Rabies in nepal

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‘‘SITUATION ANALYSIS OF
RABIES IN NEPAL & RABIES
RELATED PROGRAMME
STRATEGIES IN NEPAL’’

2/17/2013 A TERM PAPER PRESENTATION

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Prepared by
SAgun PAudel Presented with
Health Assistant • KALPANA GURUNG
Student of BPH @ • PURNIMA TIMILSINA
• RAJESH KUMAR
LA GRANDEE YADAV
International college,
Simalchour
Pokhara, Nepal

rabies control program 2/17/2013

Introduction:
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 Rabies, also known as hydrophobia is an acute,
highly fatal disease of CNS caused by Lyssavirous
type I,
 It is zoonotic, most commonly by a bite from an

infected subject. For a human, rabies is almost invariably
fatal if post exposure prophylaxis is not administered
prior to the onset of severe symptoms.

 The rabies virus infects the central nervous system,
ultimately causing disease in the brain and death.

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 The rabies virus travels to the brain by following
the peripheral nerves.
 The incubation period of the disease is usually a

few months in humans, depending on the distance
the virus must travel to reach the central nervous
system. Once the rabies virus reaches the central
nervous system and symptoms begin to show, the
infection is effectively untreatable and usually fatal
within days.

SYMPTOMS
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Prodromal symptoms
 Headache
 Malaise
 Sore throat
 Slight fever 3-4 days
 Tingling sensation at the site of the bite


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 Host factors : Although all age groups are
susceptible, rabies is most common in children aged
below 15 years
 Reservoirs:
o Rabies exists in 3 epidemiological forms:
• Urban rabies
• Wild- life rabies
• Bat rabies


Objectives:
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specific objective:
•To analyze the situation of rabies in Nepal and
strategies applied for rabies related programme.
General objectives:
•To study the Burden of disease and epidemiological
situation.
•To study about the rabies prevention strategies in
Nepal
•To study the WHO strategies for rabies control for
SEAR.


Methodology
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Secondary data


Finding & Discussion:
South-East Asia Region:
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Rabies, an invariably fatal viral disease, is transmitted
to humans through animal bites, most commonly dogs.
The disease is preventable through timely pre-and
post-exposure vaccination. However, once the disease
occurs, death is inevitable.


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Countries Number of Rate (Human cases per
estimated/reported 100 000)
cases
Bangladesh 180 (reported in 2008) 0.14
Estimation: Approx. 2000
Bhutan Sporadic (Two cases in 2008) 0.28
DPR Korea Sporadic N/A
India Approx. 20 000 3
Indonesia Approx. 100 0.045
Myanmar Approx. 1000 0.35
Nepal 32# (2007) 0.21
Sri Lanka 51^ (2008) 0.26
Thailand 8* (2008) 0.012
#Personal communication, Epidemiology and Disease Control Division, Ministry of Health and Population,
Kathmandu, Nepal
^Weekly Epidemiological Report, http://www.epid.gov.lk/wer.htm

Burden of disease in Nepal:
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Rabies has been endemic in Nepal since ancient
times.
Most human cases of rabies in the Country are
reported from urban areas where stray dogs
outnumber pet dogs and dog rabies vaccination
coverage is low.

Canine rabies is the major epidemiological pattern
and the dog is the primary source of rabies. Most
human and animal rabies cases are reported on the
basis of clinical observation and dog-bite history.

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 In Nepal, 94% of the human cases occur after
contact with rabid dogs. It is estimated that
200 people on average die annually due to
rabies. National statistics show that about 30
000 people receive post-exposure prophylaxis
(PEP), and the number of people seeking PEP
is increasing every year.


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 Most animal rabies cases are reported from rural
and semi-urban areas and villages adjoining wildlife
parks and reserves. It is estimated that more than
1000 animals succumb to rabies each year. Cattle
and buffaloes represented 84% of the total of 430
animal rabies cases reported to the Veterinary
Epidemiology Centre during the period of 2006-2010
and it clearly shows the economic impact of rabies in
livestock production in Nepal


Epidemiological situation in
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Nepal
 Rabies in Nepal is thought to circulate in two
epidemiological cycles: an urban cycle involving
maintenance of infection in dog populations and a
sylvatic cycle involving mongooses, jackals, and
wolves. There is a possibility of spill-over of rabies
virus from dogs to wildlife and vice-versa.


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 Rabies is unevenly distributed in Nepal. As can
be seen from Fig. 1, Terai district is densely
populated and there are wildlife parks and
dense forest areas. Outbreaks of rabies are
frequently reported in and around wildlife parks
and domestic animals are mainly affected.


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 Mountain districts rarely report rabies cases
as human and animal population distribution is
scattered and maintaining rabies transmission
cycle is difficult due to geographical barrier and
food scarcity.


Map showing high, moderate and
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low rabies risk districts, Nepal


Rabies control in the South East
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Asia Region
 Rabies is a 100% fatal but at the same time,
100% preventable disease. It is a disease of
poverty, affecting the very vulnerable
populations and children.
 The necessary tools and methods for control
and prevention of human and canine rabies are
available and the proof of the feasibility of
rabies elimination has been demonstrated in
countries like Japan, Singapore and Malaysia.


