Rabbies - PPTX (Repaired)

OIE GLOBAL CONFERENCE
ON RABIES CONTROL
ASSURING QUALITY AND SUSTAINABILITY OF RABIES
DOG VACCINATION PROGRAMME:
VACCINATION RABIES SURVEILLANCE
POST VACCINATION MONITORING
Florence Cliquet Jacques Barrat
Nancy Laboratory
for Rabies and Wildlife
WHO Collaborating Centre

for Research and Management
in Zoonoses Control
OIE
Reference
Laboratory
for Rabies
European Union
Reference
Laboratory for
Rabies
European Union
Reference
Institute for
Rabies Serology
7 - 9 SEPTEMBER 2011
2011 - INCHEON-SEOUL,
KOREA
INCHEON-SEOUL,
KOREA
1 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION RABIES SURVEILLANCE - POST VACCINATION
MONITORING
KEY POINTS
Final objective of control measures: prevention
and elimination of the disease in Humans.
Mass vaccination of dogs is the most successful
method for control and possibly elimination of
dog mediated rabies (WHO, 2005).
The theoretical level of vaccination coverage
should be at least 70% (WHO, 2005) to lead to
an average
0 incidence in
both humans and animals.
Given the high turnover of many dog
populations, all dogs should be
vaccinated,
puppies (<3 months)
included (Cliquet et al, 2001).
2 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

MONITORING
MAIN PREREQUISITES FOR DOG RABIES

CONTROL PROGRAMMES:
AN INTEGRATED
1. National network APPROACH
gathering one body
of each involved sector

Identification of one body responsible of the programme.
2.
3.
4.
Legal basis and long time budget allocation
5.
Dog demography information (both owned

and stray) and dog ecology
6.
7.
Ensuring availability of biological products
Strategy of control planning

Ensuring coordination between all actors: Precise identification of
each step of the programme: who is responsible of what and when.
Education of the public (in bite prevention

& rabies awareness) Strong media support
8. Trained diagnostic laboratory

9. Active surveillance network
10. Evaluation of control programme
MONITORING
INTERNATIONAL AVAILABLE GUIDELINES

WHO Expert Consultation on Rabies,
WHO Geneva, WHO Technical
Report Series, 2005, n931, 87 p.
Rabies chapter (2.1.13) of OIE
Manual, 2011, oral vaccination
paragraph.
Oral vaccination of dogs against
rabies, WHO, Geneva 2007.
Stray dog population control,
Terrestrial Animal Health Code,
chapter 7.7, OIE 2011.
Blue print for rabies prevention and
control (rabiesblueprint.com).
and numerous reports of WHO
Expert consultations.

MONITORING
LEGAL BASIS AND BUDGET ALLOCATION
Rabies should be a notifiable disease

both for humans and animals
National laws as well as regional and
local legislation and decisions,
according to country administrative
organization
Technical and administrative
responsibilities
clarified
before the campaign
Costs calculated for each sector
involved and long term funding

MONITORING
NETWORK WITH ALL INVOLVED SECTORS

(ONE HEALTH CONCEPT)
National Rabies Control Committee, generally
chaired by representative of Agriculture Authority
and gathering representatives of :
Ministry of Agriculture, Ministry of Health, Ministry
of Education, Ministry of Interior Affairs, Ministry
of Environment, Head of Rabies National
(Reference) Laboratory, Animal Welfare
associations and NGOs, Veterinary services and
private veterinarians.
Objectives:
Information and exchange (regular meetings),
coordination of different activities for rabies
prevention and control, in case of rabies
outbreak or problem arising, decision taken after
collaborative discussion.
MONITORING
INTERSECTORAL COORDINATION
DEFINING MAIN RESPONSIBILITIES AT
NATIONAL,
Veterinary authority
Human health authority
Education authority
REGIONAL AND LOCAL LEVEL
Propose and write a strategy
Calculate a budget
Propose and write a strategy

