Lessons learned_Addressing rabies through One Health approach_Indonesia 28 Sep22.pptx

Why is it important to control rabies
Rabies situation in Indonesia
Rabies control in Indonesia
IBCM and SIZE
DPM and rabies cadre

1. One Health Rabies Control Programme in Indonesia: A Lesson Learnt Directorate of Animal Health Directorate General of Livestock and Animal Health Services Ministry of Agriculture – Republic of Indonesia

2. Presentation outline Why is it important to control rabies? Rabies situation in Indonesia Rabies control in Indonesia IBCM and SIZE: A one health approach to control rabies DPM and rabies cadre empowerment Conclusion

3. Why is it important to control rabies? Rabies has a significant impact on lives and livelihoods in developing countries Rabies has the greatest impact on poor and marginalized communities Rabies is 99% fatal, but 100% vaccine preventable 4 of deaths of rabies are in children Rabies has a massive economic impact of USD 8.6 billion annually, with livestock losses accounting for 6% of it Rabies is a model disease for One Health approach

4. Rabies situation in Indonesia The average annual human death is 136 cases The average annual rabies cases in animals is around 1,200 First reported rabies case in animal (horse) in Jakarta (1884) First human case recorded in 1894 26 out of 34 provinces in Indonesia are rabies endemic areas

5. Rabies control in Indonesia Developed national rabies elimination guidelines Developed One Health rabies control roadmap Implemented rabies control strategies: Mass dog vaccination (MDV) Trial of oral rabies vaccine (ORV) Integrated bite case management (IBCM) Zoonosis and EIDs information system (SIZE) Dog population management (DPM) Rabies cadre empowerment Public awareness

6. IBCM: One Health approach to control rabies IBCM was first established in Bali in 2011 IBCM is a One Health protocol Enhance networking among different sectors (animal-wildlife health and public health) in managing and responding to bite cases IBCM improved : Response to bite cases Coordination and communication between sectors Sample submission to animal health laboratories Human case management (efficiency in the use of rabies post-exposure prophylaxis/PEP) Surveillance activities

7. IBCM: Next development 2016-19 : development of IBCM for three sectors – wildlife implemented in four pilots IBCM is used as a model for One Health control measures for other zoonoses : anthrax, leptospirosis, avian influenza, and EIDs

8. SIZE: One Health platform for information sharing on zoonoses and EIDs SIZE is a national health surveillance information system linked information systems from three different sectors (public health, animal health and wildlife/environment) SIZE aims to support early detection, reporting, and response as well as coordination from field level to policy decision-makers Reliable health surveillance is the basis of an effective infectious disease prevention and control program, particularly in relation to early disease detection, reporting, and rapid disease response Animal Health Public Health Wildlife Health

9. IBCM: Added value to cooperation between animal and human health Increase in efficiency through cost-savings Prior to the implementation of IBCM in Bali, an average of over 2,500 cases (nearly 90% of all reported bite cases) were considered high-risk bites requiring PEP administration.​ Following the IBCM training in 2011, the percentage of high-risk cases dropped to around 85%, with an average of over 3,100 high-risk bites.​ Officers’ capacity improved further following IBCM refresher training in 2016, with the percentage of high-risk bite cases falling to less than 55%, or an average of 1,300 bites per month.

10. IBCM: Added value to cooperation between animal and human health Benefit human health by combating disease in animal populations Prior to the implementation of IBCM in Bali in 2011, there were an average of 2.22 deaths per 1,000 reported cases of rabies-transmitting animal bites.​ Following the first IBCM training , the average incidence of human death from rabies  dropped to 0.23 cases per 1,000 bites.​ The average incidence of rabies deaths  decreased further after the IBCM refresher training, with only 0.07 cases of death occurring every 1,000 bites . ​

11. IBCM: Added value to cooperation between animal and human health Increase economic efficiency through the expansion of intervention programmes across sectors Economic efficiency can be seen from the results of the evaluation of cross-sectoral cooperation implementation in North Sulawesi province​ The program generates a benefit-cost ratio (BCR) between  6.56 and 14.35 , which means that for every dollar invested, the program can generate benefits worth USD 6.56-14.35. ​

12. What next? Community involvement through DPM and cadre empowerment DPM was piloted focusing on community empowerment as a cadre to educate communities and backed up by traditional law enforcement It promotes responsible dog ownership, increases public awareness of rabies risk to the community as well as increases dog vaccination coverage In recent years, the Government have involved community as zoonoses cadres to support zoonoses response and control, particularly rabies

13. Conclusion G20 leaders are committed to preventing a pandemic where emerging risks often originated from the human-animal-environment interface One Health cannot be implemented effectively without strengthening animal health systems around the world Three main issues in the G20 – Indonesia Global health architecture Digital transformation Use of renewable energy

14. Thank you Dr. Nuryani Zainuddin , DVM, MSi [email protected]