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Rabies Surveillance

Rabies Surveillance. Dr Suresh Gupta Consultant Pediatric Emergency Medicine Sir Ganga Ram Hospital, New Delhi. WHO Recommended Surveillance Standards for Rabies. Rationale for Surveillance. WHO promotes Human rabies prevention though PET

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Rabies Surveillance

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  1. Rabies Surveillance Dr Suresh Gupta Consultant Pediatric Emergency Medicine Sir Ganga Ram Hospital, New Delhi

  2. WHO Recommended Surveillance Standards for Rabies

  3. Rationale for Surveillance WHO promotes • Human rabies prevention though PET • Disease Elimination through vaccination of dogs and other animal reservoirs Surveillance is essential for • Detection of high risk areas • Detection of outbreaks quickly • Monitor use of vaccine

  4. Recommended Case Definition Case Classification:(Based on Clinical Description & Laboratory Criteria) Human Rabies : -Suspected -Probable -Confirmed Human Exposure to rabies: -Possibly Exposed -Exposed

  5. Recommended types of surveillance • Surveillance in human population: • Human exposure to rabies • Human rabies case • Outbreak investigations • Surveillance in animal population • Wild and Domestic species reservoirs

  6. Rabies Indicators 1.Presence/absence of rabies2. Human rabiesa. Number of human deathsb. Human deaths according to animal species source of exposurec. People bitten by suspected dogs3. Animal rabiesa. Total number of dog casesb. Total number of other domestic animal casesc. Total number of wild animal casesd. Total number of bats cases4. National rabies vaccine production and importationa. Veterinary vaccine according to vaccine typesb. Human vaccine according to vaccine typesc. Human rabies immunoglobulin5. Rabies vaccine administrationa. Dogs vaccinationb. Human vaccine application - Post-exposure treatmentc. Number of patients treated according to vaccination regimend. Number of persons receiving treatment according to animal speciessource of exposure

  7. Recommended minimum data elements • Human Rabies Exposure • Case based data • Aggregated data • Surveillance of Deaths from Human rabies

  8. Recommended data analysis, presentation and reports • No of human rabies death and rabies cases in animal(by species),by date of presentation • Human exposure by location, date of animal biting/scratch episode animal species, outcome in human and animal populations • Cases by geographical area and dates of biting, type of animal, occupation and outcome

  9. Principal uses of data for decision making • Detect outbreaks in endemic areas and new cases in rabies free area • Determine high risk areas for intervention • Rationalize the use of vaccine and immunoglobulins • Evaluation of intervention for animal reservoirs and exposed human population

  10. Special Aspects Intersectoral cooperation of medical and veterinary services, community involvement and participation required for targeted response and control in animal reservoir.

  11. Presence/Absence of rabies 2000 No information Absence Presence

  12. Rabies trends in 2000 No information Rabies free Stable Decreasing Increasing

  13. Geographical Distribution 2000 No information Rabies free Border area Limited area Most parts

  14. Epidemiological pattern 2000 No information Rabies free Bat Dog Wild

  15. Rabies situation and trend • Human Rabies 35-50,000/Year • Asia and Africa are the main • Animal Rabies • Africa 2344,USA 8509, Europe 5098, Asia ?? • General Trends • Europe reporting decrease in rabies cases • Animal rabies Dog 57%, Wild life 33%, Bat 10%

  16. Rabies and Prevention • Human PET • Exposure to Dog- Africa 87%, Asia 97%, Europe 4% • Vaccine alone Africa 82%, Asia 88%, Europe 80% • Vaccine • Human Vaccine: 76% vaccine on cell culture • Animal Vaccine: 99% cell culture, • Vaccine application in Dogs • Compulsory in 13/25 African countries,3/10 American countries, 18/33 European countries, 3/10 Asian countries

  17. Reported Human Rabies Cases in India

  18. Reported Human Rabies Cases in India

  19. Reported animal rabies cases in India

  20. Reported animal rabies cases in India

  21. Reported No of PET

  22. Human and animal rabies vaccine produced or imported Not available at Rabnet

  23. Rabies Vaccination for dogs and other animal species Not available at Rabnet

  24. Current country information on rabies in India at Rabnet Last update of this informations : 1999-12-01 • Region : AsiaCountry : IndiaWHO Region : EURO 1) Presence of rabies and disease surveillance • Is rabies a notifiable disease? • Does a surveillance system exist? • Is it operational? • Does rabies occur in the country? yes • Does rabies exist in the entire country? If No, please specify infected areas. 2) Reservoir species • First rabies reservoir Second rabies reservoir • not applicablenot applicable • Third rabies reservoir Other reservoir • not applicable 3) Rabies vaccine used for human postexposure treatment • Primary cell lineDiploid cell lineContinuous cell lineNervous tissue • Treatment schedules not applicablenot applicablenot applicable • Other Schedules • Is vaccine also applied intra-dermaly ?

