My Love iS dOgS Verry Hstorique Dogs

The rabies epidemiological situation has been worsening over the past 15 years in Indonesia with spread eastwards since the late 1990s and emergence on historically rabies-free islands, such as Flores in 1997 (Bingham, 2001; Windiyaningsih et al., 2004), Maluku and Ambon in 2003, Bali in 2008, and Nias islands in 2010 (G. Tallis, Jakarta, 2010, pers. comm.). The rabies epidemic on Flores island which started at the end of 1997 resulted in a least 113 deaths during the period 1998–2002 (Windiyaningsih et al., 2004) and is still entrenched in 2010. The island of Bali was free of rabies until its confirmation in late 2008. Although mass vaccination campaigns were conducted in villages around the index case, rabies spread to all provinces on the island and by February 2011 more than 100 human deaths had occurred (CDC, 2011). Dog rabies control activities that were carried out by the provincial veterinary services prioritized indiscriminate dog culling operations rather than dog vaccination campaigns, but were ineffective in preventing rabies spread. However, in late 2010 the Bali provincial authorities committed to an island-wide mass vaccination campaign to inoculate nearly 400,000 dogs against rabies, aiming to make Bali rabies-free in 2012 with the technical and financial support of the World Society for the Protection of Animals (WSPA) and direct involvement in field operations of a local organization named Bali animal welfare association (Bawa).1 Dog rabies is estimated to kill about 20,000 people annually in India (Sudarshan et al., 2007). However, following the initiation of a number of dog rabies control programmes in major cities (e.g. Bangalore, Chennai, New Delhi, Mumbai, Jaipur) (Reece, 2007) based on dog capture, vaccination, and release, as well as the wider availability of mostly locally produced cell-culture rabies vaccines and immunoglobulin for PEP, the number of human rabies deaths is thought to have decreased considerably during the second half of this decade (M.K. Sudarshan, Bangalore, 2010, pers. comm.). Rabies is a re-emerging public health risk in China. Dog rabies killed between 4000 and 7000 people a year during the period 1979– 1989, but was very swiftly brought under control in 5 years with only 159 human rabies deaths reported in 1996 (Tang et al., 2005). Yet the disease re-emerged progressively, to reach 3300 notified human rabies deaths in 2007, mostly from six south–central provinces (Fu, 2007). Disease re-emergence was associated with a lack of government commitment, relaxation of control measures, including dog vaccination, and ineffective local animal vaccines (Hu et al., 2008), coupled with increasing populations and poor awareness (Wu et al., 2009). Initially, authorities resorted to mass culling as a major tool for dog rabies control (BBC, 2006; CBC, 2009). Following public education campaigns and control activities conducted in the most affected provinces the number of notified human rabies deaths decreased to 2215 in 2009, but around 8 million PEP regimens are administered annually nationwide, and this number is continuously increasing (Q. Tang, Beijing, 2010, pers. comm.). Most African countries report the presence of human and dog rabies in all or large parts of their territories. In most countries, dog vaccination coverage remains far below the required threshold of 70% (Lembo et al., 2010), and the accessibility and affordability of human vaccine is still very limited, especially to the populations most at risk (Hampson et al., 2008). Since early 2009, South Africa and the United Republic of Tanzania have begun projects working to eliminate human and dog rabies from pilot areas within 5 years (WHO, 2007a). Strategies for dog rabies control and elimination Approaches to rabies control and prevention include strategies directed at humans (pre-exposure or post-exposure prophylaxis) and measures targeting the species mostly responsible for transmission to humans. While both approaches are ultimately aimed at protecting human health, for infection to be eliminated control measures must be directed at the species involved in rabies maintenance in any given area. Here we focus on veterinary measures adopted for the control and eventual elimination of dog rabies in a range of settings. Since the development of effective animal vaccines for rabies, mass vaccination has become an integral component of rabies control measures. However, the elimination of rabies requires several additional components to mass vaccination, including effective engagement of communities and policymakers, dog population assessment and management, and surveillance capacity and legislation. High levels of awareness amongst key players in rabies prevention and control is vital for effective policy towards canine rabies elimination, including allocation of resources, defining specific roles among all sectors responsible for rabies control and establishing legislative frameworks (e.g. compulsory dog registration and vaccination, animal movement control, and habitat management). Education and promotion of responsible dog ownership should also be considered critical to enhance the effectiveness of dog population management and vaccination efforts. Surveillance Surveillance is an essential part of rabies control efforts, and is necessary to determine the rabies situation at the start of a control programme and monitor progress towards elimination. Surveillance becomes increasingly important for the demonstration and maintenance of freedom from disease, as has been demonstrated in the Americas. Most surveillance relies on laboratory confirmation and therefore requires a system for the collection and submission of samples as well as local capacity for performing standard diagnostic tests (the direct fluorescent antibody test, DFA) (Meslin and Kaplan, 1999). In many parts of the world though, particularly in Africa, facilities for fluorescent microscopy are not available, or equipment is not adequately maintained, and capacity for sample collection in the field is limited. Hence, reported laboratory-confirmed cases are lacking and may not necessarily provide a good measure of the incidence of rabies in an area. Alternative tests for rabies are now available which show promising results, require simpler infrastructure, and are less expensive. Specifically, the direct rapid immunohistochemical test (DRIT) has been validated on field diagnostic material from developing countries and has shown complete concordance with the gold standard DFA (Lembo et al., 2006; Durr et al., 2008; Tao et al., 2008) and lateral-flow immunodiagnostic test kits are proving useful surveillance tools (Kang et al., 2007; Markotter et al., 2009). Reporting of suspect cases and hospital records of animal-bite injuries from suspect rabid animals can be very useful because of the characteristic clinical signs of rabies that are accurately recognized by local communities (Hampson et al., 2008; Lembo et al., 2008; Beyer et al., 2011). Hospital records also contain information on numbers of PEP regimens delivered, which can provide some indication of rabies trends, but may also reflect inadequate health service provision. In many developing countries, data collected at the national level are often based on clinical signs rather than laboratory diagnosis, and are largely incomplete (Dodet et al., 2008). Channels of reporting and communication, including the submission of samples for laboratory diagnosis, therefore need to be improved, as officially reported records currently underestimate the true incidence of rabies. Dog vaccination Vaccination of 70% of the dog population has repeatedly been shown to be effective in eliminating endemic canine rabies (Coleman and Dye, 1996). Although lower levels of coverage can sometimes be effective, in many developing countries mortality and birth rates in dog populations are generally high and therefore campaigns need to be repeated to prevent coverage falling to ineffective levels (Hampson et al., 2009). High vaccination coverage (70% or higher) can be attained through strategies consisting of well-designed educational campaigns, intersectoral cooperation, community

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