Transcript No Slide Title

Rabies Surveillance
Dr Suresh Gupta
Consultant
Pediatric Emergency Medicine
Sir Ganga Ram Hospital, New Delhi
WHO Recommended
Surveillance Standards
for
Rabies
Rationale for Surveillance
WHO promotes
• Human rabies prevention though PET
• Disease Elimination through vaccination of
dogs and other animal reservoirs
Surveillance is essential for
• Detection of high risk areas
• Detection of outbreaks quickly
• Monitor use of vaccine
Recommended Case Definition
Case Classification:(Based on Clinical Description
& Laboratory Criteria)
Human Rabies :
-Suspected
-Probable
-Confirmed
Human Exposure to rabies:
-Possibly Exposed
-Exposed
Recommended types of surveillance
• Surveillance in human population:
– Human exposure to rabies
– Human rabies case
– Outbreak investigations
• Surveillance in animal population
– Wild and Domestic species reservoirs
1.Presence/absence of rabies
2. Human rabies
a. Number of human deaths
b. Human deaths according to animal species source of exposure
c. People bitten by suspected dogs
3. Animal rabies
a. Total number of dog cases
b. Total number of other domestic animal cases
c. Total number of wild animal cases
d. Total number of bats cases
4. National rabies vaccine production and importation
a. Veterinary vaccine according to vaccine types
b. Human vaccine according to vaccine types
c. Human rabies immunoglobulin
5. Rabies vaccine administration
a. Dogs vaccination
b. Human vaccine application - Post-exposure treatment
c. Number of patients treated according to vaccination regimen
d. Number of persons receiving treatment according to animal species
source of exposure
Recommended minimum data
elements
• Human Rabies Exposure
– Case based data
– Aggregated data
• Surveillance of Deaths from Human
rabies
Recommended data analysis,
presentation and reports
• No of human rabies death and rabies cases in
animal(by species),by date of presentation
• Human exposure by location, date of animal
biting/scratch episode animal species, outcome
in human and animal populations
• Cases by geographical area and dates of
biting, type of animal, occupation and outcome
Principal uses of data for decision
making
• Detect outbreaks in endemic areas and new
cases in rabies free area
• Determine high risk areas for intervention
• Rationalize the use of vaccine and
immunoglobulins
• Evaluation of intervention for animal
reservoirs and exposed human population
Special Aspects
Intersectoral cooperation of medical and
veterinary services, community involvement
and participation required for targeted
response and control in animal reservoir.
Presence/Absence of rabies 2000
No information
Absence
Presence
Rabies trends in 2000
No information Rabies free
Stable
Decreasing Increasing
Geographical Distribution 2000
No information
Rabies free
Limited area
Border area
Most parts
Epidemiological pattern 2000
No information
Dog
Rabies free
Bat
Wild
Rabies situation and trend
• Human Rabies
35-50,000/Year
– Asia and Africa are the main
• Animal Rabies
– Africa 2344,USA 8509, Europe 5098, Asia ??
• General Trends
– Europe reporting decrease in rabies cases
– Animal rabies Dog 57%, Wild life 33%, Bat 10%
Rabies and Prevention
• Human PET
– Exposure to Dog- Africa 87%, Asia 97%, Europe 4%
– Vaccine alone Africa 82%, Asia 88%, Europe 80%
• Vaccine
– Human Vaccine: 76% vaccine on cell culture
– Animal Vaccine: 99% cell culture,
• Vaccine application in Dogs
– Compulsory in 13/25 African countries,3/10 American
countries, 18/33 European countries, 3/10 Asian
countries
Reported Human Rabies Cases in
India
Reported Human Rabies Cases in
India
Reported animal rabies cases in
India
Reported animal rabies cases in
India
Reported No of PET
Human and animal rabies vaccine
produced or imported
Not available at Rabnet
Rabies Vaccination for dogs and
other animal species
Not available at Rabnet
Current country information on
rabies in India at Rabnet
Last update of this informations : 1999-12-01
•
Region : Asia
Country : India
WHO Region : EURO
1) Presence of rabies and disease surveillance
•
Is rabies a notifiable disease?
•
Does a surveillance system exist?
•
Is it operational?
•
Does rabies occur in the country?
yes
•
Does rabies exist in the entire country?
If No, please specify infected areas.
2) Reservoir species
•
First rabies reservoir
Second rabies reservoir
•
not applicable
not applicable
•
Third rabies reservoir
Other reservoir
•
not applicable
3) Rabies vaccine used for human postexposure treatment
•
Primary cell line Diploid cell line
Continuous cell line
•
Treatment schedules not applicable
not applicable
•
Other Schedules
•
Is vaccine also applied intra-dermaly ?
Nervous tissue
not applicable
Contact address on rabies diagnosis, prevention
and control in human and animal in India
For questions on rabies prophylaxis and treatment in human please
contact or For questions on rabies diagnosis, surveillance and control in
animals please contact
Last name
First name
Title
Position
Institution
Department
Street
Quarter
POBox
City
Postal code
State
Phone1
Phone2
Fax
Email
Address
Epidemiology of Rabies#
• 30,000 Annual Deaths
• 10,00,000 PET annually
• 12 Govt.Institution (NTVs) for
Human
•
9 Govt. Institution Veterinary
NTVs,
• 1Pvt. Pharmas human TCV,
• 4 Pvt Pharmas veterinary TCVs.
