The Role of Human and Animal Health Professionals towards

Rabies Free Ethiopia

By Abraham Haile (DVM,MVPH)

““Human and animal Health Professionals Together To End rabies”September 26, 2015, Addis Ababa

Outline

• Introduction

• Gaps in Rabies services Provision in Ethiopia

• The role of Human and Animal Health

Professionals in Prevention and Control of

Rabies

Introduction

• Rabies is a viral disease of mammals that is transmitted from animals to humans.

• Rabies virus attacks nervous system.• There is NO CURE for the disease once

manifested 100% case fatality rate.• It results in annual loss of more than 55,000-

70,000 lives worldwide. • People at rural areas and Children under 15

years are highly affected.

Introduction….cont’d

• Transmission:– Spread by bites or contact of infected saliva with

mucous membranes (eyes, mouth, etc)– Contact with nervous tissue– People have been infected by aerosol– Organ transplantation – Consumption of food (milk and meat) from animal

products

Animal pointHuman point

Anti rabies treatment

Education

Animal vaccination

Dog population

management

Surveillance

Responsible dog

ownership

Improve research

Multi-sectoral and agency

collaboration

Law enforcement

Rabies Prevention and Control Strategies

Challenges in rabies prevention and control efforts in Ethiopia

• Weak collaboration between veterinary and public health sectors

• Lack of legal enforcement• Weak surveillance system• Lack of sufficient data • Limited access to anti rabies vaccine• Limited laboratory capacity • No standard guidelines for case management• Low awareness among the community and

Professionals

Gaps in Rabies services Provision in Ethiopia

• Only one laboratory in the country• Few facilities providing anti rabies treatment

service (Only 2 in Addis)• No RX guideline is being used• No training has been given to workers• Lack of human rabies management system• Lack of animal quarantine station and supplies to

capturing, Pre exposure vaccine, drugs• No network between the Public health and

veterinary facilities (EPHI efforts)

What needs to be done?

Strengthen and capacitate regional public health facilities (Hospitals) on treatment services– Provision of Training and National PET protocol

guidelines– Provision of cell culture vaccine and anti rabies

immunoglobulin (RIG)– Establish human rabies Case management system– Establish referral system

What needs to be done?….cont’d

Build and strengthen clinical and laboratory diagnostic service at laboratories and clinics – Training for professionals (Veterinary clinics

and regional laboratories)– Provision of guidelines – Scale up laboratory capacity– Establish referral system

What needs to be done?….cont’d

What needs to be done?….cont’d

LABORATORY

HOSPITAL/ HEALTH CENTER

VET CLINIC

COMMUNITYEPHI

The Role of Human and Animal Health in Prevention and Control of Rabies

What is your role?

The Role of Human and Animal Health in Prevention and Control of Rabies

The Concept of One Health in Prevention and Control of Rabies One Health is collaborative effort of multiple disciplines to attain optimal health for people, animals, and our environment.

Joint collaboration in Research, surveillance, education and Intervention.

The Role of Human and Animal Health in Prevention and Control of Rabies

Anti rabies treatment

Education

Animal vaccination

Dog population

management

Surveillance

Responsible dog

ownership

Improve research

Multi-sectoral and agency

collaboration

Law enforcement

The role of animal health professionals

Dog population registration Animal vaccination (>3 months of age) Animal population management Capturing and Quarantining animals for 10

days observation Education of the general public (animal

owners) Information Sharing to public health

professionals

The role of Human health professionals

First aid treatment Wash wounds immediately with soap and water for

15 minutes Avoid wounds suturing/bandaging TAT and Antibiotics

Pre exposure prophylaxis (PEP) Post exposure prophylaxis (PEP) Education of the general public Information Sharing to Animal health

professionals

The role of Human health professionals

Address Post exposure prophylaxis (PEP) based on Risk Assessment Algorithm Minimize unnecessary treatments (psychological, financial loss) Ensure appropriate distribution of vaccine

Advocate the use of modern Anti rabies treatment Nerve tissue vaccine (17 injections)

Severe adverse effects Poor immunogenicity

Cell Culture vaccine (5 injections) Minimum adverse effects Good treatment outcomes

Where do we need collaboration to strengthen service provision ???

Appropriate wound management Observation of suspected animal for 10 days Provide referral of patients

Consult individuals on brain sample transfer to EPHI

Result communication (formal and informal reporting)

Encourage Appropriate animal management Encourage pets Vaccination (dogs and cats)

Where do we need collaboration to strengthen service provision ???

Create awareness on animal rights Animal feel pain like humans!

Common Misperceptions

"Vaccinated" animals do not harbor the disease Leashed animals are free of rabies Avoiding vaccination of young animals Puppies cannot get the disease Bitches gave birth Minor bite and scratch Healed wounds as indicator of rabies virus absence

Common Misperceptions

Considering first aid treatments as anti rabiesRX Inappropriate use of vaccine

IM for fermi type (local vaccine) reduce dose

EPHI Experience

LABORATORY

EPHI

What need to be changed ?

EPHI LABORATORY

What benefits will be gained• Ensured standardized case management will

enable to reducePsychological Financial loss• Facilitate decision making through reliable

data• Enable successful Prevention and Control of

rabies to point of Elimination

End Rabies Together To See Rabies Free

Ethiopia