  25. Contact address on rabies diagnosis, prevention and control in human and animal in India • For questions on rabies prophylaxis and treatment in human please contact or For questions on rabies diagnosis, surveillance and control in animals please contact • Last name • First name • Title • Position • Institution • Department • Street • Quarter • POBox • City • Postal code • State • Phone1 • Phone2 • Fax • Email • Address

  26. Epidemiology of Rabies# • 30,000 Annual Deaths • 10,00,000 PET annually • 12 Govt.Institution (NTVs) for Human • 9 Govt. Institution Veterinary NTVs, • 1Pvt. Pharmas human TCV, • 4 Pvt Pharmas veterinary TCVs. • 15 Govt Inst. rabies diagnostic facilities in animals and 5 for testing post vaccination antibody titers in humans. # Association for prevention and control of rabies in India (APCRI)

  27. Annual Report at NICD 1997 Post-mortem diagnosis in animal 18/40 in samples by Negri body FAT & BT Diagnosis in hydrophobia cases by • Corneal Smear 0/15 • Serum Antibodies 2/15 Assessment of antibodies by modified CIEP test • Human 234/258 • Animal l5/5

  28. 6 month incidence of animal bite cases in 4 selected urban communities* City Population Bites Incidence/1000 Banglore 88469 85 0.96 Calicut 79169 20 0.25 Coonoor 43577 70 1.61 Rajamundry 71358 117 1.64 Total 282573 292 1.03 *Source: Based on reports of National Institute of Communicable Diseases

  29. No of animal bite case reported by Municipal Medical Institutions in Delhi, 1995-1998* Animal 1995 1996 1997 1998 Dog 23852 26395 27345 29905 Monkey 1093 1313 1008 1198 Cat 170 141 121 182 Horse 4 15 6 8 Buffalo 1 0 4 8 Unknown 59 96 125 182 Total 25179 27960 28609 31483 * Source: Municipal Health Officer, Delhi

  30. No. bite cases with reference to animal involved 1998-2002* Animal Total Case (Percentage) Dog 5115 (83%) Monkey 290 (05%) Buffalo 207 (3.5%) Cow-Ox 171 (03%) Cat 90 (1.5%) Rat 48 (.75%) Jackal 25 (0.5%) Leon/Leopard 11 Horse-Mule 30 (0.5%) Mongoose 34 (0.5%) Pig 6 Goat 23 (0.5%) Sheep 1 Others 4 Unknown 4 Contact Cases 131 (02%) Total : 6190 * Source:CRI, Kasauli, APRICON 2003

  31. Single animal biting many persons: Episodes reported from India* Year Animal Bitten Died RIG 1992 Dog 90 0 Yes 1995 Wolf 28 8 No 1996 Dog 43 8 No * Source: Based on reports communicated to NICD

  32. Classification of Animal bite cases reported (1998-2002)* Year Class I Class II Class III Total 1998 - 243 1384 1627 1999 8 153 1285 1446 2000 21 279 722 1022 2001 13 120 951 1084 2002 15 157 839 1011 Total 57(1%) 952(15%) 5181(84%) 6190 * Source:CRI, Kasauli, APRICON 2003

  33. No of Hydrophobia cases admitted to IDH, Delhi 1994-1999* Year No of Hydrophobia cases 1994 224 1995 210 1996 151 1997 222 1998 215 1999 241 *Source: Infectious Diseases Hospital, New Delhi

  34. Rabies Cases Admitted to IDH 1998 Age Number Percentage 0-4 13 06.0% 5-14 85 39.5% 15+ 117 54.5% Sex Male 168 78.1% Female 47 21.9% Total 215 100% *Source: Jagvir Singh et al in Indian Pediatrics, Volume 38, 2001

  35. Rabies Cases Admitted to IDH 1998Antirabies Vaccination before hospitalization Age Number No. Received ARV Percentage 0-4 13 6 46.2% 5-14 85 17 20.0% 15+ 117 25 20.0% Sex Male 168 39 23.2% Female 47 9 19.1% Total 215 48 22.3% *Source: Jagvir Singh et al in Indian Pediatrics, Volume 38, 2001

  36. Rabies Cases Admitted to IDH 1998PET received by these cases* • Local wound care: • Only 2 cases • Vaccination: • Unvaccinated 67/215 • Vaccinated 48/215 • 42 NTV( only 5 received>10doses) • 6 TCV(all received < 3 doses) • Immunoglobulins: • Only 3 cases • 1 case received (Wound care + NTV+ ERIG) *Source: Jagvir Singh et al in Indian Pediatrics, Volume 38, 2001

  37. Assessing Burden of Rabies in India* • 1000+ million Population • 24 million Dog Population • Dog:Man 1:12 to 1:40 • Animal Bites: 2.1 million • 90% due to dog ( 90% unvaccinated dog) • 1.1 million PET (0.45 NTV and 0.65TCV) • No. of Rabies death 30,000/annually ???? * Source:APCRI, Newsletter Volume III, Issue 1 & 2, 2003

  38. Assessing Burden of Rabies in India A WHO-APCRI National Multi Centric Survey Initiative 2003 This survey involves • 20 Medical Colleges, • 32 Veterinary College, • 10 million Human Population • 32 Veterinary Pathology Laboratories

  39. What could be the answer for Rabies Surveillance in India ? Integrated Disease Surveillance ??

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