Control and elimination strategies
A number of activities are underway to prevent rabies occurrence in humans and to control rabies in dogs.
Latin America is an example of a region in which several countries have successfully controlled rabies. Since their formal pledge in 1983 to eliminate human deaths from rabies transmitted by dogs, the countries of the region have had a decrease of over 90% in rabies in dogs and hence a similar decrease in human deaths. This has been achieved predominately by mass vaccination of over 45 million dogs annually.
Other recent examples are in KwaZulu-Natal (South Africa), the Visayas (the Philippines) and Bali (Indonesia).
- The KwaZulu-Natal province of South Africa had been plagued by dog rabies for several decades. During 1983–2007, 79% of laboratory-confirmed human cases in South Africa occurred in this province, with a human population estimated at 10.6 million. The dog rabies elimination project illustrates the effectiveness of collaboration between the provincial government, donors (e.g. the Bill & Melinda Gates Foundation) and WHO. More than 1.5 million dogs have been vaccinated since the beginning of the project in 2009. In 2012, more than 630 000 dogs were vaccinated, the highest number immunized in a year by the provincial veterinary services. The occurrence of animal rabies has been halved in 3 years, with an initial decrease in human cases: for the first time in 20 years, KwaZulu-Natal reported in 2010–2011 a continuous 12-month period without a single human case. Despite many challenges, the project is now being extended across southern Africa, with renewed support and momentum.
- The regional programme for rabies elimination in the Visayas is part of the national rabies programme jointly implemented by the departments of agriculture, health and education and chaired by the agriculture department’s Bureau of Animal Industry on the basis of the National Rabies Act 9482. The ‘rabies-free Visayas’ project is being carried out in collaboration with partners such as WHO, the Bill & Melinda Gates Foundation, the Global Alliance for Rabies Control (GARC) and the Optimus Foundation. The project involves vaccination of more than 3 million dogs over 5 years, and campaigns have been conducted in the Western Visayas, parts of Central Visayas including the island of Bohol and the Eastern Visayas. Intensive information and education campaigns are conducted to strengthen community support and volunteer engagement in order to increase dog vaccination and responsible pet ownership and improve clinical management of human rabies and surveillance and diagnostic capability. The number of human deaths from rabies in the Visayas has decreased significantly, from 48 cases in 2008 to 13 in 2012, a 70% reduction.
- Since the introduction of mass canine vaccination as the main strategy in Bali from late 2010, the numbers of human and animal cases of rabies have dropped dramatically: the number of human cases decreased by 72% between 2010 and 2011 and by 90% between 2010 and 2012. Two mass vaccination campaigns have been completed, and a third campaign is nearing completion. The feasibility of an islandwide vaccination campaign was demonstrated by a local nongovernmental organization, the Balinese Animal Welfare Association, with funding from the World Society for the Protection of Animals. The Government of Indonesia with technical assistance from the FAO assumes responsibility for the second and subsequent campaigns. The reasons for the success of the programme have been: a clear operational goal of vaccinating 70% of dogs in each locality on the island during each campaign; daily reporting of vaccination and post-vaccination survey results, by SMS and on paper; daily, weekly and monthly Government coordination meetings during vaccination campaigns; and campaign-specific standard operating procedures, with in-service training of field staff.