Meeting for Developing a Sustainable Canine Rabies Elimination Program in Haiti
Port-au-Prince, February 27-29, 2012.
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1- Context
In its Directing Council Resolution DC49/R19, PAHO/WHO set a goal of eliminating
human rabies transmitted by dogs from the Americas by 2015. Over the past 20 years, the
number of human rabies cases has been reduced by more than 90% due to collaboration
between regional countries and both technical and financial support from partners. In 2010, less
than 20 cases of human rabies transmitted by dogs were reported to PAHO/WHO. However,
human deaths attributable to rabies transmitted by dogs are not acceptable in the 21st century,
because efficacious tools are available for the elimination of canine rabies virus transmission.
In Haiti, rabies is still a major public health problem which must be brought under control.
Not only does rabies pose a risk to the Haitian population, but it also represents a threat of
spreading canine rabies to other countries in the region as they control and eliminate the
disease. PAHO/WHO statistics show that more than 40% of human rabies cases reported in
2006 were from Haiti. To achieve the goal of eliminating human rabies transmitted by dogs from
the Americas, it will be critical to establish effective and sustainable rabies prevention and
control measures in Haiti.
During the celebration of the 2007 World Rabies Day , the Minister of Public Health and
Population (MSPP) and the Minister of Agriculture, Natural Resources and Rural Development
(MARNDR) committed their respective Ministries to work together in their fight against rabies in
Haiti. At that time, both ministries launched a joint inter-sectorial plan for rabies prevention and
control in Haiti: "PLAN NATIONAL DE LUTTE CONTRE LA RAGE EN HAÏTI-2007".
Against this background, the Ministry of Health of Brazil made a donation of 500,000
doses of canine anti-rabies vaccine and a Technical Inter-Country Cooperation (TCC) group of
five countries (Brazil, Canada, Cuba, Haiti, and Dominican Republic) was established to support
rabies prevention and control efforts in Haiti. The Brazilian donation allowed Haiti to carry out
one of the largest animal vaccination campaigns in its history, with nearly 400,000 cats and
dogs vaccinated between the end of 2007 and the beginning of 2008. However, the TCC’s
proposal to support further implementation of the 2007 plan was not approved for funding.
Meeting for Developing a Sustainable Canine Rabies Elimination Program in Haiti
Following the January 2010 earthquake, many dogs were separated from their owners
and joined the increasing population of community dogs freely roaming across the country. As a
result, the number of reported human bites by dogs increased from 1,005 in 2009 to 1,455 by
the end of 2010. At the same time, the number of reported human rabies cases transmitted from
dogs increased from 1 in 2010 to at least 13 in 2011. This increase in the burden of human
rabies demonstrates once more that, despite concerted efforts by the Government of Haiti and
other partners, the risk of human rabies transmitted by dogs is still significant. It is therefore
imperative to re-establish and strengthen rabies prevention and control in Haiti.
To ensure effective prevention and control of human rabies transmitted by dogs,
PAHO/WHO recommends focusing on the following four key interventions: annual dog antirabies vaccination, administration of post-exposure prophylaxis for persons at risk, combined
human and animal laboratory-based rabies surveillance, and educational outreach to the public.
These interventions were discussed during a PAHO/WHO-sponsored mission held in August
2011 with the participation of MSPP and MARNDR representatives. At the end of the mission, a
debriefing was organized to disseminate findings and recommendations from the mission.
Among others, the Brazilian Embassy, CDC-Haiti, and FAO local office were invited to the
debriefing. During the mission and throughout the debriefing meeting, lack of coordination
between the health and agriculture sectors was highlighted as one of the key issues that
deserve particular attention to ensure successful implementation of the 2007 plan. A draft
budget covering the basic components of the Haiti rabies control plan was also proposed.
2- Rabies control meeting, 27-29 February 2012
A follow-up meeting was organized jointly by CDC and PAHO/WHO. Participants included
representatives from MSPP, MARNDR, the Ministry of Health of the Dominican Republic, and
several NGOs (i.e. Global Alliance for Rabies Control, Humane Society International, and
Christian Veterinary Mission).
The goals for this meeting included:
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Defining the current status of rabies in Haiti.
Reviewing the 2007 plan for rabies prevention and control in Haiti.
Discussing next steps for a sustainable effort towards canine rabies elimination in
Haiti.
After three days of presentations and discussion, participants focused on strategies for rabies
prevention and control, confirmed the strategic orientations of the 2007 plan, agreed on
indicators to use in monitoring the implementation of the plan, and committed to working
Meeting for Developing a Sustainable Canine Rabies Elimination Program in Haiti
together to strengthen components of the plan with particular emphasis on the following
recommendations:
a) Surveillance:
i.
CDC and PAHO/WHO will provide technical assistance to MSPP and MARNDR
and will support the two Ministries’ efforts to mobilize necessary resources for
strengthening human and animal laboratory-based rabies surveillance systems.
ii.
