Translating "policy into practice" for effective rabies control

Manila, January 22, 2014. Rabies experts from the public health and veterinary sectors of 7 Asian countries[1], from the Global Alliance for Rabies Control (GARC), and the regional offices of WHO (World Health Organization) and OIE (World Organization for Animal Health) gathered for 3 days in Manila for the tenth annual meeting of the Asian Rabies Expert Bureau (AREB).

The meeting was opened by the Philippines’ Assistant Secretary of Health, Dr Enrique Tayag, who highlighted the commitment of the Philippines government towards rabies control and elimination.

Marking the 10-year anniversary, rabies experts from 7 AREB countries acknowledged progress in rabies control accomplished in Asia.  These countries have established policies to control rabies, yet the experts debated their experience on the challenges to translate these “Policies into Practice”.  Major challenges identified included logistics, socio-cultural factors, and resources.

The majority of AREB countries have clear policies requesting notification of human and animal rabies cases, however the availability of data at the central level is not necessarily reflecting the true situation. Indeed, these data are crucial to document the importance of the disease, to help design and direct controls efforts, and to monitor the effectiveness of rabies control programs. AREB concluded by calling all Asian countries to implement effective surveillance for human and animal rabies.

AREB members agreed that elimination of dog-transmitted human rabies relies on collaboration of several stakeholders such as veterinarians and physicians, Ministries of Health, Education and Agriculture, local authorities, the private sector, the community, international organizations and NGOs. 

International organizations such as WHO, OIE and FAO (Food and Agriculture Organization) through their joint collaboration are establishing lead mechanisms for a “One Health” approach and are providing practical guidelines to implement this strategy at the country level.

Thailand was one of the first AREB countries to thoroughly implement a One Health approach to rabies control, and has succeeded in reducing the number of annual human rabies deaths down to currently less than 10.

Rabies control programs include both dog vaccination campaigns and treatment of bite victims through post-exposure prophylaxis (PEP). While some countries only have Animal Bite Treatment Centers (ABTCs) in major cities, close proximity to ABTC was identified by AREB members as key to saving lives.

In the Philippines, access to PEP significantly improved with the systematic establishment of additional ABTCs, from 257 centers before the Anti-Rabies Act of 2007, to 410 currently, with the goal of reaching 1000 centers by the end of 2016.

This latest AREB meeting was recognized as an important regional forum for exchange, sharing of experiences and debating practical solutions. AREB members remain committed to achieving the ASEAN+3[2] objective to eliminate rabies by 2020. 

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About rabies: Rabies is one of the most deadly diseases in the world today; it affects both humans and animals. It is caused by a virus that is transmitted through a bite, scratch, or lick of an infected animal, (mostly dogs) referred to as ‘exposure to rabies’. Once the symptoms occur, the disease inexorably leads to death. However, if ‘post-exposure prophylaxis’ (PEP) is provided rapidly after exposure, the patient’s life can be saved. This treatment includes immediate and extensive washing of the wound with soap and water, followed by immunization with a safe and effective vaccine and, if necessary, local administration of rabies immunoglobulin. Rabies PEP ensures both immediate and long-lasting protection.

The Asian Rabies Expert Bureau (AREB), founded in 2004, is an informal network of rabies experts from 12 countries: Bangladesh, Cambodia, China, India, Indonesia, Lao PDR, Myanmar, Pakistan, Philippines, Sri Lanka, Thailand, and Viet Nam. AREB is committed to contributing to rabies elimination in Asia. AREB members meet annually to present and discuss the rabies situation in their respective countries, share experiences, address specific problems encountered in clinical practice, and find practical solutions. 

AREB acknowledges a grant from Sanofi Pasteur and Merial.

[1] Cambodia, Indonesia, Laos, Myanmar, Philippines, Thailand and Vietnam.

[2] Association of South-East Asian Nations