Rabies Prevention and Control Measures

Abraham Ali (DVM, MPH)Ethiopian Public Health Institute

Outline• Definitions• Introduction• Rabies Prevention and Control• Elements of Animal Rabies Control• Elements of Human Rabies Prevention• Basic Issues on Rabies Prevention and Control• Key Message

Definitions

• Prevention:– The management of those factors that could lead

to disease so as to prevent the occurrence the disease

– It is the first line of defense against disease. • Control: – Reduction of disease incidence, prevalence,

morbidity, or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction.

Introduction(1)• Disease prevention and control program are

developed to monitor the occurrence of infectious diseases, and safeguard the public.

• Prevention and Control program : is a set of policies and exposure control plans that form a comprehensive strategy to prevent and control infectious diseases.

• The health policy of the Federal Democratic Republic of Ethiopia has given due emphasis to promotive and preventive interventions coupled with basic curative services.

Introduction(2)Generally, diseases can be controlled and prevented by adequate measures which involve:

1. Diagnosis 2. Notification 3. Isolation 4. Treatment 5. Quarantine

6. Investigation7. Disinfection 8. Blocking of transmission9. Immunization 10. Health education.

Rabies Prevention and control

• It has two components:1. Animal Rabies Control

Primary Prevention measures Measures used to prevent the disease

at the source2. Human Rabies Prevention

Secondary Prevention Measures

Elements of Animal Rabies Control• Rabies control strategies include :

I. Mass vaccination of dogs

II. Movement restriction/Confinement

III. Control of ‘stray’ dogs

I. Mass vaccination of dogs

• Animal Pre-Exposure Vaccination

• For effective control at least 75-80% of the population Should be vaccinated

• Should be done at regular Bases

II. Movement restriction/Confinement

• Isolation and Observation

Periods( 10 days for Dogs and

cats): -Suspect Rabid Animal

Exposes a Person-Lab Diagnosis

• Animal Quarantine(Six month) :

-Animal Exposes and previously

vaccinated

• Euthanasia of unvaccinated

animals If exposed

III. Control of ‘stray’ dogs

• Objective is to decrease stray dog population on certain level or to keep and management with the population on certain level

• Stray dog : each dog that is not under direct control of the owner or it is nor being stopped in roam (including lost and abandoned dogs)

Measures for stray dog control• Create responsible dog ownership among the

community• Dog registration and Identification:- mandatory rabies

vaccination and traceability.• Environmental Control:-excluding dogs from sources of

food (e.g. rubbish dumps and abattoirs, and installing animal-proof rubbish containers).

• Humane dog population management:- Animal Birth control

• Euthanasia: -means the act of inducing death in a humane manner.

• Control of dog movements:- (e.g. leash laws, roaming restrictions)

Elements of Human Rabies Prevention• Avoiding exposure :-– Avoiding contact with unknown animals– Nursing rabid Human /animal with Care

• Pre-Exposure Prophylaxis (PrEP) : –– is recommended for anyone who is at continual,

frequent or increased risk for exposure to the rabies virus such as laboratory workers, veterinarians and animal handlers.

• Post-Exposure Prophylaxis (PEP):-– anti-rabies prophylaxis ( Vaccine) administered after

an exposure

Post-exposure prophylaxis

• Post-exposure prophylaxis consists of:a) Local treatment of the wound as soon as

possible after exposure,b) Exposure assessment and administration of

potent, effective anti rabies vaccine that meets WHO recommendations and/or

c) Administration of rabies immunoglobulin, if indicated

a) Local treatment of wounds

The recommended first-aid procedures include immediate, thorough flushing and washing of the wound with soap and water, detergent, povidone iodine or other substances with virucidal activity.• Next visit health facility to

receive specialised treatments such as:– Post Exposure vaccination and

rabies immunoglobulin– Administration of antibiotics– Tetanus prophylaxis,

b)Exposure Assessment and Anti rabies Vaccination

• Exposure assessment for Anti Rabies administration is done based on WHO guideline

• It consider the following points :– Exposure status– Availability of responsible animal for Diagnosis– Laboratory Result– Epidemiology of the disease in the country

Categories of Exposure

• Exposure: Rabies exposure occurs when the virus is introduced into bite wounds or open cuts in skin or onto mucous membranes.

• Two categories of exposure, bite and non bite, should be

considered.

• Bite: Any penetration of the skin by teeth constitutes a bite exposure.

• Non bite: The contamination of open wounds, abrasions, mucous membranes, or theoretically, scratches, with saliva or other potential infectious material (such as neural tissue) from a rabid animal constitutes a non bite exposure.

Vaccines for post-exposure prophylaxisNervous Tissue vaccine•17 Injections•Administered around the umbilicus SC

Cell culture Based Vaccines• 5 Injections• Administered intramuscularly

c)Administration of Rabies immunoglobulin• It is to provide neutralizing antibodies at the site of

exposure before patients can begin producing their own antibodies physiologically after vaccination.

• It should be administered to all patients presenting with single or multiple transdermal bites.

Basic Issues on Rabies Prevention and Control• Should be backed by legal framework• Allocation of Resources : availing Vaccines & RIG• Expand diagnostic service and strengthen

surveillance system• Skill man power• Collaboration among stakeholders• Community education and participation

Key Message

• ‘Prevention is better than cure’

• Since, there is no cure for Rabies

• Prevention is the only alternative

• Let’s work hard together to prevent

rabies

Thank You