Philippines (Ilocos Norte) CARE Project, 2012-2015
External Link: Valenzuela LM, Jayme SI, Amparo ACB, Taylor LH, Dela Cruz MPZ, Licuan DA, Gamal-Bitao R and Nel LH (2017) The Ilocos Norte Communities against Rabies Exposure Elimination Project in the Philippines: Epidemiological and Economic Aspects. Front. Vet. Sci. 4:54. doi: 10.3389/fvets.2017.00054 https://doi.org/10.3389/fvets.2017.00054
Project Background
Goal: Eliminate canine-mediated human rabies in Ilocos Norte by 2015.
Stakeholders: Provincial Rabies Control Committee, Provincial Veterinary Office, Provincial Health Office, local agencies, Department of Education, local police, medical associations, and universities.
External Link: Vigilato Marco Antonio Natal, Clavijo Alfonso, Knobl Terezinha, Silva Hugo Marcelo Tamayo, Cosivi Ottorino, Schneider Maria Cristina, Leanes Luis Fernando, Belotto Albino José and Espinal Marcos Antonio 2013Progress towards eliminating canine rabies: policies and perspectives from Latin America and the CaribbeanPhil. Trans. R. Soc. B36820120143 https://doi.org/10.1098%2Frstb.2012.0143
Background
1983 Commitment: Latin America and Caribbean countries (LAC) decided to eliminate dog-transmitted rabies with strong political commitment, multinational efforts, and Pan American Health Organization (PAHO) support.
Action Plan Approval: The ‘Action Plan for the Elimination of Urban Rabies’ was approved at the 1983 I Rabies Program Directors of the Americas (REDIPRA) meeting in Guayaquil, Ecuador, and evaluated at II and III REDIPRA in 1988 and 1989.
Mass Canine Vaccination: Campaigns are crucial, with a goal to vaccinate 80% of the canine population. A 2001-2003 survey showed an average vaccination rate of 81%, with some countries like Mexico and Brazil nearing 100%.
Vaccine Production: LAC produces 51 million doses annually, mostly for Mexico and Brazil, with the largest dog populations (16 million and 25 million dogs, respectively).
Post-Exposure Prophylaxis (PEP): Widely available, about a million people (0.2%) seek health services annually for rabies exposure, with 25% receiving free prophylaxis. Between 2001-2003, 25.4% of dog bite victims received PEP, varying from 3.2% in Cuba to 58.4% in Brazil.
Laboratories and Testing: LAC has 141 decentralized labs testing over 74,000 samples annually for rabies.
Program Impact
Success Indicators: Nearly 90% decrease in human and canine rabies incidence; elimination of canine rabies in many countries.
Case Reduction: From 1980 to 2010, dog rabies cases dropped from 25,000 to less than 300, and human deaths from dog rabies decreased from 350 to less than 10.
SIRVERA Data: From 2000-2008, an average of 25 dog-transmitted rabies cases were recorded annually in seven countries. In the last three years, only seven countries reported human rabies cases from dogs.
Areas for Improvement
Endemic Regions: Rabies remains endemic in Haiti and Bolivia and sporadically in Cuba, Nicaragua, Venezuela, and parts of Central America and Brazil.
Localized Cases: Rabies cases are highly localized, affecting 0.2% of second-level communities, mostly in low-income areas on city outskirts.
PEP Challenges: Ensuring immunoglobulin administration to seriously exposed bite-victims is a challenge; over a third of LAC countries did not meet this requirement until 2004.
Vaccine Quality: The shift to more potent, safe, and effective cell-culture vaccines for humans is needed; some countries still use older, riskier vaccines.
Continuous Transmission Areas: Areas with ongoing transmission include Haiti, Cuba, Nicaragua, Colombia, Ecuador, Venezuela, northeast Brazil, and border areas of Mexico, Guatemala, Honduras, El Salvador, Bolivia, Argentina, and Peru.
Burden of Disease: Haiti and Bolivia were responsible for over half of dog-transmitted human rabies cases between 2008-2011, with the greatest burden in the past 7 years.