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Pan American Health OrganizationWorld Health Organization
Veterinary Public Health
OIE- Global Conference on Rabies Control:
ELIMINATION OF HUMAN RABIES TRANSMITED BY DOG IN
THE AMERICAS: ACHIEVMENTS
Hugo Tamayo SilvaPANAFTOSA-OPS/OMS
Incheon - Seoul - Republic of Korea
7 - 9 September 2011
EPIDEMIOLOGICAL CONTEXT...
COUNTRY
/SUBREGIÓ N
ANIMAL SPECIES
CANADA - SKUNKS (34%) – FOXES (9%)
- NON HEMATOPHAGUS BATS (38%)TOTAL 2009 = 145 CASOS CON DL
USA - RACCONS (35%) - SKUNKS (24%)
- FOXES (7%)
- NON HEMATOPHAGUS BATS (24%)TOTAL 2009 = 6.694 CASOS CON DL
MEXICO - DOGS (V1 - V2)
- HEMATOPHAGUS BATS (V3)
- NOT HEMATOPHAGUS BATS (V4)
CENTRAL A. and
CARIBE L.
CUBA - HAITI
R.DOMINCANA
P. RICO
- DOGS (V1 - V2)
- HEMATOPHAGUS BATS (V3)
- NOT HEMATOPHAGUS BATS (V4)
- MANGOOSES (V1)
ANDEAN A.:
COLOMBIA
- DOGS (V1 - V2)
- HEMATOPHAGUS BATS (V3)
- NON HEMATOPHAGUS BATS (V4)
- UROCYON CINEREOARGENTUS (VNC)
SUL CONE
BRAZIL
- DOG (V1 - V2)
- HEMTOPHAGUS BATS (V3)
- NON HEMATOPHAGUS B. (V4) (VNC)
- MARMOSET (VNC)
- CRAB EATING FOXES (VNC)
Venezuela V3, V5
Colombia V3
Brazil 1 V3
Peru-Brazil V3
Brazil 2 V3
Argentina V3
Bolivia V3
Brazil 3 V3
Mexico 1 V3
Mexico-Colombia V3
Mexico V11
Colombia V8/V3 – Peru V3
Mexico V8 atypical
Tadarida brasiliensis V9 North America
Tadarida brasiliensis V4 South America
Colonial bats North America
Other bats South America
Solitary bats North America
Terrestrial carnivores North America
Sagui monkey Brazil
Out group 3
PHYLOGENETIC
TREE OF RABIES
VIRUSES
0
1000
2000
3000
4000
5000
6000
1959 1964 1969 1974 1979 1984 1989 1994 1999 2004 2009
Cases
Year
Rabies in Wild Animals, 1959-2009
Raccoons Skunks Skunk Variant Bats Foxes
Source: Centers for Disease Control and Prevention, November 2010
USA: RABIES IN WILD ANIMALS, 1959-2009
257 millions (46%) without health care, public or private
685,000 children without vaccination
17% parturition done by personel not qualified
LAC: CONTEXT, 2007.....
- Population: 572 millions
- In poverty 35.1%
- In extreme poverty: 15.9%
POLITICAL
FRAMEWORK…
MANDATES
1983:
1a REDIPRA - III RIMSA – OPS/CD 31
2008 - 2009
XV RIMSA - OPS/CD 48/R13 CD 49/R19
2010:
13ª REDIPRA
COMMITMENTS....
• REDIPRA, Guayaquil 1983: Strategy and action plan for the
elimination of urban rabies from the major urban centers in Latin
America by the end of 1980’s
• PAHO, 1991: extension policies and strategies to isolated areas
and small rural populations
• PAHO, 1992: emphasize the surveillance of wildlife rabies,
particularly transmitted by bats
• PAHO, 2008: to eliminate dog- trasmittd human rabies from hemisphere
by 20102 (XV RIMSA – CD 48/R13)
REGIONAL PLAN: COMPONENTS ...
• Timely post-exposure
prophylaxis for people bitten.
