Date Published: September 21, 2011
Publisher: SAGE-Hindawi Access to Research
Author(s): Gyanendra Gongal, Alice E. Wright.
There are eleven Member States in the WHO southeast Asia region (Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste) of which eight are endemic for rabies. More than 1.4 billion people in the Region are at risk of rabies infection, and approximately 45% of worldwide rabies deaths occur in Asia. Dog bites account for 96% of human rabies cases. Progress in preventing human rabies through control of the disease in dogs has been slow due to various factors. Innovative control tools and techniques have been developed and standardized in recent years. The introduction of cost-effective intradermal rabies vaccination regimens in Asian countries has increased the availability and affordability of postexposure prophylaxis. Elimination of rabies is not possible without regional and intersectoral cooperation. Considering the importance of consolidating achievements in rabies control in Member countries, the WHO Regional Office for southeast Asia has developed a regional strategy for elimination of human rabies transmitted by dogs in the Region. They have committed to provide technical leadership, to advocate national health authorities to develop major stakeholder consensus for a comprehensive rabies elimination programme, and to implement national strategies for elimination of human rabies.
Rabies is an ancient viral zoonotic disease that is invariably fatal in humans and mammals. The disease circulates in two epidemiological cycles: an urban cycle involving maintenance of infection in dog populations and a sylvatic cycle involving wildlife. There is a possibility of spill-over of rabies virus from dogs to wildlife and vice versa.
Rabies is a disease of public health and economic importance in southeast Asia. The annual expenditure due to rabies has been estimated to be more than US$ 563 million in Asia . This figure is based on the direct and indirect costs of PEP in humans and costs incurred from dog rabies control efforts.
The necessary tools and methods for prevention and control of human and canine rabies are available. The proof of the feasibility of elimination of dog-mediated rabies has been demonstrated in countries like Singapore and Malaysia. It is thought that strict enforcement and policies of dog registration, vaccination, and dog population management have made rabies control and eradication effective in these countries. Malaysia borders Thailand, and the concept of an immune belt has been developed by dog licensing and mandatory vaccination of dogs as well as systematic destruction of unvaccinated dogs in a buffer zone to prevent entry of rabies from the northern border.
India is the only country in the Region producing various types of quality rabies tissue-culture vaccines (TCVs). It is capable of producing 15 million doses of rabies vaccine annually (Personal communication, Dr. RL Ichhpujani), which is sufficient for whole region. Use of RIG in category three bites is limited due to the high cost of HRIG administration. Purified ERIG is now produced in sufficient quantities in India and Thailand and is safe and affordable to use. The availability of highly effective human rabies vaccines and ERIG within the region is important to prevent possible human deaths due to exposure to rabid animals.
Except for island countries, elimination of rabies is not possible without regional cooperation. No single country can maintain rabies-free status unless it is brought under control in neighbouring countries. Regionally coordinated efforts are necessary for elimination of human rabies with consideration of country-specific needs and sociocultural acceptability. WHO launched a regional rabies control project in the 1980s in Asia and many countries developed and strengthened national capacity for rabies surveillance, diagnosis, vaccine production, and dog population management. This encouraged coordination and cooperation between human and animal health sectors for rabies prevention and control at the country level.
The elimination of human rabies transmitted by dogs is an achievable goal. The initiative has been taken to develop a unique strategic framework for elimination of human rabies transmitted by dogs in consideration of the epidemiological situation, technical feasibility, and the sociocultural context. The cost benefits of using intradermal rabies vaccines and equine immunoglobulin for postexposure prophylaxis has been demonstrated. These techniques must be adopted. The WHO Strategic Framework will be a vital guide for the collaborative, intersectoral approach that is necessary for rabies control. With the adoption of the strategic elements of this document the huge public health and economic burden of human rabies can by eliminated in southeast Asia.