1. WHO/MZCP RABIES in the MIDDLE EAST A. Seimenis, D.V.M. Director, WHO/Mediterranean Zoonoses Control Centre ATHENS, GREECE mzcc@ath.forthnet.grmzcc@ath.forthnet.gr, www.mzcp-zoonoses.grwww.mzcp-zoonoses.gr

2. WHO/MZCP most Endemic in most countries of the ME; with common Mediterranean (southern and eastern) littoral countries with common climatic, geographical, socio-cultural, epidemiological characteristics Serious Serious public health problems. RABIES in the MIDDLE EAST (ME) 1

3. WHO/MZCP DOG: main source of human infection; CATS: second most important source followed by other domestic animals and wild life; WILDLIFE: red fox, jackals, wolves, etc. 2 RABIES in the MIDDLE EAST

4. WHO/MZCP Rabies in Humans: approximately 300 reported cases annually Post-exposure treatment: several hundreds of thousands Most cases in: EGYPT, IRAQ, IRAN, PAKISTAN, SUDAN, YEMEN 3 RABIES in the MIDDLE EAST

5. WHO/MZCP Rabies in Animals: Rabies in Animals: part only of cases are reported Laboratory confirmation upon restricted number of cases only Laboratory confirmation upon restricted number of cases only Growing problem for certain countries, e.g. YEMEN Growing problem for certain countries, e.g. YEMEN Rabies in wildlife : growing public health problem Rabies in wildlife : growing public health problem Wild animals population (red fox, jackals) on increase Wild animals population (red fox, jackals) on increase 4 RABIES in the MIDDLE EAST

6. WHO/MZCP Epidemiological surveillance NOT well established Data NOT always reliable No regular laboratory confirmation Correlation between DOG and WILDLIFE rabies difficult 5 RABIES in the MIDDLE EAST

7. WHO/MZCP Difficulties for efficient control programmes Control activities based on stray dog elimination and voluntary individual vaccination Cell-culture vaccines and immunoglobulins for human post-exposure treatment Dog mass vaccination campaigns never performed Lack of dog population estimates Dog vaccination rate not estimable 6 RABIES in the MIDDLE EAST

8. WHO/MZCP Rabies control failure due to: Weak infrastructures; Inappropriate control strategies; Lack of sustainable resources and workforce; Weak laboratory diagnosis support; Lack of intersectoral collaboration; Population socio-cultural factors; Weak community awareness. 7 RABIES in the MIDDLE EAST

9. WHO/MZCP Wildlife rabies control-no activities Need for Need for : Ecological studies for target animals; Vaccination strategy to be developed; Live vaccine strain/high temperatures relation to be evaluated; Trained personnel; Adequate funding; Intercountry agreements. 8 RABIES in the MIDDLE EAST

10. WHO/MZCP Weaknesses of various kind: infrastructures, no co-operation, funds, personnel, etc. ), should NOT BE ACCEPTABLE as they maintain DESPERATE HUMAN SUFFERING from preventable zoonoses, 9 RABIES in the MIDDLE EAST

11. WHO/MZCP 10

12. WHO/MZCP Thank you. Source: www. pbase.com