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EPIDEMIOLOGY OF AND IN NEPAL

Joshi DD, Heron BR

Introduction: Nepal contains five development regions, 75 districts, 58 municipalities and 4,200 Village Development Committees. The human population is about 20 million (CBS,1994). There are approximately 6.3 million cattle, 3.7 million buffaloes, and 10.5 million sheep and goats in Nepal. Human rabies deaths reported in the city of Kathmandu range from 15 to 20 every year. One hundred and twenty to 200 deaths occurred each year during 1991 to 1996 in Nepal. The animal reservoirs for Rabies are the , cat, jackal, monkey, and rodents. About 94% of the animal bites humans suffer are from (both and stray dogs). The total population of dogs in Nepal is 1,849,110. Echinococcosis was first investigated in Nepal (Joshi, 1973) when cysts were found in buffalo, goats, sheep and pigs killed in Kathmandu. A later, preliminary study of echinococcosis in Kathmandu (Joshi, 1984) indicated that there had been 47 human cases of echinococcosis amongst the 30,792 operations performed in the city's three hospitals between 1985 and 1990. Of these 47 patients, 26 were male and 21 female and most had cysts in the liver (55%) or lungs (43%). Five per cent (153/3065) of the water buffalo, 3% (55/1783) of goat, 8% (12/150) of sheep and 7% (10/143) of the pig carcasses examined in 77 small abattoirs in Kathmandu between May and September 1991 also carried hydatid cysts (Joshi, 1985a). Thirty (10%) of 291 canine stools collected in the vicinity of the abattoirs and examined by stool concentration methods were found positive for Echinococcus eggs. Adult E. granulosus parasites were also recorded. Materials and Methods: An epidemiological survey was carried out during 1998 and 1999 in 18 districts declared endemic for rabies and echinococcosis after the completion of first preliminary study during the years 1991_1996. The study team collected information on human and animal morbidity and mortality on rabies from medical as well as veterinary hospitals of the endemic districts. The team collected hydatid case records the last 5 years. The team collected hydatid cysts from buffaloes, sheep, goats and pigs in slaughtering areas and meat markets. Secondary information were also collected, tabulated and analyzed. Results : Rabies: a ) In humans: The age, sex and area distribution of post exposure rabies treatment human cases treated in various hospitals during the year 2055 BS (1998/99) were investigated. Out of a total of 9776 of such cases admitted to various hospitals of the country during the year 2055 BS, the most, 2296, (23.49%) were admitted to Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu, (also known as Teku Hospital), followed by Narayani (13.36%), Bheri (13.14%), Koshi (11.28%) and Janakpur (9.13%) zonal hospital. Mahakali, Lumbini and Mechi hospitals received around 7% of the total, while only 4.25% cases were recorded in Sagarmatha Zonal Hospital. Of the 9776 cases males <15 yrs, accounted for 3130

Proceedings of the 9th International Symposium on Veterinary Epidemiology and Economics, 2000 Available at www.sciquest.org.nz cases (32.0%); females <15 yrs (11.9%); adult males 3857 (39.5%); and adult females 1622 (16.6%). b) In animals: A significant decline in the use of antirabies vaccine (20% ARV) was found during the past three years in the study area. Only 8710 doses of ARV were given for prophylaxis during that time. Current vaccine requires boosting ever 6 months. Dog population and control: Current situation: Street dog control is by an annual programme of strychnine poisoning. This is inappropriate because:1) There is considerable community resentment; 2.) it is indiscriminate _ community dogs and pet dogs may be killed by accident; 3) it is potentially dangerous to humans and livestock; 4) it is inhumane; 5) mass slaughter programmes have been shown to be ineffective in controlling the population. The latter is reflected by the available food source. Currently registration is administered by the kennel club. It appears ineffective and is not linked to compulsory rabies vaccination. Pet owners can purchase vaccines directly from a pharmacy and take them to a veterinarian without the assurance that the vaccine has been stored properly. There is generally an increased frequency of vaccination in response to an outbreak rather than as a general prophylactic measure. Dog Population Control - Background to the recommendations: 1) the dog population in Kathmandu can broadly be divided into three groups: owned pet dogs; community dogs; street dogs; 2) the street dog population is maintained by: breeding within the group; excess breeding of community dogs leading to migration; abandonment of pet dogs; availability of food sources; 3) the recommendations take into account the practical and financial challenges. It is proposed to approach the problem in 3 phases, each addressing the different groups of dogs as described above. Specific recommendations: Dogs not identified properly must be considered as street dogs by the municipality and treated appropriately.