Access immunobiological
• Elimination of human rabies
transmitted by dogs. Dog mass
vaccination
• Active surveillance and
prevention of wildlife rabies
• Social organization, education
end information diffusion
ALC: ACHIEVEMENTS, 1970 – 2011*
Source: SIRVERASource: SIREVERA/SIEPI - PANAFTOSA/OPS August/2011
0
20
40
60
80
100
120
140
160
180
200
220
240
260
280
300
320
340
360
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Year
Hu
man
Rab
ies
0
2500
5000
7500
10000
12500
15000
17500
20000
22500
25000
Rab
ies in
Do
gs
Human Cases transmitted by dog Human cases transmitted by bats Rabies in Dogs
15
19
196
25,000 351
60
LAC: SPATIAL DISTRIBUTION: 1999 - 2006
Rabia Humana Origen Perro
Año 2006
3 a 7 (2)
2 (3)
1 (8)
0 (404)
AmericaAdm1Rabia by Rc1999
8 to 8 (1)
3 to 8 (2)
2 to 3 (6)
1 to 2 (19)
0 to 1 (389)
AmericaAdm1Rabia by Rh2007
8 to 8 (1)
3 to 8 (1)
1 to 3 (1)
0 to 1 (414)
AmericaAdm1Rabia by Rh2006
2 to 2 (1)
1 to 2 (2)
0 to 1 (414)
AmericaAdm1Rabia by Rh2005
4 to 17 (2)
3 to 4 (2)
2 to 3 (1)
1 to 2 (2)
0 to 1 (410)
Rabia origen pe rros 1999
8 (1)
3 a 7 (2)
2 (6)
1 (19)
0 (389)
Rabia Humana Origen Perros
Año 1999
8 y + (1)
3 a 7 (2)
2 (6)
1 (19)
0 (389)
AmericaAdm1Rabia by Rh2007
8 to 8 (1)
3 to 8 (1)
1 to 3 (1)
0 to 1 (414)
AmericaAdm1Rabia by Rh2006
2 to 2 (1)
1 to 2 (2)
0 to 1 (414)
AmericaAdm1Rabia by Rh2005
4 to 17 (2)
3 to 4 (2)
2 to 3 (1)
1 to 2 (2)
0 to 1 (410)
Rabia origen pe rros 1999
8 (1)
3 a 7 (2)
2 (6)
1 (19)
0 (389)
111111
PAHO RESOLUTION (DC 49
2009): ELIMINATION OF HUMAN
RABIES TRANSMMMITED
BY DOG….
LAC: RABIES HOTSPOTS - 2009
LAC: CAPACITY FOR RABIES ELIMINATION ….
Brasil - México
Argentina - Colombia Venezuela - Perú
Ecuador - Nicaragua
DECLARATION OF RABIES FREE
COUNTRY/TERRITORIES, VARIANTS 1 AND 2
DECLARED IN PROCESS PROGRAMMED
Chile
Mexico
Peru
Costa Rica
Nicaragua
Uruguay
Argentina
Brazil -south
Colombia
Equador
Venezuela
• Epidemiological Surveillance: A Network for
rabies diagnosis laboratories
• > more than 100 laboratories
• Medical care to people exposed (PEP)
> 1,000,000 people bitten annually
> 500,000 patients prophilaxis post exposition
> 2,000,000 vaccine doses applied (> C.C.)
• Canine Vaccination
> 45,000,000 dogs vaccineted annually
• Education, community participation
KEY TO SUCCESS....
0
15
19
1
37
5
0
10
20
30
40
50
60
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Years
Hu
ma
n C
as
es
of
Ra
bie
s
Cat Dog Bat
CHALLENGE: WILD RABIES RE-EMERGENCE...
Source: SIREVERA/SIEPI - PANAFTOSA/OPS August/2011
D.rotundus
Artibeus spp
1°
Brasil
CatDog
D.rotundus
Artibeus spp
2° Costa Rica
3° Colômbia
4° Equador
Secondary transmission of rabies in the Americas
(Wild Cicle Urbanization?)
Challenges Opportunities
Country/Areas with rabies : less
developed:
- Inmunobiological deficiency
- Low dog vaccination coverage
- Lack integration, coordination
Strengthening National Progr. bi or
multinational border:
- Policies to combat poverty
- Unfinished agenda in health
- Local Development
- Weakening national
- programs
- Low epidemiological
surveillance
- Declaration countries / territories
free (WHO-OIE)
- Strengthening Field-laboratory
surveillance
•Re-emergence wild rabies cicle - Strengthening regional laboratory
network
- Strengthening active survillance
field-laboratory
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