Rabies prevention and control

1. Rabies Prevention and Control Measures Abraham Ali (DVM, MPH) Ethiopian Public Health Institute

2. 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

3. 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.

4. 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.

5. Introduction(2) Generally, diseases can be controlled and prevented by adequate measures which involve: Diagnosis Notification Isolation Treatment Quarantine 6. Investigation 7. Disinfection 8. Blocking of transmission 9. Immunization 10. Health education.

6. Rabies Prevention and control It has two components: Animal Rabies Control Primary Prevention measures Measures used to prevent the disease at the source Human Rabies Prevention Secondary Prevention Measures

7. Elements of Animal Rabies Control Rabies control strategies include : Mass vaccination of dogs Movement restriction/Confinement Control of ‘stray’ dogs

8. 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

9. 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

10. 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)

11. 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)

12. 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

13. Post-exposure prophylaxis Post-exposure prophylaxis consists of : Local treatment of the wound as soon as possible after exposure, Exposure assessment and administration of potent, effective anti rabies vaccine that meets WHO recommendations and/or Administration of rabies immunoglobulin , if indicated

14. 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,

15. 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

16. 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.

17. Vaccines for post-exposure prophylaxis Nervous Tissue vaccine 17 Injections Administered around the umbilicus SC Cell culture Based Vaccines 5 Injections Administered intramuscularly

18. 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 .

19. 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

20. 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

21. Thank You