Calculate a budget
Acquire inactivated rabies

vaccines for dogs
Acquire inactivated rabies

vaccines for humans and
immunoglobulins
Organize, implement and

monitor vaccination campaigns
of dogs
Register and identify dogs
Organize PEP to assess

availability of vaccines and if
all over the country
Declare and report to ad hoc

authorities all positive cases
Declaration and reporting to

ad hoc authorities all positive
cases
Organise surveillance of
suspect animals and evaluation
of the programme
Organize surveillance in
humans
Provide information for

school: books, videos, movies,
posters
Interior affairs
authority
Organize garbage
elimination
(containers)
Remove stray dogs,
ABC programme
Collaborate with local

authorities, animal welfare
NGOs, private veterinarians
Educate responsible
ownership
Education of general public

MONITORING
DEFINING THE STRATEGY OF CONTROL 1/2

Assessment of the current epidemiological situation
Knowledge of dog population ecology
Parenteral vaccination of dogs:
Person responsible of vaccination plan
Mass vaccination campaign? Hot spots? Limited
area? Oral vaccination? Dog identification?
Vaccine used and cold storage places
Teams involved and training for
vaccinators and dog catchers
Material used (syringes, needles,
lassos)
Model of grids to complete
Period of time and frequency of vaccination
campaigns
Practical organization in the fields
MONITORING
DEFINING THE STRATEGY OF CONTROL 2/2

Dog population management (if any
ABC programmes, garbage
management, )
Rabies surveillance:
Person responsible for surveillance
Practical organization in the fields
Model of grids to complete
Evaluation of the programme:
Person responsible for evaluation
Method used for evaluation and
frequency of evaluation

MONITORING
CATEGORIZATION OF DOGS (WHO, 2007)

None
Semi
Full
Restriction
None
Feral dogs
Semi
Full
Neibourhood
or community
dogs
Family
dogs
Restricted or
supervised
dogs
Dependency
10
Ecological survey (questionnaires) conducted prior to the strategy

elaboration to identify needs in management of dog population
and to determine the method of vaccination (interest of oral
vaccination in the campaign)
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
MONITORING
IMMUNOLOGICAL RESPONSE TO
VACCINATION
Vaccination against rabies with injectable vaccines
induces a humoral response with the production of
rabies neutralising antibodies.
Latency
Level
of
antibodies
Exponen
tial
increasi
ng
Plateau
Decreasing
Vaccination
Time after vaccination
In cats and dogs, the peak of rabies neutralising

antibodies is generally reached between 4 to 6
weeks after first antigenic stimulation.
MONITORING
RABIES VACCINES FOR DOGS: INJECTABLE

VACCINES
WHO and OIE recommendations
Cell culture produced
Inactivated
Adjuvanted
Possibly combined with other antigens
Potency : 1.0 IU/dose
Quality controls have to be performed to
guarantee:
Safety: control of the inactivation process
Stability: during long storage and under
liquid or lyophilized forms
Efficacy:
Potency test: NIH test or Pharmacopeia
test (Rabies vaccine (inactivated) for
veterinary use, 2008, 451).
Immunogenicity on 35 animals

MONITORING
CENTRAL POINT PARENTERAL VACCINATION
Intended for domestic dogs which have affiliations (family

or community dogs)
Considered as the most cost effective strategy (Kaare et al,
2009; Zingstag et al, 2009)
Requires owners participation
Requires engagement of local authorities and public
awareness
Vaccination of dogs against rabies and possibly other
diseases
Possible identification of dogs (plastic collars or coloured
tags)

MONITORING
HOUSE TO HOUSE PARENTERAL

VACCINATION
VET L
AB
Intended for domestic dogs which have affiliations but less

accessible (aggressive dogs and dispersed community dogs)
Requires:
detailed organizations (maps)
dog owners being present at home
engagement of local authorities and public awareness
Possible:
Vaccination of dogs against rabies and possibly other diseases
Possibly identification of dogs (plastic collars or colored tags)
Possibly dog vaccination card/certificate
MONITORING
ORAL VACCINATION OF DOGS

COMBINED TO PARENTERAL VACCINATION
The major obstacle in rabies control is the

accessibility to vaccination of inaccessible
owned and ownerless dogs
Since 1988, WHO has elaborated several
guidelines and recommendations (last ones in
2009) for encouraging the launching of
studies on oral vaccination in combination
with parenteral vaccination
Trials undertaken in East Europe, Asia and Africa
using commercial vaccine baits intended for
wildlife immunization

