OIE Global conference - PowerPoint Presentation

OIE Global conference on Rabies control Assuring quality and sustainability of rabies dog vaccination programme: vaccination – rabies surveillance post vaccination monitoring   7 - 9 September 2011 Incheon-Seoul, Korea Florence Cliquet – Jacques Barrat European Union Reference Laboratory for Rabies Nancy Laboratory for Rabies and Wildlife WHO Collaborating Centre for Research and Managementin Zoonoses Control OIE Reference Laboratoryfor Rabies European Union Reference Institute for Rabies Serology

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).

Main prerequisites for dog rabies control programmes: an integrated approach National network gathering one body of each involved sector – Identification of one body responsible of the programme. Legal basis and long time budget allocation Strategy of control – planning Ensuring coordination between all actors: Precise identification of each step of the programme: who is responsible of what and when. Dog demography information (both owned and stray) and dog ecologyEnsuring availability of biological productsEducation of the public (in bite prevention & rabies awareness) – Strong media support Trained diagnostic laboratoryActive surveillance networkEvaluation of control programme

International available guidelines WHO Expert Consultation on Rabies, WHO Geneva, WHO Technical Report Series, 2005, n°931, 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.

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 insurance Rabies should be a notifiable disease both for humans and animals National laws as well as regional legislation and decisions, depending upon country administrative organization

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.

Intersectoral coordination Defining main responsibilities at national, regional and local level Veterinary authority Human health authority Education authority Interior affairs authority Propose and write a strategy Calculate a budget Propose and write a strategy Calculate a budget Provide information for school: books, videos, movies, posters… Organize garbage elimination (containers) Acquire inactivated rabies vaccines for dogs Acquire inactivated rabies vaccines for humans and immunoglobulins Remove stray dogs, ABC programme 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 Collaborate with local authorities, animal welfare NGOs, private veterinarians… Educate responsible ownership Education of general public

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 placesTeams involved and training for “vaccinators” and dog “catchers” Material used (syringes, needles, lassos…)Model of grids to completePeriod of time and frequency of vaccination campaignsPractical organization in the fields

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

Categorization of dogs (who, 2007 ) None Semi Full None Semi Full Dependency Restriction Feral dogs Neibourhood or community dogs Family dogs Restricted or supervised dogs 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)

Vaccination against rabies with injectable vaccines induces a humoral response with the production of rabies neutralising antibodies. In cats and dogs, the peak of rabies neutralising antibodies is generally reached between 4 to 6 weeks after first antigenic stimulation. Immunological response to vaccination Level of antibodies Time after vaccination Latency Exponential increasing Decreasing Plateau Vaccination

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 (serological survey and challenge study). Rabies vaccines for dogs: Injectable vaccines

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 owner’s participation Requires engagement of local authorities and public awarenessVaccination of dogs against rabies and possibly other diseases Possible identification of dogs (plastic collars or coloured tags)Possible dog vaccination card/certificate

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 House to house parenteral vaccination VET LAB

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

100% Immunization coverage : - Oral vaccination combined or not with PV - Parenteral vaccinationProportion of restricted dogs (accessible and not)80% 50% Potential of Oral versus Parenteral vaccinationaccording to dog population structure YEM 60 --- 80 20 --- 40 20 TUN 65 --- 75 20 TUR 45 40 --- 50 Dog population (segments in %) ownerless owned & unaccessible owned & accessible Oral vaccination of dogs Slide kindly given by Dr. F.X.Meslin

Oral vaccination of dogs 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

Schematic representation of vaccination areas General organisation of vaccination campaigns All teams vaccinated correctly dogs except for team 4. Team 4 had not a methodical organization of vaccination. Result: too large areas insufficiently vaccinated. TEAM 4 Team 2 Team 3 Team 8 Team 5 Team 7 Team 6 Team 1 Caption : Contamination between areas because of one deficient team Rabid dog

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)

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 Virus typing: Mabs or molecular methods

Citizens, NGOs, associations, founding an animal cadaver or a suspect live animal Example of rabies surveillance network Such network must have a legal basis (legislation article) Sending of results Sending of samples Caption National reference Laboratory for rabies EFSA, WHO / OIE ( Rabnet and WAHID* database) National competent authority for animal health National competent authority for human health National rabies database (all diagnosis negative and positive results from both animals and humans) *http://web.oie.int/wahis/public.php?page=home Veterinary services Veterinarians Regional Lab

Evaluation of control programme Ultimate indicator of the success of vaccination programme: decrease in rabies incidence in vaccinated areas both in humans and animals Animal bite injury from hospitals The strategy must be rapidly changed or adapted in case rabies incidence remains unchanged despite vaccination. The main reason is generally an insufficient vaccination coverage. It is therefore advised, if budgets are limited, to analyse the entire programme for improvement and possibly to decrease the surface of the area of vaccination

Reported and estimated vaccination coverages in domestic dog populations from various settings in sub-Saharan Africa since 1990 Region Country Dates Vaccines delivered Dog population Estimated coverage (%)N’djamena Chad 2011 23,560 19.00 Machakos Kenya 1992 24.00 National Kenya 2003 33.00 Mzuzu Malawi 1996-2000 7823 44,932 12.1-20.2 National Mozambique 1997-2000 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)Nigeria2007<15.6NationalSudan1992-200237,62071,5405.26Khartoum stateSudan20002,94691,0003.24 NationalSwaziland1994-199857,20463.2-91.7 (dropped to 3% in 1998)NationalTanzania199211,635<1NationalUganda2001-200316.00NationalZimbabwe2002314,3191,300,00013.93From Lembo et al., 2010

Vaccinated dogs (Millions) Rabies cases in dogs Cases of rabies in dogs and number of vaccinated dogs in Mexico 1990-2004 Slide kindly given by Dr. F.X.Meslin

A dog without antibodies at Day x may be protected if seroconversion was achieved before Day x. Vaccinated domestic carnivore Vaccinated domesticcarnivore then in contact with a rabid animalDomestic carnivorein contact with a rabidanimal then vaccinated Production of rabies neutralising antibodiesAround 30 days Variation in duration of the incubation period Serological survey following vaccinationtion Performed on a defined number of dogs Blood sampling at D0 and D30 on each dog to be tested Analysis using FAVN test or RFFIT (threshold 0.5IU/ml)

Serological follow up of dogs vaccinated with a local cell culture inactivated and adjuvanted vaccine (Unpublished Anses data – serological survey done in Morocco) Day 30Day 0

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.Importance of GARC, PRP and Rabies Elimination Demonstration projects.

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