Présentation PowerPoint - Home: OIE - World …€¦ · PPT file · Web view · 2011-09-13Slide kindly given by Dr. F.X.Meslin. ... Sterilization or immunocontraception tools (WHO,

OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREAASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES SURVEILLANCE - POST VACCINATION MONITORING

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OIE GLOBAL CONFERENCEON RABIES CONTROL

ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME:

VACCINATION – RABIES SURVEILLANCEPOST VACCINATION MONITORING

7 - 9 SEPTEMBER 2011INCHEON-SEOUL, KOREA

Florence Cliquet – Jacques Barrat

European Union Reference

Laboratory for Rabies

Nancy Laboratoryfor Rabies and Wildlife

WHO Collaborating Centrefor Research and Management

in Zoonoses Control

OIE Reference Laboratoryfor Rabies

European Union Reference

Institute for Rabies Serology


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KEY POINTS

Final objective of control measures: prevention and elimination of the disease in Humans.

Mass vaccination of dogs is the most successful method for control and possibly elimination of dog mediated rabies (WHO, 2005).

The theoretical level of vaccination coverage should be at least 70% (WHO, 2005) to lead to an average 0 incidence in both humans and animals.

Given the high turnover of many dog populations, all dogs should be vaccinated, puppies (<3 months) included (Cliquet et al, 2001).


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MAIN PREREQUISITES FOR DOG RABIES CONTROL PROGRAMMES:

AN INTEGRATED APPROACH1. National network gathering one body of each involved sector – Identification of one body responsible of the programme.

2. Legal basis and long time budget allocation

3. Strategy of control – planning

4. Ensuring coordination between all actors: Precise identification of each step of the programme: who is responsible of what and when.

5. Dog demography information (both owned and stray) and dog ecology

6. Ensuring availability of biological products

7. Education of the public (in bite prevention & rabies awareness) – Strong media support

8. Trained diagnostic laboratory

9. Active surveillance network

10.Evaluation of control programme


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INTERNATIONAL AVAILABLE GUIDELINES

WHO Expert Consultation on Rabies, WHO Geneva, WHO Technical Report Series, 2005, n°931, 87 p.

Rabies chapter (2.1.13) of OIE Manual, 2011, oral vaccination paragraph.

Oral vaccination of dogs against rabies, WHO, Geneva 2007.

Stray dog population control, Terrestrial Animal Health Code, chapter 7.7, OIE 2011.

Blue print for rabies prevention and control (rabiesblueprint.com).

… and numerous reports of WHO Expert consultations.


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LEGAL BASIS AND BUDGET ALLOCATION

Rabies should be a notifiable disease both for humans and animals

National laws as well as regional and local legislation and decisions, according to country administrative organization

Technical and administrative responsibilities clarified before the campaign

Costs calculated for each sector involved and long term funding insurance

Rabies should be a notifiable

disease both for humans and animalsNational laws as well as regional

legislation and decisions, depending upon country administrative organization


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NETWORK WITH ALL INVOLVED SECTORS(“ONE HEALTH” CONCEPT)

National Rabies Control Committee, generally chaired by representative of Agriculture Authority and gathering representatives of :

Ministry of Agriculture, Ministry of Health, Ministry of Education, Ministry of Interior Affairs, Ministry of Environment, Head of Rabies National (Reference) Laboratory, Animal Welfare associations and NGOs, Veterinary services and private veterinarians.

Objectives:Information and exchange (regular meetings), coordination of different activities for rabies prevention and control, in case of rabies outbreak or problem arising, decision taken after collaborative discussion.


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INTERSECTORAL COORDINATIONDEFINING MAIN RESPONSIBILITIES AT NATIONAL,

REGIONAL AND LOCAL LEVELVeterinary authority Human health authority Education authority Interior affairs authority

• Propose and write a strategy• Calculate a budget

• Propose and write a strategy• Calculate a budget

• Provide information for school: books, videos, movies, posters…

• Organize garbage elimination (containers)

• Acquire inactivated rabies vaccines for dogs

• Acquire inactivated rabies vaccines for humans and immunoglobulins

• Remove stray dogs, ABC programme

• Organize, implement and monitor vaccination campaigns of dogs• Register and identify dogs

• Organize PEP to assess availability of vaccines and if all over the country

•Declare and report to ad hoc authorities all positive cases

•Declaration and reporting to ad hoc authorities all positive cases

• Organise surveillance of suspect animals and evaluation of the programme

• Organize surveillance in humans

• Collaborate with local authorities, animal welfare NGOs, private veterinarians…

• Educate responsible ownership • Education of general public


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DEFINING THE STRATEGY OF CONTROL 1/2

Assessment of the current epidemiological situation – Knowledge of dog population ecology

Parenteral vaccination of dogs:Person responsible of vaccination planMass vaccination campaign? Hot spots? Limited area? Oral vaccination? Dog identification?Vaccine used and cold storage placesTeams involved and training for “vaccinators” and dog “catchers”Material used (syringes, needles, lassos…)Model of grids to completePeriod of time and frequency of vaccination campaignsPractical organization in the fields