• 15 Govt Inst. rabies diagnostic
facilities in animals and 5 for
testing post vaccination antibody
titers in humans.
# Association for prevention and control of rabies in India (APCRI)
Annual Report at NICD 1997
Post-mortem diagnosis in animal
18/40
in samples by Negri body FAT & BT
Diagnosis in hydrophobia cases by
• Corneal Smear
0/15
• Serum Antibodies
2/15
Assessment of antibodies by modified CIEP test
• Human
234/258
• Animal
l5/5
6 month incidence of animal bite cases in 4
selected urban communities*
City
Population Bites Incidence/1000
Banglore
88469
85
0.96
Calicut
79169
20
0.25
Coonoor
43577
70
1.61
Rajamundry 71358
117
1.64
Total 282573
292
1.03
*Source: Based on reports of National Institute of Communicable Diseases
No of animal bite case reported by Municipal
Medical Institutions in Delhi, 1995-1998*
Animal
Dog
Monkey
Cat
Horse
Buffalo
Unknown
Total
1995
23852
1093
170
4
1
59
25179
1996
26395
1313
141
15
0
96
27960
* Source: Municipal Health Officer, Delhi
1997
27345
1008
121
6
4
125
28609
1998
29905
1198
182
8
8
182
31483
Animal
Dog
Monkey
Buffalo
Cow-Ox
Cat
Rat
Jackal
Leon/Leopard
Horse-Mule
Mongoose
Pig
Goat
Sheep
Others
Unknown
Contact Cases
Total Case
5115
290
207
171
90
48
25
11
30
34
6
23
1
4
4
131
* Source:CRI, Kasauli, APRICON 2003
(Percentage)
(83%)
(05%)
(3.5%)
(03%)
(1.5%)
(.75%)
(0.5%)
(0.5%)
(0.5%)
(0.5%)
(02%)
Single animal biting many persons: Episodes
reported from India*
Year
1992
1995
1996
Animal
Dog
Wolf
Dog
Bitten
90
28
43
Died
0
8
8
* Source: Based on reports communicated to NICD
RIG
Yes
No
No
Classification of Animal bite cases
reported (1998-2002)*
Year
1998
1999
2000
2001
2002
Total
Class I
8
21
13
15
57(1%)
Class II
243
153
279
120
157
952(15%)
* Source:CRI, Kasauli, APRICON 2003
Class III
1384
1285
722
951
839
5181(84%)
Total
1627
1446
1022
1084
1011
6190
No of Hydrophobia cases admitted to IDH,
Delhi 1994-1999*
Year
1994
1995
1996
1997
1998
1999
No of Hydrophobia cases
224
210
151
222
215
241
*Source: Infectious Diseases Hospital, New Delhi
Rabies Cases Admitted to IDH 1998
Age
0-4
5-14
15+
Sex
Male
Female
Total
Number
13
85
117
Percentage
06.0%
39.5%
54.5%
168
47
215
78.1%
21.9%
100%
*Source: Jagvir Singh et al in Indian Pediatrics, Volume 38, 2001
Rabies Cases Admitted to IDH 1998
Antirabies Vaccination before hospitalization
Age
Number No. Received ARV
0-4
13
6
5-14
85
17
15+
117
25
Sex
Male
168
39
Female
47
9
Total
215
48
Percentage
46.2%
20.0%
20.0%
23.2%
19.1%
22.3%
*Source: Jagvir Singh et al in Indian Pediatrics, Volume 38, 2001
Rabies Cases Admitted to IDH 1998
PET received by these cases*
• Local wound care:
– Only 2 cases
• Vaccination:
– Unvaccinated
– Vaccinated
67/215
48/215
• 42 NTV( only 5 received>10doses)
• 6 TCV(all received < 3 doses)
• Immunoglobulins:
• Only 3 cases
• 1 case received (Wound care + NTV+ ERIG)
*Source: Jagvir Singh et al in Indian Pediatrics, Volume 38, 2001
Assessing Burden of Rabies in India*
•
•
•
•
•
•
•
1000+ million Population
24 million Dog Population
Dog:Man
1:12 to 1:40
Animal Bites: 2.1 million
90% due to dog ( 90% unvaccinated dog)
1.1 million PET (0.45 NTV and 0.65TCV)
No. of Rabies death 30,000/annually ????
* Source:APCRI, Newsletter Volume III, Issue 1 & 2, 2003
Assessing Burden of Rabies in India A
WHO-APCRI National Multi Centric
Survey Initiative 2003
This survey involves
•20 Medical Colleges,
•32 Veterinary College,
•10 million Human Population
•32 Veterinary Pathology Laboratories
What could be the answer for Rabies
Surveillance in India ?
Integrated Disease Surveillance ??