G. Robert Weedon, DVM, MPH Veterinary Outreach Coordinator Alliance for Rabies Control The Global Burden of Rabies

2 Introduction  Rabies is a viral infection transmitted in the saliva of infected animals  Rabies can affect all mammals  The virus enters the central nervous system of the host causing an encephalomyelitis Picture of rabies virus. Courtesy CDC East Carolina University

3 3 In the United States  Wild animals are the principal vector  Mandatory rabies vaccination laws  Encroachment on wild animals because of development East Carolina University

4 4 In the United States CDC East Carolina University

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6 6 In the United States CDC East Carolina University

7 7 Developing Countries  55,000 people die annually of rabies  Dogs are the principal reservoir  Human exposure much more likely East Carolina University

8 8 Developing Countries  “Unowned” dogs  Valued and recognized as part of the community  However, no supervision of movement East Carolina University

Developing Countries East Carolina University

10 Global Burden of Rabies  Rabies is 100% preventable yet at least 55,000 humans die from rabies each year around the world, mostly from exposure to dogs.  A person dies of rabies almost every 10 minutes. East Carolina University

11 Global Burden of Rabies  Almost half of all rabies deaths occur in children under the age of 15 years.  Many developed countries have vaccines for animals and humans to prevent rabies. These countries might only have a few deaths each year. East Carolina University

Global Burden of Rabies 12 Knobel, DL, et al. Re-evaluating the burden of rabies in Africa and Asia. Bulletin of the World Health Organization. May 2005, 83 (5) East Carolina University

13 Rabies in India  Rabies is common in most parts of India.  The dog population of India is around 25 to 30 million animals.  Each year approximately 7 million people undergo PEP East Carolina University

14 Rabies in India  In 2004 that there were 20,565 reported human deaths  Nearly 96% of cases are due to bites from stray, ownerless, dogs.  About 70% of the victims are children younger than 15 years. East Carolina University

15 Rabies Prevention Canine rabies control programs should incorporate three basic elements Epidemiological surveillance Mass vaccination Dog population control East Carolina University

16 Rabies Prevention Population control versus removal No evidence that removal alone impacts the spread of rabies Population turnover may be too high May be aesthetically unacceptable East Carolina University

17 Rabies Prevention Mass vaccination of dogs Vaccinating 70% of the dog population has been shown to reduce the incidence of human rabies to zero East Carolina University

18 Rabies Prevention Mass vaccination of dogs 70% of the dog population can be attained through strategies consisting of:  Well-designed educational campaigns,  Intersectoral cooperation,  Community participation,  Local commitment in planning and execution East Carolina University

19 Rabies Prevention Mass vaccination of dogs 70% of the dog population can be attained through strategies consisting of:  Availability of recognized quality vaccine,  Media support, and  Effective general coordination and supervision of the activities by the health services. East Carolina University

Rabies Prevention 20 Source: Dr. Carlos H. Alvarez Lucas Mexico Ministry of Health East Carolina University

Rabies Prevention 21 Source: Dr. Carlos H. Alvarez Lucas Mexico Ministry of Health East Carolina University

22 Social and Cultural Barriers to Rabies Prevention Social Structural Barriers Cost Education about rabies Infrastructure of veterinary care Public health programs Animal population control Treatment of strays and “unwanted” dogs East Carolina University

23 Social and Cultural Barriers to Rabies Prevention Insufficient surveillance systems Not a notifiable disease Accurate mortality data unknown Low priority for disease control Limited diagnostics Questionable reliability of data East Carolina University

24 Social and Cultural Barriers to Rabies Prevention Limited accessibility of modern rabies vaccine and supply problems High cost of modern cell culture rabies vaccines Cost of importation Barriers to total protection East Carolina University

25 Social and Cultural Barriers to Rabies Prevention Lack of public awareness Lack of effective health education programs Poor participation in rabies control programs Consideration of cultural, religious, and political factors East Carolina University

26 Social and Cultural Barriers to Rabies Prevention Insufficient political commitment Low priority of rabies control programs Costs fall short when compared to other programs Political and economic situations East Carolina University

27 Opportunities Utilize models of successful rabies control programs Success in Japan, Taiwan, and peninsular Malaysia Operational strategies Cost/benefit analysis East Carolina University

28 Opportunities Mobilize the support of the civil society, private sector and government sponsored initiatives Public education through media (radio, TV, printed material) Public and/or private technology initiatives East Carolina University

29 Opportunities Population Control and vaccination Jaipur, India project (Veterinary Record (2006) 159, ) East Carolina University

The Public Health Need 30East Carolina University

31 Opportunities Vaccination combined with an injectable sterilant Jaipur, India project (Veterinary Record (2006) 159, ) ACC&D initiative ( 31East Carolina University

32East Carolina University

Some of ACC&D’s 98 Organizational Partners…

The Michelson Prize and Grants in Reproductive Biology The Michelson Prize in Reproductive BiologyThe Michelson Prize in Reproductive Biology: $25 million for innovation in non-surgical sterilization for cats and dogs Found Animals will offer a $25 million prize to the first entity to provide to the Foundation with a safe, effective, and practical non- surgical sterilant for use in cats and dogs. The Michelson Grants in Reproductive BiologyThe Michelson Grants in Reproductive Biology: Up to $50 million of grant funding available for research directed to achieving this goal Found Animals will provide up to $50 million in grant funding for promising research in pursuit of a safe, effective, and practical non- surgical sterilant for use in cats and dogs. East Carolina University

The Michelson Prize and Grants in Reproductive Biology East Carolina University

36 Social and Cultural Barriers to Rabies Prevention Cultural factors Religious view of animals “Place” of dogs in the household and community Value of dogs—utilitarian or emotional benefit East Carolina University

37 Conclusions Rabies is an extraordinarily preventable disease, however in cultures where the dog is the principal reservoir, human exposure is much more likely, and in such instances, there may exist significant cultural, social, and religious barriers to implementing programs for its prevention East Carolina University

38 World Rabies Day, 2010 The mission of World Rabies Day is to raise awareness about the impact of human and animal rabies, how easy it is to prevent it, and how to eliminate the main global sources. “One Health, One Medicine” 38East Carolina University

39 To Learn More  World Rabies Day Website:  US Centers for Disease Control and Prevention (CDC) Rabies Website:  CDC’s Kids Rabies Website:  World Health Organization  Pan American Health Organization  Alliance for Rabies Control East Carolina University

World Rabies Day 40 Working Together to Make Rabies History! 40East Carolina University