Rabies: Elimination History

Data and facts from rabies eradication campaigns.

Jump to: Asia | Central & South America

Highlights

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Asia

Jump to: Indonesia (Flores), 1998-2003 | Philippines CARE Project, 2012-2015

Indonesia (Flores), 1998-2003

External Link: 
Windiyaningsih C, Wilde H, Meslin FX, Suroso T, Widarso HS. The rabies epidemic on Flores Island, Indonesia (1998-2003). J Med Assoc Thai. 2004 Nov;87(11):1389-93. PMID: 15825719.
https://medassocthai.org/journal/files/Vol87_No11_1389.pdf

Dog Population

District	1998	1999	2000	2001	2002
East Flores	76,171	37,701	20,528	20,528	5,314
Sikka	124,311	108,644	46,075	46,075	6,999
Ende	67,278	67,278	67,899	65,278	13,124
Ngada	72,522	72,522	82,366	72,522	8,769
Manggarai	234,046	234,046	234,046	233,125	69,276
Lembata	43,223	28,318	13,990	13,659	24,000
Total	617,551	548,509	464,904	451,187	127,482

Dogs Vaccinated

District	1998	1999	2000	2001	2002
East Flores	0	0	0	2,117	0
Sikka	0	0	0	0	5,881
Ende	0	0	0	7,926	0
Ngada	0	0	5,157	0	0
Manggarai	0	0	6,469	0	0
Lembata	0	0	13,428	18,000	0
Total	0	0	25,054	28,043	5,881

Dogs Examined

District	1998	1999	2000	2001	2002
East Flores	469	116	45	122	0
Sikka	121	287	58	0	0
Ende	0	4	62	197	0
Ngada	0	0	1,549	54	0
Manggarai	0	0	221	565	0
Lembata	36	3	0	8	0
Total	68871	64728	147,576	14,394	0

Dogs Lab Positive

District	1998	1999	2000	2001	2002
East Flores	377	93	36	98	0
Sikka	97	231	47	0	0
Ende	0	4	50	158	0
Ngada	0	0	1,246	43	0
Manggarai	0	0	179	455	0
Lembata	29	2	0	6	0
Total	503	330	1,550	760	0

Animal Bites

District	1998	1999	2000	2001	2002
East Flores	582	151	70	145	156
Sikka	141	386	151	60	25
Ende	0	5	445	226	41
Ngada	0	0	1,770	62	55
Manggarai	0	0	124	650	466
Lembata	0	44	5	9	0
Total	723	586	2,565	1,152	718

Post Exposure Prophylaxis (PEP)

District	1998	1999	2000	2001	2002
East Flores	281	34	66	137	35
Sikka	60	62	60	0	25
Ende	0	5	63	224	40
Ngada	0	0	1,306	58	55
Manggarai	0	0	326	0	459
Lembata	0	44	2	0	0
Total	341	96	1,823	419	710

Human Deaths

District	1998	1999	2000	2001	2002
East Flores	10	13	1	2	0
Sikka	0	13	2	1	0
Ende	0	0	3	2	1
Ngada	0	0	50	4	0
Manggarai	0	0	2	2	7
Lembata	0	0	0	0	0
Total	10	26	58	11	8

Other Data

• 53,204 of the 76,171 (69.8%) dogs in East Flores were culled in 1998
• In 2004, about 30% of dogs tested were found to have rabies.
• Nearly half of all dog bites and more than half of rabies deaths occurred in children under 15 years old.
• Only 58.7% of people bitten by animals received rabies treatment. None of those who were treated died from rabies

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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.
• Partners: OIE (vaccine donation), GARC (technical input).
• Interventions: Mass dog vaccination (70% target), community awareness, surveillance training.
• Surveillance: Between 2008 to 2011, 19-50 annual canine rabies cases, 2 annual human deaths.
• Timeline: April 2012 – September 2016.

Project Key Activities and Timeline

Activities	2012	2013	2014	2015
Establishment of Provincial Rabies Control Committee	✓
Intersectoral collaboration	✓	✓	✓	✓
Mobilize volunteers	✓	✓	✓	✓
Train volunteers as vaccinators				✓
Mass dog vaccination	✓	✓	✓	✓
Dog registration	✓	✓	✓	✓
Dog Population Survey	✓	✓	✓	✓
Human Rabies Case investigations	✓	✓	✓	✓
Institutionalization of “One Health” response system				✓
Laboratory diagnosis training and biosafety		✓		✓
Training on humane handling of dogs				✓
Dog rabies case investigation training				✓
Rabies Speakers’ Bureau				✓
Integration of rabies in school curriculum			✓	✓
Early Childhood Intervention Program				✓
Provincial quiz bee on rabies		✓	✓	✓
Information campaign to strengthen border control				✓
Regional Rabies Summit				✓
Policy advocacy for local executives	✓	✓	✓	✓
Media Awareness Workshop		✓
Awards for local rabies implementers				✓
Community-based survey on rabies knowledge	✓		✓

Rabies Cases and Vaccination Efforts Prior to Project Implementation

	2008	2009	2010	2011
Animal and human cases
Dog brain samples tested	123	87	90	66
Confirmed dog cases	50	29	44	19
% of samples positive	40.7	33.3	48.9	28.8
Suspect human cases	2	1	2	2
Annual incidence of suspect human cases per 100,000 (n = 568,017)	0.352	0.176	0.352	0.352
Patients seeking animal bite consultations	897	954	1,475	2,015
Number of children seeking animal bite consultations (%)	Not Available	Not Available	Not Available	Not Available
Dog Vaccinations
Number of barangays reached by the vaccination campaign	329	342	381	266
% Barangays reached (n=557)	59.1	61.4	68.4	47.8
Number of dogs vaccinated	12,044	12,203	28,581	12,066
% Dogs vaccinated (assuming n = 76,628)	15.7	15.9	37.3	15.7
% Dogs vaccinated (assuming n = 149,748)	8.0	8.1	19.1	8.1
% Dogs vaccinated (assuming n = 278,691)	4.3	4.4	10.3	4.3

Notes: Barangay – the smallest administrative unit in the Philippines; There was a rabies outbreak in 2010.

