsBlack are recognized locally onlyRed are WHO condemned products
The major reservoir is the domestic dog >90% human cases from
dogs There is no dog registration There is no dog leash There is little dog
vaccination
Anti-ABLV and the newly discovered lyssavirus antibodies have been found in bats in Thailand.
Detection of RV antibodies in bats in China?
Raccoon dogs spread RV in the Korean peninsula.
Dog vaccination coverage
Countries (regions) Total # Vaccinated Coverage (%)
Japan 6.5 m 4.8 m 74
Vietnam 6 m 3 m 50
Taiwan 1.3 m 0.6 m 47
Sri Lanka 2.5 m 1 m 43
Philippines 0.84 m 0.18 m 21
China >100 m ? <3
Myanmar 0.11 m 0.02 m 2
Nepal 1.9 m 0.015 m <1
Laos ? 7248 ?
Rabies Control in Far East Asia
Dog vaccination is the key!!!!!Establish infrastructure.Adapt methods of diagnosis and surveillance.Produce cheap dog rabies vaccines.National or regional campaigns.WHO/OIE/EC encouragement and assistance.As the economy improves in Asia, resources
will become available. Many countries are initiating dog immunization programs.
ACKLOWLEDGEMENTS
Dr. Yongzhen Zhang, China Dr. T. Hemachudha, Thailand
Dr. S Takahashi, Japan Dr. Hyaw Sunn, Myanmar Dr. Dhan Raj Ratala, Nepal Dr. Davinio P. Catbagan, Philippines Dr. S. K. R. Amarasekara, Sri Lanka Dr. Huang-lin Kao, Taiwan Dr. Van Dang Ky, Vietnam
