FAO's Support Rabies Control in Bali_Jul22.pptx

What is FAO doing to support rabies control programmes in Bali, Indonesia, using One Health approach with mass dog vaccination and integrated bite case management as main strategies

1. FAO’s Support on Rabies Control in Bali, Indonesia Denpasar, 7 July 2022 Rabies Control Team Emergency Center for Transboundary Animal Diseases, FAO Indonesia

2. Why rabies is important? Story of rabies in Bali Lessons for rabies control and elimination Presentation content FAO’s Support on Rabies Control in Bali, Indonesia

3. Rabies has a significant impact on lives and livelihoods in developing countries The poor and marginalized communities are most heavily impacted Rabies is 99% fatal, but 100% vaccine preventable 4 of 10 deaths of rabies are in children The economic impact of rabies is enormous at USD 8.6 billion annually, 6% of that is due to livestock losses Rabies is a model disease for One Health approach Why rabies is important? FAO’s Support on Rabies Control in Bali, Indonesia

4. Bali had been historically rabies-free, but then rabies was introduced in 2008 Over the last decade, the Indonesian Government together with other stakeholders, has implemented control and elimination activities with the aim of re-securing Bali’s freedom from rabies FAO has been involved in rabies control and eradication programmes in Bali since 2011 Story of rabies in Bali: rabies incursion and spread FAO’s Support on Rabies Control in Bali, Indonesia

5. How rabies emerged and evolved within a decade after introduction in Bali FAO’s Support on Rabies Control in Bali, Indonesia 2010 2012 2008 2009 2015 2017

6. FAO has been supporting the Government of Indonesia to control rabies: Support the development of national rabies elimination guidelines Support the implementation of rabies control strategies Mass dog vaccination (MDV) Oral rabies vaccination (ORV) – pilot study Integrated bite case management (IBCM) Dog population management (DPM) Public awareness Story of rabies in Bali: what is FAO doing? FAO’s Support on Rabies Control in Bali, Indonesia

7. R10 R2 R3 R4 R5 R6 R7 R8 R9 Story of rabies in Bali: MDV implementation FAO’s Support on Rabies Control in Bali, Indonesia Annual MDV across the island has been implemented by local government with the support from central government and FAO since 2011 ( https://rabiesalliance.org/resource/faos-technical-cooperation-project-bali )  Additional strategies to increase coverage: sweeping vaccination Pilot vaccination in Gianyar Island-wide Vaccination R1

8. Story of rabies in Bali: A-Team On the front-line of eradicating rabies from Bali and remote rural areas are the vaccination teams, known as the “A-Teams” 1 vaccinator, 1 recorder, 4 dog catchers The teams search villages and remote mountainous areas for roaming dogs  ( https ://www.youtube.com/watch?v=_VBxYMXY0nc&t=73s )  FAO’s Support on Rabies Control in Bali, Indonesia

9. Story of rabies in Bali: ORV pilot FAO’s Support on Rabies Control in Bali, Indonesia One of the biggest challenges: vaccinating free-roaming dogs To address this challenge the option of using ORV is considered Two studies of ORV on the bait acceptance and oral vaccine immunogenicity were implemented in Karangasem and Buleleng , Bali ( https://kumparan.com/kanalbali/uji-coba-vaksin-oral-rabies-dilakukan-kementan-di-bali-1wzIVFtahjl/full ) 

10. IBCM was first established in Bali in 2011 Which then, was re-introduced in 2016 following the surge in cases in 2015 ( https://www.fao.org/indonesia/news/detail-events/fr/c/431438/ )  IBCM is a One Health protocol to enhance networking among different sectors (animal-wildlife health and public health) in managing and responding to bite cases Story of rabies in Bali: IBCM protocol FAO’s Support on Rabies Control in Bali, Indonesia

11. Story of rabies in Bali: IBCM added value FAO’s Support on Rabies Control in Bali, Indonesia Generating benefits for human by tackling disease in animal population Better targeted treatment Averted rabies cases Improved animal welfare Increase in efficiency through cost-savings PEP doses saved Generating better knowledge and information by using integrative analysis Improved networking and communication (inter-sector) Increased awareness (efficiency of awareness campaign)

12. Story of rabies in Bali: DPM pilot FAO’s Support on Rabies Control in Bali, Indonesia DPM program was piloted in Gianyar , Bali ( https://www.fao.org/indonesia/news/detail-events/zh/c/426486/ )  Focus on community empowerment and educating communities on the risk of rabies and available control and prevention measures; promote responsible dog ownership, supported by village health workers and backed up by local law enforcement The results showed that increased public engagement and awareness of rabies risk in the community, fostered daily dialogue with the veterinary and public health and lead to increased dog vaccination coverage

13. Target: Elementary school Communities Culture and religion group FAO’s Support on Rabies Control in Bali, Indonesia Story of rabies in Bali: Public awareness

14. Lessons for rabies control and elimination FAO’s Support on Rabies Control in Bali, Indonesia Control strategies Lessons learned + Annual MDV campaign   + High quality vaccines   + Sweeping vaccination   + Emergency vaccination   + IBCM protocol + DPM + Rabies public awareness Not fast enough or wide enough https://pubmed.ncbi.nlm.nih.gov/31564729/  

15. Recommendations FAO’s Support on Rabies Control in Bali, Indonesia Comprehensive island-wide MDV campaigns should be conducted annually with high quality vaccines in all villages  on as short time as possible and aim to achieve high coverage (minimum 70%) Supplementary vaccinations should target puppies born after campaigns and unvaccinated dogs missed during campaigns-involving all sectors including veterinary surgeons/practitioners Emergency response vaccinations should be  implemented rapidly and cover sufficient radius of risk areas Targeted surveillance through IBCM , coupled with increased public awareness, is a sensitive and efficient way to increase case detection DPM strategy implemented to encourage responsible dog ownership, with a focus on vaccinating dogs, particularly puppies , to maintain high levels of vaccination coverage Creating awareness for children and students is effective to send messages to their parents and their communities.

16. Options to enhance rabies control in future FAO’s Support on Rabies Control in Bali, Indonesia The usage of other funding resources to strengthen rabies control program in Bali: Dana Desa,  Biaya Tak Terduga (BTT), Dana Siap Pakai (DSP) Increased puppy vaccination (involving private practitioners and IVMA) Oral rabies vaccination for roaming dogs/ hard to catch dogs Increased community involvement  Expand the DPM and responsible dog ownership to the whole of Bali Children Declaration for Indonesia to be Free of Rabies by 2030, at World Rabies Day, 2019

17. Thank you!