Oie G R: Lobal Conference ON Abies Control

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 WHO Collaborating Centre OIE European Union European Union
for Rabies and Wildlife for Research and Management Reference Laboratory Reference Laboratory Reference Institute
in Zoonoses Control for Rabies for Rabies for Rabies Serology
7 - 9 SEPTEMBER 2011
1 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - IINCHEON -S,EOUL
NCHEON-SEOUL KOREA, KOREA
ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG VACCINATION PROGRAMME: VACCINATION – RABIES SURVEILLANCE - POST VACCINATION MONITORING
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).
2 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

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. Legal basis and long time budget allocation
3. Strategy of control – planning
4. Ensuring coordination between all actors: Precise identification of
each step of the programme: who is responsible of what and when.
5. Dog demography information (both owned
and stray) and dog ecology
6. Ensuring availability of biological products
7. 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
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.

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

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.

INTERSECTORAL COORDINATION
DEFINING MAIN RESPONSIBILITIES AT NATIONAL,
REGIONAL AND LOCAL LEVEL
Veterinary authority Human health authority Education authority Interior affairs authority
• Propose and write a strategy • Propose and write a strategy • Provide information for school: • Organize garbage
• Calculate a budget • Calculate a budget books, videos, movies, posters… elimination (containers)
• Acquire inactivated rabies • Acquire inactivated rabies • Remove stray dogs,

vaccines for dogs vaccines for humans and ABC programme
immunoglobulins
• Organize, implement and monitor • Organize PEP to assess

vaccination campaigns of dogs availability of vaccines and if all
• Register and identify dogs over the country
•Declare and report to ad hoc •Declaration and reporting to ad

authorities all positive cases hoc authorities all positive cases
• Organise surveillance of suspect • Organize surveillance in humans

animals and evaluation of the
programme
• Collaborate with local authorities,
animal welfare NGOs, private
veterinarians…
• Educate responsible ownership • Education of general public

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
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
CATEGORIZATION OF DOGS (WHO, 2007)
None Semi Full
Restriction
None
Feral dogs
Neibourhood
Semi or community
dogs
Full Restricted or
Family
dogs 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)
IMMUNOLOGICAL RESPONSE TO VACCINATION
Vaccination against rabies with injectable vaccines induces a humoral

response with the production of rabies neutralising antibodies.
Exponential
Latency Plateau Decreasing
increasing
Level
Vaccination
of
antibodies
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.

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).
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
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
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

POTENTIAL OF ORAL VERSUS PARENTERAL VACCINATION
ACCORDING TO DOG POPULATION STRUCTURE
100% Immunization coverage:
20
20 - Oral vaccination combined
40 60 or not with PV
--- --- 80%
80
50 - Parenteral vaccination
50%
65
--- 20 ownerless
75 45
--- owned & unaccessible
40
TUN TUR YEM owned & accessible
Dog population Proportion of restricted dogs

(segments in %) (accessible and not)
Slide kindly given by Dr. F.X.Meslin
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

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.
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)

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
EXAMPLE OF RABIES SURVEILLANCE NETWORK
SUCH NETWORK MUST HAVE A LEGAL BASIS (LEGISLATION ARTICLE)
National competent authority for

National reference Laboratory for rabies
animal health
Regional Lab
EFSA, WHO / National rabies database
OIE (Rabnet (all diagnosis negative and
and WAHID* Veterinary services
positive results from both
database) animals and humans)
*http://web.oie.int/wahi
s/public.php?page=home Veterinarians
Citizens, NGOs, associations,

National competent authority for
founding an animal cadaver or
human health
a suspect live animal
Caption
Sending of results Sending of samples
EVALUATION OF CONTROL PROGRAMME
500
400
Ultimate indicator of the success of vaccination 300
programme: decrease in rabies incidence in 200
vaccinated areas both in humans and animals 100

0
Animal bite injury from hospitals 1998 2000 2002 2004 2006 2008
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

REPORTED AND ESTIMATED VACCINATION COVERAGES
IN DOMESTIC DOG POPULATIONS
FROM VARIOUS SETTINGS IN SUB-SAHARAN AFRICA SINCE 1990
Region Country Dates Vaccines delivered Dog population Estimated coverage (%)
N’djamena Chad 2011 23,560 19.00

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
63.2-91.7
National Swaziland 1994-1998 57,204
(dropped to 3% in 1998)
National Tanzania 1992 11,635 <1
National Uganda 2001-2003 16.00
National Zimbabwe 2002 314,319 1,300,000 13.93
From Lembo et al., 2010

CASES OF RABIES IN DOGS AND NUMBER OF VACCINATED DOGS IN MEXICO
1990-2004
Vaccinated dogs Rabies cases
(Millions) in dogs
Slide kindly given by Dr. F.X.Meslin

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 Vaccinated domestic

domestic carnivore in contact with a rabid carnivore then in contact
animal then vaccinated with a rabid animal
Around 30 days 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.
SEROLOGICAL FOLLOW UP OF DOGS VACCINATED
WITH A LOCAL CELL CULTURE INACTIVATED
AND ADJUVANTED VACCINE
3
2,5
2
Day 30
1,5
1
log (UI/ml)
0,5
0
Day 0
-0,5
-1
-1,5
-2
(Unpublished Anses data – serological survey done in Morocco)
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.

THANK YOU FOR
YOUR ATTENT ON


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OIE GLOBAL CONFERENCE

ASSURING QUALITY AND SUSTAINABILITY OF RABIES DOG

Florence Cliquet – Jacques Barrat

Final objective of control measures: prevention and

2 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

WHO Expert Consultation on Rabies, WHO

4 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

Rabies should be a notifiable disease both for

National laws as well as regional and local

Technical and administrative responsibilities

Costs calculated for each sector involved and

5 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

6 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

• Acquire inactivated rabies • Acquire inactivated rabies • Remove stray dogs,

• Organize, implement and monitor • Organize PEP to assess

•Declare and report to ad hoc •Declaration and reporting to ad

• Organise surveillance of suspect • Organize surveillance in humans

• Educate responsible ownership • Education of general public

7 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

Dog population management (if any – ABC

Evaluation of the programme:

Ecological survey (questionnaires) conducted prior to the strategy elaboration

Vaccination against rabies with injectable vaccines induces a humoral

Time after vaccination

In cats and dogs, the peak of rabies neutralising antibodies is generally

11 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

Intended for domestic dogs which have affiliations (family or

The major obstacle in rabies control is the accessibility to

Since 1988, WHO has elaborated several guidelines and

15 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

100% Immunization coverage:

Dog population Proportion of restricted dogs

Commercial vaccine baits available

17 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

All teams vaccinated correctly dogs except for team 4.

19 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

Rabies surveillance is the basis for any control and

National competent authority for

Citizens, NGOs, associations,

vaccinated areas both in humans and animals 100

The strategy must be rapidly changed or adapted in

22 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

N’djamena Chad 2011 23,560 19.00

From Lembo et al., 2010

23 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

Slide kindly given by Dr. F.X.Meslin

Vaccinated Domestic carnivore Vaccinated domestic

Around 30 days Variation in duration

Production of rabies neutralising antibodies

A dog without antibodies at Day x may be protected if seroconversion

To be sustainable, rabies control programmes based on

27 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

28 OIE GLOBAL CONFERENCE ON RABIES CONTROL - 7 - 9 SEPTEMBER 2011 - INCHEON-SEOUL, KOREA

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