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 Rabies elimination programme focused mainly on
mass vaccination of dogs are largely justified by the
future savings of human rabies prevention
programme.
 A concerted effort between the human and

animal health sectors and support from other
stakeholders is needed to achieve the goals of
rabies elimination. WHO will continue to provide
technical inputs and support such effort.

Strategies
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WHO recommends the following five major activities
to be initiated/strengthened in the Member Countries
of the SEA Region :
1) Develop a comprehensive national rabies control
programme: Consensus on national strategy and policy and
multi sectoral and coordinated approach for rabies control at
different levels.
2) Promote prompt and proper care of dog bite wounds:
Immediate and thorough cleansing and flushing of dog-bite
wounds with simple soap water is the most effective first-aid
treatment against rabies. There is a need to educate the public
on this important first step in the prevention of rabies.

Strategies
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 3) Increase access to tissue cell-culture vaccines (TCVs):
TCVs are safe and effective, with very low failure rates.
Multi-site intra-dermal administration of TCVs greatly
reduces the cost of post-exposure treatment, without
sacrificing safety and efficacy. WHO strongly recommends
discontinuation of the old nerve-tissue vaccines (NTVs),
which are still produced and used in two countries of the
Region, viz. Bangladesh, and Myanmar. NTVs have a high
rate of adverse reactions and failures, and lower efficacy.


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4) Prevent dog rabies through dog vaccination and dog
population management:
This includes:
•organization of sustainable mass dog vaccination programmes
using highly potent tissue-culture rabies vaccine

•promotion of responsible dog ownership at the community
level

•promotion of oral rabies vaccine for stray dogs to improve
vaccination coverage

•dog population management through animal birth control
(ABC) programme, and rabies control program 2/17/2013

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Control of trade and movement of dogs.
o It has been seen that where >80% community dogs
are properly vaccinated against rabies, the
occurrence of human rabies cases ceases promptly.

5) Public health education and advocacy: This is an
important component of any public health programme
and Member States are encouraged to implement
public education and awareness campaigns on rabies
prevention and control.


Rabies control activities and
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achievements in Nepal:
 Nepal has phased out production and use of Simple type
vaccine for humans in 2006.
 Tissue culture vaccine for human use is purchased and
supplied by the Ministry of Health and Population to
government hospitals on regular basis.
 Tissue-culture dog rabies vaccine has been produced
since 2005 and dog rabies vaccine is also imported by
private sector.


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 There is an ongoing study on possibility of
local production of human rabies vaccine
based on experience of animal tissue-culture
rabies vaccine by Rabies vaccine Production
Unit under Directorate of Animal Health.


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 Dog rabies vaccination is not mandatory and
pet dogs are vaccinated against rabies in
urban areas. About 55 000 dogs are
immunized against rabies. Dog vaccination
campaigns are organized as a part of the
World Rabies Day events by the government
as well as non-governmental organizations.


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Many NGOs have been involved in animal birth control
and dog rabies vaccination activities in major cities of
Nepal in the last 10 years.
 In 2007 a workshop on "Consensus Building among

National Alliance Partners to Eliminate Canine Rabies
in Nepal and Development of Strategic Plan" was
organized and supported by the World Health
Organization (WHO).
The Alliance Group for Rabies Control in Nepal has
been formed, comprising the Department of Livestock
Services, the Veterinary

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 Public Health Division, Kathmandu Metropolitan City
(KMC), Department of Public Health and Social Welfare,
Kathmandu Animal Treatment (KAT) Centre and National
Zoonoses and Food Hygiene Research Centre (NZFHRC).

 A National Workshop was organized in December 2010
to formulate a Rabies Control Strategy, which was
attended by all partners involved in rabies control in
Nepal.
 The Rabies Control Strategy will serve as a roadmap
for control and subsequent elimination of human rabies.

conclusion
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 In Nepal Rabies elimination programme focused
mainly on mass vaccination of dogs are largely justified
by the future savings of human rabies prevention
programme.
 A concerted effort between the human and animal

health sectors [jointed effort] for rabies elimination
was established.
WHO also provide technical inputs and support such

effort contineously.


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 Ministry of Health and Population
provideTissue culture vaccine for human use
to government hospitals on regular basis.
 WHO recommendition of five major activities

are applied.


Recommendation:
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The following all the actions that are needed:
1) Establish national rabies control programmes,
including appointment of National Programme
Officers, and develop five-year strategic plans of
action.
2) Improve rabies surveillance and data
collection.
3) Initiate measures to phase out nerve tissue
vaccines and replace them with modern tissue
culture vaccines.

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4) Promote rational use of TCVs for PEP and
encourage the introduction of cost-effective
intradermal (I/D) human rabies vaccination
schedule in major rabies vaccination centres.
5) Strengthen inter-ministerial and
intersectoral collaboration for rabies control in
canine population through mass vaccination,
dog population management and active
community participation. Many NGOs and
animal welfare groups are interested and
involved in rabies control.

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6) Develop appropriate measures to regulate
movement of dogs from one place to another
(rural to urban or island to island).
7) Community participation


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 www.searo.who.int
 Rabies Country Profile: Nepal
 www.nep.searo.who.int
 k park.


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Rabies in nepal

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