Caribvet Steering Committee

Rabies Situation in the Caribbean Region and the national plan for

Antigua, April 2th 2008 Definition

Rabies is a viral transmitted in the saliva of infected . The virus enters the of the host, causing an encephalo- that is always fatal. Vector of rabies In this region, rabies is transmitted by : ™ (more eighty percent human rabies is transmitted by /Haiti ) ™ ™Raccoon dog ™Bats ™Mongoose (Herpestes auropunctatus) (human cases particularly in Cuba) (introduced from South Asia to most Caribbean Island in the second half of the 19th century for rodent and snipe control) Categorization of the dog population

The dog population can be categorized into three groups: - Owned dogs - Community dogs (living in public area and fed by the population) which can be reached by control measures under certain conditions. - Ownerless dogs stays which usually escape control program Rabies Notified Human cases /American Countries (1998-2007)

z Most patients who died from rabies are either not treated or do not receive timely and appropriate post Cases exposure treatment.

Year

Cases Centro Panamericano de Fiebre Aftosa Rabies in dog by subregión ( Central América, caribe latin y cono sur). América Latina, 1998 - 2007 z Rabies control in dogs remains the only long-term, cost- effective means of eliminating or preventing most human cases. Human public health preventive measures should be paralleled by programmes for dog rabies control. Rabies situation in Haiti Rabies situation in Haiti/Human

Year Animal bite Human Rabies

2002 804 5

2003 848 1

2004 984 4

2005 1263 1

2006 1151 11

2007 400 5

TOTAL 5530 27 Outbreak rabies in Haïti

• No reliable data to determine with precision the importance of rabies in Haiti. Although the number of human rabies is very high, there is a big problem of subnotification of animal and human cases of rabies

• Some zones of the country are considered however like zones at risks . Principaux foyers de rabies en Haïti Distribution of the rabies outbreaks in Haïti

Capotille

PHANORD Siméon, Ing Agr, Msc / September 2007 susceptible Species Species of mammals warm‐blooded. z Domestic species having contracted rabies in Haiti : dog, , z Goat, pig, rabbit and horse z Rabies has been detected in bats z The dog is the main vector‐reservoir of the Caribbean countries Vaccination campaign Result of the vaccination campaign in 2007

DDA Chiens Chats Total Nombre de bénéficiaires Port au prince 56839 53310 110149 79459 Nord 8393 3678 12071 9313 Nord Est 6377 3195 9572 6322 Nord Ouest 4829 1871 6700 3681 Haut ATB 31572 14339 45911 23776 Bas ATB 6451 4238 10689 6612 Haut Plateau 9204 2100 11304 6164 Bas Plateau 3789 1377 5166 4073 Leogane 2074 1044 3118 2897 Sud Est Jac 10624 4347 14971 10272 Sud Est Thiotte 2477 992 3469 1558 Nippes 4283 1099 5382 3582 Sud 4733 998 5731 4351 Côte Sud 1166 575 1741 1261 Jérémie 1209 924 2133 1834 Total 154020 94087 248107 165 155 We are realizing the campaign during the year 2008, more than 200 000 dogs and cats are already vaccinated National Plan for rabies in Haiti General situation z Unfortunately, Haiti is the country of the Caribbean to record the biggest number of human cases of mortality caused by rabies( 11 cases out of 29 [year 2006]) . z Since 2006,a big effort to face the canine rabies is done with the cooperation of WHO, Government of Brazil, USDA/APHIS/IICA. z In December 2007, we had a three days meeting to validate the national rabies plan that has been prepared by a local technical team. Different countries and institutions are taken part at this meeting. There are Dominican Republic, Cuba, Brazil, Canada, CIRAD, technical staff of WHO from Washington, Health Ministry,etc. General objective of this plan