MONITORING

POTENTIAL OF ORAL VERSUS PARENTERAL
VACCINATION
ACCORDING TO DOG POPULATION STRUCTURE
100%
20
20
40 60
--- --80
50
80%
Immunization
coverage:
- Oral vaccination
combined
or not with PV
50%
- Parenteral
vaccination
65
---
20
45
75
ownerless
---
40
TUNTURYEM
Dog population
(segments in
%)
owned & unaccessible

owned & accessible
Proportion of restricted dogs

(accessible and not)
Slide kindly given by Dr. F.X.Meslin

MONITORING

COMBINED TO PARENTERAL VACCINATION
Commercial vaccine baits available
Considerations regarding:
Method of bait distribution (house to house,
central places, wildlife model)
Baits attractiveness in local conditions (pilot
studies)
Vaccine bait efficacy in local conditions
(pilot studies)
Safety requirements for candidate
vaccines
Assessment of vaccination efficacy :
dog vaccination coverage in the
field, monitoring rabies incidence

MONITORING
GENERAL ORGANISATION OF VACCINATION

CAMPAIGNS
Schematic representation of vaccination areas
Caption:
Contamination
between areas because
of one deficient team
Rabid dog
TEAM
1
TEAM
2
TEAM
3
TEAM
4
TEAM
5
TEAM
6
TEAM
7
TEAM
8
All teams vaccinated correctly dogs except for

team 4.
Team 4 had not a methodical organization of
vaccination. Result: too large areas
insufficiently vaccinated.

MONITORING
DOG POPULATION MANAGEMENT

Sanitary measures:
Culling (not recommended, not efficient and
humanely unaccepted): only limited to
suspected rabid dog or unvaccinated
contact dogs
Temporary removal (adoption programmes)
Waste management
Reproduction control:
Animal birth control programme
Sterilization or immunocontraception tools
(WHO, 2009)
MONITORING
EPIDEMIOLOGICAL SURVEILLANCE
Rabies surveillance is the basis for any control
and prevention programme
Surveillance based on laboratory investigation
on brain of dead or sick animals (not on killed
at random dogs)
No sample size Animals must be sampled
from all
parts of the country and all
along the year
Routine reference diagnostic test (WHO, 1996;
OIE, 2011):
Antigen detection (FAT): gold standard test
Virus isolation RTCIT / MIT if cell cultures
are not available
Viral genome detection
MONITORING
Virus typing: Mabs or molecular methods
EXAMPLE OF RABIES SURVEILLANCE

SUCH NETWORK MUST HAVE A LEGAL BASIS (LEGISLATION ARTICLE)
NETWORK
National competent authority for
animal health
National reference Laboratory for rabies
Regional Lab
EFSA, WHO /
OIE (Rabnet
and WAHID*
database)
*http://web.oie.int/wahi
s/public.php?page=home
National rabies database

(all diagnosis negative and
positive results from both
animals and humans)
Veterinarians
National competent authority for

human health
Caption
Veterinary services
Sending of results
Citizens, NGOs, associations,

founding an animal cadaver or
a suspect live animal
Sending of samples

MONITORING

MONITORING
REPORTED AND ESTIMATED VACCINATION

COVERAGES
IN DOMESTIC DOG POPULATIONS
Vaccines
Dog
Estimated coverage
Dates
FROMRegion
VARIOUSCountry
SETTINGS
IN delivered
SUB-SAHARAN
AFRICA
population
(%)
Ndjamena
Chad
2011
23,560
19.00
SINCE
1990
Machakos
Kenya
1992
24.00
National
Kenya
2003
33.00
Mzuzu
Malawi
19962000
7823
44,932
12.1-20.2
National
Mozambiqu
e
19972000
175,769
7,000,000
<1
Northern communal
land
Namibia
2001
115,000
12.00
Bomo State (urban)
Nigeria
2007
<46.00
Borno State (rural)
Nigeria
2007
<15.6
National
Sudan
19922002
37,620
71,540
Khartoum state
Sudan
2000
2,946
91,000
National
Swaziland
1994-
57,204
5.26
3.24
From Lembo
et al., 2010
63.2-91.7
(dropped to 3% in
1998
1998)
MONITORING
CASES OF RABIES IN DOGS AND NUMBER OF