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DEFINING THE STRATEGY OF CONTROL 2/2

Dog population management (if any – ABC programmes, garbage management, …)

Rabies surveillance: Person responsible for surveillancePractical organization in the fieldsModel of grids to complete

Evaluation of the programme:Person responsible for evaluationMethod used for evaluation and frequency of evaluation


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CATEGORIZATION OF DOGS (WHO, 2007)

None

Semi

Full

None Semi Full

Dependency

Restriction

Feral dogs

Neibourhood or community

dogs

Familydogs

Restricted or supervised

dogs

Ecological survey (questionnaires) conducted prior to the strategy elaboration to identify needs in management of dog population and to determine the method of vaccination (interest of oral vaccination in the campaign)


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Vaccination against rabies with injectable vaccines induces a humoral response with the production of rabies neutralising antibodies.

In cats and dogs, the peak of rabies neutralising antibodies is generally reached between 4 to 6 weeks after first antigenic stimulation.

IMMUNOLOGICAL RESPONSE TO VACCINATION

Levelof

antibodies

Time after vaccination

Latency Exponential increasing DecreasingPlateau

Vaccination


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WHO and OIE recommendationsCell culture produced InactivatedAdjuvantedPossibly combined with other antigensPotency : 1.0 IU/dose

Quality controls have to be performed to guarantee: Safety: control of the inactivation process Stability: during long storage and under

liquid or lyophilized forms Efficacy: » Potency test: NIH test or Pharmacopeia test (Rabies

vaccine (inactivated) for veterinary use, 2008, 451).» Immunogenicity on 35 animals (serological survey

and challenge study).

RABIES VACCINES FOR DOGS: INJECTABLE VACCINES


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CENTRAL POINT PARENTERAL VACCINATION

Intended for domestic dogs which have affiliations (family or community dogs)Considered as the most cost effective strategy (Kaare et al, 2009; Zingstag et al, 2009)Requires owner’s participationRequires engagement of local authorities and public awarenessVaccination of dogs against rabies and possibly other diseasesPossible identification of dogs (plastic collars or coloured tags)Possible dog vaccination card/certificate


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Intended for domestic dogs which have affiliations but less accessible (aggressive dogs and dispersed community dogs)Requires:

detailed organizations (maps)dog owners being present at homeengagement of local authorities and public awareness

Possible:Vaccination of dogs against rabies and possibly other diseasesPossibly identification of dogs (plastic collars or colored tags)Possibly dog vaccination card/certificate

HOUSE TO HOUSE PARENTERAL VACCINATION

VET LAB


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ORAL VACCINATION OF DOGSCOMBINED TO PARENTERAL VACCINATION

The major obstacle in rabies control is the accessibility to vaccination of inaccessible owned and ownerless dogs

Since 1988, WHO has elaborated several guidelines and recommendations (last ones in 2009) for encouraging the launching of studies on oral vaccination in combination with parenteral vaccination

Trials undertaken in East Europe, Asia and Africa using commercial vaccine baits intended for wildlife immunization


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100% Immunization coverage:

- Oral vaccination combined or not with PV

- Parenteral vaccination

Proportion of restricted dogs (accessible and not)

80%

50%

POTENTIAL OF ORAL VERSUS PARENTERAL VACCINATIONACCORDING TO DOG POPULATION STRUCTURE

YEM

60---80

20---40

20

TUN

65---75

20

TUR

45

40---50

Dog population(segments in %)

ownerless

owned & unaccessible

owned & accessible

ORAL VACCINATION OF DOGS

Slide kindly given by Dr. F.X.Meslin


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ORAL VACCINATION OF DOGSCOMBINED TO PARENTERAL VACCINATION

Commercial vaccine baits available

Considerations regarding:

Method of bait distribution (house to house, central places, wildlife model)Baits attractiveness in local conditions (pilot studies)Vaccine bait efficacy in local conditions (pilot studies)Safety requirements for candidate vaccinesAssessment of vaccination efficacy : dog vaccination coverage in the field, monitoring rabies incidence


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Schematic representation of vaccination areas

GENERAL ORGANISATION OF VACCINATION CAMPAIGNS

All teams vaccinated correctly dogs except for team 4.

Team 4 had not a methodical organization of vaccination. Result: too large areas insufficiently vaccinated.