Rabies Cases and Vaccination Efforts After Project Implementation

	2012	2013	2014	2015
Animal and human cases
Dog brain samples tested	36	45	48	32
Confirmed dog cases	8	1	0	0
% of samples positive	22.2	2.2	0	0
Suspect human cases	2	1	0	0
Annual incidence of suspect human cases per 100,000 (n = 568,017)	0.352	0.176	0.000	0.000
Patients seeking animal bite consultations	3,070	3,571	5,908	5,520
Number of children seeking animal bite consultations (%)	1,265 (42)	1,378 (43)	2,052 (40)	1,394 (41)
Dog Vaccinations
Number of barangays reached by the vaccination campaign	340	420	485	447
% Barangays reached (n=557)	61.0	75.4	87.1	80.3
Number of dogs vaccinated	23,539	39,647	38,722	36,460
% Dogs vaccinated (assuming n = 76,628)	30.7	51.7	50.5	47.6
% Dogs vaccinated (assuming n = 149,748)	15.7	26.5	25.9	24.3
% Dogs vaccinated (assuming n = 278,691)	8.4	14.2	13.9	13.1

Notes: During this period, the proportion of animal bites attributed to dogs was 83 to 89%, and other bites were from cats and various small mammals.

Dog Population Survey Results

2014 Community-Based Survey

• Dog Ownership: 65.9% of households owned dogs.
• Number of Dogs: 71% owned 1-2 dogs, 5% owned 4+ dogs.
• Dog:Human Ratio: 1:3.8
• Estimated Owned Dog Population: 149,748
• Free-Roaming Dogs: 67% of owned dogs were free-roaming.

2016 Rigorous Dog Population Survey

• Dog:Human Ratio: 1:2.24
• Total Owned Dog Population: 217,469 (53% free-roaming)
• Unowned Free-Roaming Dogs: 61,222
• Total Dog Population Estimate: 278,691 (36% confined by owners)

Dog Vaccination Costs

	2012	2013	2014	Overall
Dog vaccination costs for Laoag City
Total cost of dog vaccination (PHP)	1,110,365	1,040,485	1,054,202	3,205,053
Total cost of dog vaccination (USD)	24,428	22,891	23,192	70,511
Number of dogs vaccinated	3,476	4,527	7,513	15,516
Cost/ dog (USD)	7.03	5.06	3.09	4.54
Dog vaccination costs for Dingras Municipality
Total cost of dog vaccination (PHP)	591,155	751,045	648,821	1,991,021
Total cost of dog vaccination (USD)	13,005	16,523	14,274	43,802
Number of dogs vaccinated	726	2,982	1,357	5,065
Cost/ dog (USD)	17.91	5.54	10.52	8.65

Components of Dog Vaccination Costs

(%)	Laoag City (Urban)	Dingras Municipality (Rural)
Personnel	73.4	84.0
Vaccine	13.5	6.0
Consumables	6.1	5.3
Awareness	5.8	3.1
Transport	0.7	1.5
Cold chain	0.2	0.1
Diagnostics	0.2	0.0
Office supplies	0.1	0.0

Contributors of Dog Vaccination Costs

(%)	Laoag City (Urban)	Dingras Municipality (Rural)
City	56.8	78.7
Province	24.2	11.8
Global Alliance for Rabies Control (GARC)	15.5	6.5
Other donors	3.1	2.7
Regional	0.2	0.4
National	0.2	0.0

PEP Provision Costs

	2012	2013	2014	Overall
PEP costs for Laoag City
Total cost for PEP (PHP)	2,156,857	2,297,622	2,755,215	7,209,695
Total cost for PEP (USD)	47,751	50,548	60,615	158,613
Number of PEP doses provided	2,295	2,402	3,397	8,093.13
Number of patients vaccinated	636	726	913	2,275
Average doses/patient	3.61	3.31	3.72	3.56
Cost per PEP dose (USD)	20.68	21.05	17.85	19.60
Cost per patient (USD)	74.61	69.62	66.39	69.72
PEP provision costs for Dingras Municipality
Total cost for PEP (PHP)	183,976	404,390	755,128	1,343,494
Total cost for PEP (USD)	4,047	8,897	16,613	29,557
Number of PEP doses provided	202	507	1,207	1,917
Number of patients vaccinated	63	158	382	603
Average doses/patient	3.21	3.21	3.16	3.18
Cost per PEP dose (USD)	20.01	17.54	13.76	17.11
Cost per patient (USD)	64.25	56.31	43.49	49.02

Components of PEP Provision Costs

(%)	Laoag City (Urban)	Dingras Municipality (Rural)
Vaccine and biologics	69.6	80.0
Personnel	23.6	13.1
Consumables	3.7	4.3
Awareness	3.1	0.5
Cold chain	0.0	2.1
Office supplies	0.1	0.0

Contributors of PEP Provision Costs

(%)	Laoag City (Urban)	Dingras Municipality (Rural)
Patient	49.2	55.1
City	38.0	23.8
Province	8.1	9.1
National	3.9	11.6
Private provider	0.7	0.0
Global Alliance for Rabies Control (GARC)	0.1	0.5

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Central & South America

Jump to: Latin America and Caribbean, 1980 onwards

Latin America and Caribbean, 1980 onwards

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.

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