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
7 - 9 SEPTEMBER 2011
1
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - IINCHEON
NCHEON-SEOUL
KOREA, KOREA
-S,EOUL
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES SURVEILLANCE - POST
VACCINATION MONITORING
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).
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OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING
MAIN PREREQUISITES FOR DOG RABIES CONTROL PROGRAMMES:
AN INTEGRATED APPROACH
1.
National network 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
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OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING
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.
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OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION 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 insurance
5
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION 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.
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OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING
INTERSECTORAL COORDINATION
DEFINING MAIN RESPONSIBILITIES AT NATIONAL,
REGIONAL AND LOCAL LEVEL
Veterinary authority
Human health authority
• 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
Education authority
• Provide information for school:
books, videos, movies, posters…
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• Education of general public
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
• Organize garbage
elimination (containers)
• Remove stray dogs,
ABC programme
• Collaborate with local authorities,
animal welfare NGOs, private
veterinarians…
• Educate responsible ownership
Interior affairs authority
SURVEILLANCE
- POST
VACCINATION 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
8
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION 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
9
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION 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
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)
10
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION 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
Exponential
increasing
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.
11
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION 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 (serological survey
and challenge study).
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OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION 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 owner’s 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)
Possible dog vaccination card/certificate
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OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING
HOUSE TO HOUSE PARENTERAL VACCINATION
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
14
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION 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
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OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING
ORAL VACCINATION OF DOGS
POTENTIAL OF ORAL VERSUS PARENTERAL VACCINATION
ACCORDING TO DOG POPULATION STRUCTURE
100%
20
20
- Oral vaccination combined
or not with PV
40
60
--- --80
50
75 45
80%
- Parenteral vaccination
50%
65
---
Immunization coverage:
20
ownerless
---
owned & unaccessible
40
TUN TUR YEM
Dog population
(segments in %)
owned & accessible
Proportion of restricted dogs
(accessible and not)
Slide kindly given by Dr. F.X.Meslin
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OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING
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
17
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING
GENERAL ORGANISATION OF VACCINATION CAMPAIGNS
Schematic representation of vaccination areas
Caption:
Contamination
between areas because
of one deficient team
Rabid dog
All teams vaccinated correctly dogs except for team 4.
Team 4 had not a methodical organization of vaccination.
Result: too large areas insufficiently vaccinated.
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OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION 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)
19
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION 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
Virus typing: Mabs or molecular methods
20
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING
EXAMPLE OF RABIES SURVEILLANCE NETWORK
SUCH NETWORK MUST HAVE A LEGAL BASIS (LEGISLATION ARTICLE)
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
21
Veterinary services
Sending of results
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
Citizens, NGOs, associations,
founding an animal cadaver or
a suspect live animal
Sending of samples
SURVEILLANCE
- POST
VACCINATION MONITORING
EVALUATION OF CONTROL PROGRAMME
500
Ultimate indicator of the success of vaccination
programme: decrease in rabies incidence in
vaccinated areas both in humans and animals
400
300
200
100
0
Animal bite injury from hospitals
1998
2000
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
22
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING
2002
2004
2006
2008
REPORTED AND ESTIMATED VACCINATION COVERAGES
IN DOMESTIC DOG POPULATIONS
FROM VARIOUS SETTINGS IN SUB-SAHARAN AFRICA SINCE
Dog population
1990
Region
Country
Dates
Vaccines delivered
Estimated coverage (%)
N’djamena
Chad
2011
23,560
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)
Nigeria
2007
<15.6
National
Sudan
1992-2002
37,620
71,540
5.26
Khartoum state
Sudan
2000
2,946
91,000
3.24
National
Swaziland
1994-1998
57,204
63.2-91.7
(dropped to 3% in 1998)
National
Tanzania
1992
11,635
<1
National
Uganda
2001-2003
National
Zimbabwe
2002
19.00
16.00
314,319
1,300,000
13.93
From Lembo et al., 2010
23
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING
CASES OF RABIES IN DOGS AND NUMBER OF VACCINATED DOGS IN MEXICO
1990-2004
Vaccinated dogs
(Millions)
Rabies cases
in dogs
Slide kindly given by Dr. F.X.Meslin
24
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING
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)
Vaccinated
domestic carnivore
Around 30 days
Domestic carnivore
in contact with a rabid
animal then vaccinated
Vaccinated domestic
carnivore then in contact
with a rabid animal
Variation in duration
of the incubation period
Production of rabies neutralising antibodies
A dog without antibodies at Day x may be protected if seroconversion
was achieved before Day x.
25
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING
SEROLOGICAL FOLLOW UP OF DOGS VACCINATED
WITH A LOCAL CELL CULTURE INACTIVATED
AND ADJUVANTED VACCINE
3
2,5
2
Day 30
log (UI/ml)
1,5
1
0,5
0
Day 0
-0,5
-1
-1,5
-2
26
(Unpublished Anses data – serological survey done in Morocco)
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION 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.
Importance of GARC, PRP and Rabies Elimination
Demonstration projects.
27
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING
THANK YOU FOR
YOUR ATTENT ON
28
OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES
SURVEILLANCE
- POST
VACCINATION MONITORING