TEAM4

TEAM2

TEAM3

TEAM8

TEAM5

TEAM7

TEAM6

TEAM1Caption:

Contamination between areas because of one deficient team

Rabid dog


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DOG POPULATION MANAGEMENT

Sanitary measures:

Culling (not recommended, not efficient and humanely unaccepted): only limited to suspected rabid dog or unvaccinated contact dogs

Temporary removal (adoption programmes)

Waste management

Reproduction control:

Animal birth control programme

Sterilization or immunocontraception tools (WHO, 2009)


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EPIDEMIOLOGICAL SURVEILLANCE

Rabies surveillance is the basis for any control and prevention programmeSurveillance based on laboratory investigation on brain of dead or sick animals (not on killed at random dogs)No sample size – Animals must be sampled from all parts of the country and all along the yearRoutine reference diagnostic test (WHO, 1996; OIE, 2011):

Antigen detection (FAT): gold standard test

Virus isolation RTCIT / MIT if cell cultures are not available

Viral genome detection

Virus typing: Mabs or molecular methods


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Citizens, NGOs, associations, founding an

animal cadaver or a suspect live animal

EXAMPLE OF RABIES SURVEILLANCE NETWORKSUCH NETWORK MUST HAVE A LEGAL BASIS (LEGISLATION ARTICLE)

Sending of results Sending of samplesCaption

National reference Laboratory for rabies

EFSA, WHO / OIE (Rabnet and WAHID* database)

National competent authority for animal health

National competent authority for human health

National rabies database (all diagnosis negative and positive

results from both animals and humans)*http://web.oie.int/

wahis/public.php?page=home

Veterinary services

Veterinarians

Regional Lab


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EVALUATION OF CONTROL PROGRAMME

Ultimate indicator of the success of vaccination programme: decrease in rabies incidence in vaccinated areas both in humans and animals

Animal bite injury from hospitals

The strategy must be rapidly changed or adapted in case rabies incidence remains unchanged despite vaccination. The main reason is generally an insufficient vaccination coverage.

It is therefore advised, if budgets are limited, to analyse the entire programme for improvement and possibly to decrease the surface of the area of vaccination

0

100

200

300

400

500

1998 2000 2002 2004 2006 2008


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REPORTED AND ESTIMATED VACCINATION COVERAGES

IN DOMESTIC DOG POPULATIONSFROM VARIOUS SETTINGS IN SUB-SAHARAN AFRICA SINCE 1990

Region Country Dates Vaccines delivered Dog population Estimated coverage (%)

N’djamena Chad 2011 23,560 19.00

Machakos Kenya 1992 24.00

National Kenya 2003 33.00

Mzuzu Malawi 1996-2000 7823 44,932 12.1-20.2

National Mozambique 1997-2000 175,769 7,000,000 <1

Northern communal land Namibia 2001 115,000 12.00

Bomo State (urban) Nigeria 2007 <46.00

Borno State (rural) Nigeria 2007 <15.6

National Sudan 1992-2002 37,620 71,540 5.26

Khartoum state Sudan 2000 2,946 91,000 3.24

National Swaziland 1994-1998 57,204 63.2-91.7 (dropped to 3% in 1998)

National Tanzania 1992 11,635 <1

National Uganda 2001-2003 16.00

National Zimbabwe 2002 314,319 1,300,000 13.93

From Lembo et al., 2010


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Vaccinated dogs (Millions)

Rabies cases in dogs

CASES OF RABIES IN DOGS AND NUMBER OF VACCINATED DOGS IN MEXICO

1990-2004

Slide kindly given by Dr. F.X.Meslin


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A dog without antibodies at Day x may be protected if seroconversion was achieved before Day x.

Vaccinateddomestic carnivore

Vaccinated domesticcarnivore then in contact

with a rabid animal

Domestic carnivorein contact with a rabidanimal then vaccinated

Production of rabies neutralising antibodies

Around 30 days Variation in duration of the incubation period

SEROLOGICAL SURVEY FOLLOWING VACCINATIONTION

• Performed on a defined number of dogs • Blood sampling at D0 and D30 on each dog to be tested• Analysis using FAVN test or RFFIT (threshold 0.5IU/ml)


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-2

-1,5

-1

-0,5

0

0,5

1

1,5

2

2,5

3

log

(UI/m

l)

SEROLOGICAL FOLLOW UP OF DOGS VACCINATEDWITH A LOCAL CELL CULTURE INACTIVATED

AND ADJUVANTED VACCINE

(Unpublished Anses data – serological survey done in Morocco)

Day 30

Day 0


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CONCLUSION

To be sustainable, rabies control programmes based on vaccination of dogs should be integrated in a multiannual project of rabies elimination.Mass dog vaccination programs using injectable vaccines are successful for rabies control in different places (e.g. Latin America, Bohol, Bali, KwaZulu Natal, Sri Lanka).Priority of government for rabies control is the main prerequisite associated with long term funding insurance.Oral vaccination trials should be undertaken in those areas where rabies control using injectable vaccines is a success to increase the vaccination coverage.Importance of GARC, PRP and Rabies Elimination Demonstration projects.


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THANK YOU FOR YOUR ATTENT ON

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Présentation PowerPoint - Home: OIE - World …€¦ · PPT file · Web view · 2011-09-13Slide kindly given by Dr. F.X.Meslin. ... Sterilization or immunocontraception tools (WHO,