Pan American Health OrganizationWorld Health Organization

Veterinary Public Health

OIE- Global Conference on Rabies Control:

ELIMINATION OF HUMAN RABIES TRANSMITED BY DOG IN

THE AMERICAS: ACHIEVMENTS

Hugo Tamayo SilvaPANAFTOSA-OPS/OMS

Incheon - Seoul - Republic of Korea

7 - 9 September 2011

EPIDEMIOLOGICAL CONTEXT...

COUNTRY

/SUBREGIÓ N

ANIMAL SPECIES

CANADA - SKUNKS (34%) – FOXES (9%)

- NON HEMATOPHAGUS BATS (38%)TOTAL 2009 = 145 CASOS CON DL

USA - RACCONS (35%) - SKUNKS (24%)

- FOXES (7%)

- NON HEMATOPHAGUS BATS (24%)TOTAL 2009 = 6.694 CASOS CON DL

MEXICO - DOGS (V1 - V2)

- HEMATOPHAGUS BATS (V3)

- NOT HEMATOPHAGUS BATS (V4)

CENTRAL A. and

CARIBE L.

CUBA - HAITI

R.DOMINCANA

P. RICO

- DOGS (V1 - V2)

- HEMATOPHAGUS BATS (V3)

- NOT HEMATOPHAGUS BATS (V4)

- MANGOOSES (V1)

ANDEAN A.:

COLOMBIA

- DOGS (V1 - V2)

- HEMATOPHAGUS BATS (V3)

- NON HEMATOPHAGUS BATS (V4)

- UROCYON CINEREOARGENTUS (VNC)

SUL CONE

BRAZIL

- DOG (V1 - V2)

- HEMTOPHAGUS BATS (V3)

- NON HEMATOPHAGUS B. (V4) (VNC)

- MARMOSET (VNC)

- CRAB EATING FOXES (VNC)

Venezuela V3, V5

Colombia V3

Brazil 1 V3

Peru-Brazil V3

Brazil 2 V3

Argentina V3

Bolivia V3

Brazil 3 V3

Mexico 1 V3

Mexico-Colombia V3

Mexico V11

Colombia V8/V3 – Peru V3

Mexico V8 atypical

Tadarida brasiliensis V9 North America

Tadarida brasiliensis V4 South America

Colonial bats North America

Other bats South America

Solitary bats North America

Terrestrial carnivores North America

Sagui monkey Brazil

Out group 3

PHYLOGENETIC

TREE OF RABIES

VIRUSES

0

1000

2000

3000

4000

5000

6000

1959 1964 1969 1974 1979 1984 1989 1994 1999 2004 2009

Cases

Year

Rabies in Wild Animals, 1959-2009

Raccoons Skunks Skunk Variant Bats Foxes

Source: Centers for Disease Control and Prevention, November 2010

USA: RABIES IN WILD ANIMALS, 1959-2009

257 millions (46%) without health care, public or private

685,000 children without vaccination

17% parturition done by personel not qualified

LAC: CONTEXT, 2007.....

- Population: 572 millions

- In poverty 35.1%

- In extreme poverty: 15.9%

POLITICAL

FRAMEWORK…

MANDATES

1983:

1a REDIPRA - III RIMSA – OPS/CD 31

2008 - 2009

XV RIMSA - OPS/CD 48/R13 CD 49/R19

2010:

13ª REDIPRA

COMMITMENTS....

• REDIPRA, Guayaquil 1983: Strategy and action plan for the

elimination of urban rabies from the major urban centers in Latin

America by the end of 1980’s

• PAHO, 1991: extension policies and strategies to isolated areas

and small rural populations

• PAHO, 1992: emphasize the surveillance of wildlife rabies,

particularly transmitted by bats

• PAHO, 2008: to eliminate dog- trasmittd human rabies from hemisphere

by 20102 (XV RIMSA – CD 48/R13)

REGIONAL PLAN: COMPONENTS ...

• Timely post-exposure

prophylaxis for people bitten.