Phase 1: Registration and compulsory vaccination of 1. Form a working group with representatives of all the key ministries and NGOs. to ensure future communication. 2. Review the current, relevant legislation in Nepal. 3. Decide which authority (ministry) will maintain the Register. 4. Decide on which veterinary groups will be licensed to administer the vaccine and sign the Registration documents. 5. Decide on the certificate format and information to be recorded. 6. Decide on information transferrence and central database maintenance. 7. Decide methods of identification, and contained coding, information. 8. Cost of vaccination / registration of pet dogs should be self_financing. 9. Rabies vaccination and registration only at authorised centres. 10. Advise pet owners on responsible pet ownership: worming; fleas and mange treatment; neutering. 11. Timescale - once the infrastructure is agreed upon and in place, a public education campaign is necessary before implementation.

Phase 2 - The community dogs 1. Once registration and neutering of pet dogs is widespread, the community leaders will be fully briefed as to the details of phase 2. 2. Investigation to determine the number of dogs in this category.

Proceedings of the 9th International Symposium on Veterinary Epidemiology and Economics, 2000 Available at www.sciquest.org.nz 3. Seek public attitude toward: supplemented / free registration of community dogs as a separate category with identifification; free rabies vaccination and future birth control measures. 4. Medium term _ introduce specialised registration and free annual vaccination for community dogs 5. Long term - introduce neuter and release programmes to stabilise community dog population.

Phase 3: The street dogs 1. Immediate action to reduce the availability of food for street dogs: improved rubbish collection, hygiene in slaughter areas and food markets 2. Institute proper methods for the disposal of dead dogs 3. Investigate more humane methods of euthanasia. 4. Although the long_term aim is to avoid the killing of dogs, this is not practical in the short term due to pressure on the Municipality. Indeed, if the food source can be significantly reduced, a targeted killing policy could help reduce the population to a lower level that would re_stabilise to the lower food supply. 5. Long term - consider a vaccination / neuter / release programme to control this reduced street dog population.

Echinococosis: Human Serum Tests: Of 831 sera, collected from blood banks, a community study and hospitals, tested in Nepal using a commercial ELISA (LMD Labs, Carlsbad, CA) and an automated reader and retested by the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA, 115 (14%) were ELISA positive with an optical density (O.D.) greater than 0.5. Slaughtered Animal Examination: Regular slaughtered animal examination was done for the period of two years in the eight municipalities of the country with the collaboration of Danish Meat Trade College Denmark. The cysts were observed, involved organs were examined.

Discussion and Conclusion: Rabies poses a considerable health threat to humans and animals in Nepal. Transmission is mainly via bites from infected dogs. This proposal is to reduce the incidence of rabies through regular prophylactic vaccination, improve vaccine production and quality, improve rabies diagnostic infrastructure, an efficient epidemiological surveillance scheme and the control of the dog population by humane methods. It is further recognised that the success of the recommended actions relies on the cooperation of many ministries and the education of the population. Echinococcosis: The present survey identified the requirements for slaughter/abattoir facilities in Nepal. Based upon the findings the main conclusions and recommendations are (Joshi et al., 1995ab): pass the National Meat Act as soon as possible; establish slaughterhouses in all municipalities and a biogas plant adjacent to each slaughterhouse; implement training and education programs for construction maintenance and waste treatment; implement a training programs for supervisors, veterinarians, public health authorities, butchers and meat sellers; establish a national coordination committee; plan a course for selected veterinarians and medical officers that would take place in the Veterinary Dept. of the Danish Meat Trade College in Roskilde, Denmark.

References: Twenty-one references available upon request.

Proceedings of the 9th International Symposium on Veterinary Epidemiology and Economics, 2000 Available at www.sciquest.org.nz