z To reduce as much as possible the prevalence and the impact of the canine and feline rabies into the country. z Eliminate the human cases of mortality during the next ten years. Specific objectives z Vaccinate 500,000 dogs and cats against rabies per year during the first two years and 600.000 to 700.000 during the seven consecutive years of the program ; z Realize in routine into the veterinary Laboratory the main techniques of rabies diagnosis recommended by the World organization of the Animal Health (OIE). Specific objectives z Inform and motivate the population about the methods of prevention and control the rabies ; z Establish an efficient system of alert and notification of suspected cases of the rabies monthly during the first three years and weekly during the seven other years of the Program. z Assure a better treatment of people bitten by rabies suspected animal. z Contribute to training of the veterinary professionals and public health specialists on rabies. ORGANIZATION AND MANAGEMENT OF THE PROGRAM Structure of framing and orientation

z Establishment of an interdepartmental Commission for the global coordination of the rabies prevention and national control program . z Creation of a Steering committee of this program : Agriculture, Public Health, Interior, Environment, Ministry Economy and of Finance as well as of the members of the international organizations as OPS/OMS, FAO, IICA, APHIS/USDA, USAID, etc. Structure of framing and orientation

z The project will be managed by the Direction of Animal Health of the MARNDR in cooperation with the Direction of the Public Health or all other technical Directions in charge of the . It will be executed by the ministry of Agriculture jointly to the other ministry concerned by the problem, the NGOs and the private institutions. To the central level a) A national Direction that must coordinate the set of the activities that will be achieved on the camp. b) The supervision and control unit c) The technical components • Information/motivation/training •Epidemiological surveillance •Vaccination Structure of framing and orientation a) a departmental coordination of the Program b) a mixed committee that will be constituted by the representative : • the Agricultural Departmental Direction • the Departmental Direction of Public Health • the representatives of the other ministries being part of the interdepartmental Commission; • the private Institutions concerned by the struggle against the rabies ; • the institutions of agricultural teaching • the NGO • The representatives of Animal Health Group (GSB); • the private veterinarians. d) - The communal coordinators e) -The representatives of rural section Legal Frame

Actualization of the legislation on rabies to facilitate the application of the sanitary measures for the control or the eradication of the disease. STRATEGY The vaccination includes two (2) big phases: - Information and motivation of the population • Press Campaign • Spots of information to the radio and Tv • Flyers and posters • Interpersonal Communication

-Organization of the field vaccination operations

• Selection and training of the vaccinator agents • Organization of the cold chain • Organization of the vaccination posts • Administration of the vaccine • Identification of the Vaccinated animals by a necklace • Supervision Activities z Epidemiosurveillance • Collection of data -Survey about the dynamics of the populations canine and feline in Haiti. -Distribution of epidemiological surveillance forms to the veterinary professionals, to the agents of health, to the officers and sanitary inspectors to notify the cases of morbidity and mortality of the animals suspected of rabies. Collection of samples

z Head or whole cadaver of every dead animal suspected of rabies must be sent to the veterinary Laboratory for the official test. z Dogs suspected of rabies or having attacked people must be captured and placed under observation. z Control of the ownerless dogs Laboratory Analysis

z The main tests of diagnosis will be the direct immunofluorescence and the mouse inoculation. z The results will be compiled, treated and sent to the individuals and institutions concerned for this disease. PERFORMANCE INDICATORS

z Average number of heads of animals vaccinated by brigade per day z On the basis of the existing deals, the average number of heads to vaccinate by brigade is 125 per day of work. z Rate of the vaccines lost z Quantity of lost doses due to bad use,( rupture of the cold chain or a bad conservation). z Number of suspected cases of animal and human rabies notified per month z Number of human rabies cases notified per year Recommendation for further regional study and activities z Promote dog rabies control and elimination z Reinforce rabies surveillance z Apply appropriated methods and strategies for dog population management Conclusion

™Study the prevalence of this disease in the Caribbean Region ™Setting up of a strong animation unit ™Inclusion of rabies in the data base national ™Development of performance indicators ™Formalization of a surveillance protocol Thank you