VACCINATED DOGS IN MEXICO
Vaccinated dogs
(Millions)
1990-2004
Rabies cases
in dogs
Slide kindly given by Dr. F.X.Meslin

MONITORING
SEROLOGICAL SURVEY FOLLOWING

VACCINATIONTION
erformed on a defined number of dogs

lood sampling at D0 and D30 on each dog to be tested
nalysis using FAVN test or RFFIT (threshold 0.5IU/ml)
Vaccinated
Domestic carnivore
Vaccinated domestic
domestic carnivore in contact with a rabidcarnivore then in contac
animal then vaccinated with a rabid animal
Variation in
duration
of the incubation
period
Production of rabies neutralising antibodies
Around 30 days
A dog without antibodies at Day x may be protected if

seroconversion was achieved before Day x.
MONITORING
SEROLOGICAL FOLLOW UP OF DOGS

VACCINATED
WITH A LOCAL CELL CULTURE INACTIVATED
AND ADJUVANTED VACCINE
Day 30
Day 0
(Unpublished Anses data serological survey done in Morocco)

MONITORING
CONCLUSION
To be sustainable, rabies control programmes
based on vaccination of dogs should be
integrated in a multiannual project of rabies
elimination.
Mass dog vaccination programs using injectable
vaccines are successful for rabies control in
different places (e.g. Latin America, Bohol, Bali,
KwaZulu Natal, Sri Lanka).
Priority of government for rabies control is the main
prerequisite associated with long term funding
insurance.
Oral vaccination trials should be undertaken in
those areas where rabies control using injectable
vaccines is a success to increase the vaccination
coverage.

MONITORING
THANK YOU
FOR YOUR
ATTENT ON

MONITORING

Rabbies - PPTX (Repaired)

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OIE GLOBAL CONFERENCE

WHO Collaborating Centre

2 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

MAIN PREREQUISITES FOR DOG RABIES

of each involved sector

Legal basis and long time budget allocation

Dog demography information (both owned

Ensuring availability of biological products

Strategy of control planning

Education of the public (in bite prevention

8. Trained diagnostic laboratory

INTERNATIONAL AVAILABLE GUIDELINES

4 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

LEGAL BASIS AND BUDGET ALLOCATION

Rabies should be a notifiable disease

5 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

NETWORK WITH ALL INVOLVED SECTORS

Propose and write a strategy

Acquire inactivated rabies

Acquire inactivated rabies

Organize, implement and

Organize PEP to assess

Declare and report to ad hoc

Declaration and reporting to

Provide information for

Collaborate with local

Education of general public

7 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

DEFINING THE STRATEGY OF CONTROL 1/2

DEFINING THE STRATEGY OF CONTROL 2/2

9 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

CATEGORIZATION OF DOGS (WHO, 2007)

Ecological survey (questionnaires) conducted prior to the strategy

Time after vaccination

In cats and dogs, the peak of rabies neutralising

RABIES VACCINES FOR DOGS: INJECTABLE

12 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

CENTRAL POINT PARENTERAL VACCINATION

Intended for domestic dogs which have affiliations (family

13 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

HOUSE TO HOUSE PARENTERAL

Intended for domestic dogs which have affiliations but less

ORAL VACCINATION OF DOGS

The major obstacle in rabies control is the

15 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

ORAL VACCINATION OF DOGS

owned & unaccessible

Proportion of restricted dogs

Slide kindly given by Dr. F.X.Meslin

16 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

ORAL VACCINATION OF DOGS

17 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

GENERAL ORGANISATION OF VACCINATION

All teams vaccinated correctly dogs except for

18 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

DOG POPULATION MANAGEMENT

Virus typing: Mabs or molecular methods

EXAMPLE OF RABIES SURVEILLANCE

National reference Laboratory for rabies

National rabies database

National competent authority for

Citizens, NGOs, associations,

21 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA