Rabies Bali 2008-2020_WRD Webinar_WSAVA 2020_Final.pptx

A decade of rabies control programmes in Bali with support from FAO ECTAD Indonesia with Mass Dog Vaccination, Integrated Bite Case Management, Dog Population Management, and Risk Communication as the backbone of the programmes

1. FAO ECTAD Indonesia Bali rabies elimination program

2. March 2019 A decade of Rabies in Bali Lessons for rabies control and elimination FAO ECTAD Indonesia

3. Rabies in Bali 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

4. 2010 2012 2008 2009 2015 2017 How rabies emerged and evolved within a decade after introduction in Bali…

5. Control Strategies Mass dog vaccination (MDV) Integrated bite case management (IBCM) Rapid response Dog population management (DPM) Public awareness

6. Mass dog vaccination (MDV) Annual MDV across the island has been implemented by local government with the support from central government and FAO since 2011 (aiming for 70% vaccination coverage of the 500,000 Bali dog population) Additional strategies to increase coverage: Sweeping vaccination: puppies and roaming dogs Emergency vaccination: as a response to rabies cases Pilot vaccination in Gianyar R2 R3 R4 R5 R6 R7 R8 R9 R10 Island-wide Vaccination R1

7. A-Teams 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 The A-teams work in addition to center point and house to house vaccination during the MDV campaign Vaccinated dogs are marked by red collars

8. IBCM was first established in Bali in 2011 which then re-introduced in 2016 following the surge in cases in 2015 IBCM is a protocol to enhance networking among different sectors (animal health and public health) and promote coordination of rabies control activities IBCM  became a One Health network between animal and public health sectors in managing and responding to bite cases Integrated Bite Case Management (IBCM)

9. Advantages of IBCM Improved coordination and communication in the field level Increased response to bite cases Increased sample submission to animal health laboratory Improved human case management Improved surveillance activities of suspect rabid animals

10. Dog population management (DPM) DPM program was piloted in several villages in Bali 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

11. Dog population management activities in Bali

12. Public Awareness : Elementary students   Communities  Culture and Religion Group

13. Private Veterinary Practitioners involvement Veterinary practitioners under the Indonesian Veterinary Medicine Association (IVMA) have also been involved in the rabies program in Bali Puppies vaccination (sweeping vaccination) Dogs sterilization (DPM) Public Awareness

14. Control Strategies Lessons Learned + Annual MDV campaign + High quality vaccines (high efficacious/ long lasting immunity) + Sweeping Vaccination for puppies and roaming dogs in between MDV campaigns + Emergency vaccination + IBCM protocol + DPM + Rabies public awareness   + Dogs culling   Lessons learned Not fast enough or wide enough I t is not a control strategy but it actually happens

15. Dogs culling (not official part of the strategy) Roaming dogs culling in the first outbreak (2008) failed to stop the spread of rabies throughout the island Dog culling was reduced in 2011 and 2012, but never completely stopped: to respond human and animal cases; in the area with large dog population Culling frequently resulted in backlash of support from the community, especially if  inhumane methods were used Culling is ineffective method which resulted in reduced vaccination coverage and herd immunity Lessons learned… **image source: youtube account of Bali’s community *image source: nusabali.com

16. Conclusions 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

17. Conclusions 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. Culling dogs is not recommended – ineffective for rabies control and undermines the development of a longer-term solutions - vaccination and other control strategies

18. Options to enhance rabies control in the future 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

19. Thank you..