MSPP and MARNDR will identify focal points responsible for coordination of
rabies surveillance activities at the national and departmental levels.
iii.
MSPP, MARNDR, and the Ministry of Health of the Dominican Republic will
establish a method for exchanging information on human and animal rabies
surveillance data in border areas and will cooperate on canine rabies elimination
efforts in an island wide approach.
b) Human Rabies Prevention:
i.
CDC and PAHO/WHO will help MSPP review and update relevant rabies
prevention and exposure assessment protocols
ii.
MSPP and MARNDR will establish a protocol for ensuring pre-exposure
prophylaxis for first responder personnel (i.e. laboratory diagnostic staff and
animal control).
iii.
MSPP will consider the introduction of dose-saving intradermal vaccination for
pre- and post-exposure prophylaxis.
iv.
PAHO/WHO will support MSPP to establish a decentralized mechanism for
distributing human anti-rabies vaccines to prevent frequent shortages of stock at
the departmental level.
v.
MSPP will create a budget line to ensure a regular supply of human anti-rabies
vaccines and rabies immune globulin.
vi.
PAHO/WHO will use mechanisms for medicines and medical product
procurement to facilitate the purchase of human anti-rabies vaccines and rabies
immune globulin, at competitive prices.
c) Dog Rabies Control:
Meeting for Developing a Sustainable Canine Rabies Elimination Program in Haiti
i. MARNDR will include in its annual budget a line to cover annual procurement of
canine anti-rabies vaccines used during annual animal vaccination campaigns.
ii. CDC will provide technical support for MARNDR to carry out a survey of the
current canine population in Haiti and post-vaccination assessments to determine
vaccine coverage
d) Diagnostics:
i.
CDC will provide technical support for the training of MSPP and MARNDR
personnel in laboratory diagnostic techniques for human and animal rabies.
ii.
CDC will provide financial support for laboratory reagents over a set time period
to establish decentralized rabies laboratory based diagnosis
iii.
CDC will provide technical support at the national laboratories for human and
animal rabies diagnosis to establish a quality control system.
iv.
MARNDR will submit an application to OIE to establish a laboratory twinning
program (ideally with CDC) for improvement of rabies diagnostic capacity in Haiti.
e) Communication and Education:
i.
Global Alliance for Rabies Control will provide technical support for the
development and pre-testing of rabies prevention and control messages,
education, and communication materials.
f)
Coordination, political support
i.
MSPP and MARNDR will review and update the 2007 rabies plan and re-validate
with the Ministry of Health and Agriculture and partners.
ii. MSPP and MANRDR will establish the national rabies committee as outlined in the
2007 plan and ensure regular meetings of the committee to improve interministerial
communications on rabies control efforts.
iii. PAHO/WHO will help facilitate annual meetings of the “Commission
Interministerielle” to strengthen the coordination of human and animal rabies control
activities.
Meeting for Developing a Sustainable Canine Rabies Elimination Program in Haiti
iv.
PAHO/WHO will continue to support advocacy efforts of MSPP and MARNDR
technical units to ensure sustained political commitment for canine rabies
elimination by 2015.
g) Budget, monitoring, and external resources mobilization
i.
PAHO/WHO and CDC will assist MSPP and MARNDR to finalize an operational
budget for the control and elimination of dog rabies, taking into account the
budget estimates included in the TCC proposal of 2007.
ii.
MSPP and MARNDR will work with CDC to establish a reasonable set of
evidence-based indicators and milestones that will be met to ensure CDCs
continued engagement in rabies control efforts.
iii.
PAHO/WHO and CDC will collaborate with MSPP and MARNDR to raise the
interest of “Partners for Rabies Prevention” to support rabies control and
elimination efforts in Haiti.
iv.
PAHO/WHO will continue to facilitate cooperation with Brazil and advocate for
more involvement in other aspects of rabies control in addition to the donation of
human and canine anti-rabies vaccines.
Dra. Jocelyne Pierre Louis
Dr. Max Millien
Dr. Martin Villoria
Representative of Minister of
Representative of Minister
Representative of the Rabies
Public Health and Population of
of Agriculture, Natural
Control Program of
Haiti
Resources and Rural
Dominican Republic
Development of Haiti
Dr. Charles E. Rupprecht
Dr. Jean Marie
Dr. Marco Vigilato
Representative of CDC
Rwangabwoba
PANAFTOSA/VPH/PAHO/WHO
Haiti Office PAHO/WHO
Annex 1 - Meeting Agenda
Annex 2 – List of Participants
Meeting for Developing a Sustainable Canine Rabies Elimination Program in Haiti
Annex 3 - “PLAN NATIONAL DE LUTTE CONTRE LA RAGE EN HAÏTI-2007/2008”
Annex 4 - DRAFT GUIDELINES TO STRATEGIC REVIEW OF THE “PLAN NATIONAL DE
LUTTE CONTRE LA RAGE EN HAÏTI-2007/2008”
Annex 5 – Draft - CDC Haiti Health Plan - Rabies