Access immunobiological

• Elimination of human rabies

transmitted by dogs. Dog mass

vaccination

• Active surveillance and

prevention of wildlife rabies

• Social organization, education

end information diffusion

ALC: ACHIEVEMENTS, 1970 – 2011*

Source: SIRVERASource: SIREVERA/SIEPI - PANAFTOSA/OPS August/2011

0

20

40

60

80

100

120

140

160

180

200

220

240

260

280

300

320

340

360

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Year

Hu

man

Rab

ies

0

2500

5000

7500

10000

12500

15000

17500

20000

22500

25000

Rab

ies in

Do

gs

Human Cases transmitted by dog Human cases transmitted by bats Rabies in Dogs

15

19

196

25,000 351

60

LAC: SPATIAL DISTRIBUTION: 1999 - 2006

Rabia Humana Origen Perro

Año 2006

3 a 7 (2)

2 (3)

1 (8)

0 (404)

AmericaAdm1Rabia by Rc1999

8 to 8 (1)

3 to 8 (2)

2 to 3 (6)

1 to 2 (19)

0 to 1 (389)

AmericaAdm1Rabia by Rh2007

8 to 8 (1)

3 to 8 (1)

1 to 3 (1)

0 to 1 (414)

AmericaAdm1Rabia by Rh2006

2 to 2 (1)

1 to 2 (2)

0 to 1 (414)

AmericaAdm1Rabia by Rh2005

4 to 17 (2)

3 to 4 (2)

2 to 3 (1)

1 to 2 (2)

0 to 1 (410)

Rabia origen pe rros 1999

8 (1)

3 a 7 (2)

2 (6)

1 (19)

0 (389)

Rabia Humana Origen Perros

Año 1999

8 y + (1)

3 a 7 (2)

2 (6)

1 (19)

0 (389)

AmericaAdm1Rabia by Rh2007

8 to 8 (1)

3 to 8 (1)

1 to 3 (1)

0 to 1 (414)

AmericaAdm1Rabia by Rh2006

2 to 2 (1)

1 to 2 (2)

0 to 1 (414)

AmericaAdm1Rabia by Rh2005

4 to 17 (2)

3 to 4 (2)

2 to 3 (1)

1 to 2 (2)

0 to 1 (410)

Rabia origen pe rros 1999

8 (1)

3 a 7 (2)

2 (6)

1 (19)

0 (389)

111111

PAHO RESOLUTION (DC 49

2009): ELIMINATION OF HUMAN

RABIES TRANSMMMITED

BY DOG….

LAC: RABIES HOTSPOTS - 2009

2010

2011-2012

To here

High

Moderate

Low

RABIES IN LAC: GOAL

LAC: CAPACITY FOR RABIES ELIMINATION ….

Brasil - México

Argentina - Colombia Venezuela - Perú

Ecuador - Nicaragua

DECLARATION OF RABIES FREE

COUNTRY/TERRITORIES, VARIANTS 1 AND 2

DECLARED IN PROCESS PROGRAMMED

Chile

Mexico

Peru

Costa Rica

Nicaragua

Uruguay

Argentina

Brazil -south

Colombia

Equador

Venezuela

• Epidemiological Surveillance: A Network for

rabies diagnosis laboratories

• > more than 100 laboratories

• Medical care to people exposed (PEP)

> 1,000,000 people bitten annually

> 500,000 patients prophilaxis post exposition

> 2,000,000 vaccine doses applied (> C.C.)

• Canine Vaccination

> 45,000,000 dogs vaccineted annually

• Education, community participation

KEY TO SUCCESS....

0

15

19

1

37

5

0

10

20

30

40

50

60

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Years

Hu

ma

n C

as

es

of

Ra

bie

s

Cat Dog Bat

CHALLENGE: WILD RABIES RE-EMERGENCE...

Source: SIREVERA/SIEPI - PANAFTOSA/OPS August/2011

D.rotundus

Artibeus spp

1°

Brasil

CatDog

D.rotundus

Artibeus spp

2° Costa Rica

3° Colômbia

4° Equador

Secondary transmission of rabies in the Americas

(Wild Cicle Urbanization?)

WILD RABIES SURVEILLANCE:

SIMPLIFICATION OF ECOSYSTEMS

Challenges Opportunities

Country/Areas with rabies : less

developed:

- Inmunobiological deficiency

- Low dog vaccination coverage

- Lack integration, coordination

Strengthening National Progr. bi or

multinational border:

- Policies to combat poverty

- Unfinished agenda in health

- Local Development

- Weakening national

- programs

- Low epidemiological

surveillance

- Declaration countries / territories

free (WHO-OIE)

- Strengthening Field-laboratory

surveillance

•Re-emergence wild rabies cicle - Strengthening regional laboratory

network

- Strengthening active survillance

field-laboratory