The 14th REDIPRA in Lima, Peru

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Since their first meeting in Ecuador in 1983, the regular Meetings of Directors of National Programs for Rabies Control in Latin America (REDIPRA) have established regional agreements for and driven progress towards the elimination of dog-transmitted human rabies and the control of wildlife rabies in the region. Under, the institutional umbrella of PAHO, they integrate both human and veterinary health services and have achieved remarkable success.

The 14th REDIPRA was held in Lima (Peru) in August 2013, and focused on the elaboration of an action plan targeting the countries or pockets within countries where dog-mediated rabies circulation still persists, in order to accelerate progress towards dog-mediated rabies elimination in Latin America by 2015. This will be submitted to the all Ministries of Health and Agriculture for their endorsement and political commitment.

Additional objectives focused on strengthening surveillance, preventing wildlife-mediated rabies (mainly in vampire bats), defining and characterizing risk areas, strengthening awareness campaigns, and improving regional programme coordination (in terms of vaccines, funding and data management).

There were contributions from countries on the progress of their rabies elimination programmes, and also valuable reports on individual projects;  on the appropriateness of pre-exposure vaccination in remote high risk areas, modelling  control of bat-transmitted livestock rabies, developing  a new regional rabies diagnostic laboratory network (REDILAR) and the perspectives of international organisations and NGOs including GARC.

The control and elimination of rabies in Latin America is frequently cited in the rabies community as the exemplary regional programme, and there are many reasons why this region can be proud of its achievements.

Since 1983, the number of cases of human rabies has dropped 95 % (from 355 cases in 1982 to 10 in 2012). Cases of rabies in dogs have fallen by 98 % (from ~25,000 cases in 1980 to 400 in 2010), with a very localized geographic distribution. Of the 570 provinces and  states in Latin America, only 11 (2 %) have recorded cases of human rabies in the last four years. These were concentrated on the outskirts of large cities and in international border zones, where transient and marginalized populations have little knowledge of the risks of the disease and limited access to quality health services.

Sitting in the meeting, the deep sense of commitment of all participants collectively striving towards the goal of eliminating dog-mediated human rabies from the region and to seriously tackle the next step of better managing wildlife-mediated rabies risks was evident.

This region has accumulated considerable knowledge in on how to achieve dog-mediated rabies elimination and has a story to tell to other regions who are still struggling. Of course there are still challenges, notably maintaining high political commitment and funds for national rabies programmes, despite the disappearance of human rabies cases.

Or how to certify elimination of dog-mediated rabies for an entire region and deferring from it what would be the appropriate level of surveillance feasible to prove this and satisfy international standards.

Other aspects discussed were the involvement and responsibilities of actors beyond the medical and veterinary field, such as municipalities, private sector, tourism, communication and education and other disease control programmes. For the latter, Peru presented an interesting case on how PrEP vaccination on  Amazonian populations for protection against rabies in an enormous effort to prevent bat-mediated rabies exposures. Many countries in the region have observed an increase in tourism, particularly ecotourism to remote areas, leading to wildlife exposures, e.g. in caves. There was a call for new strategies and international guidelines how to better deal with awareness creation on rabies risks in ecotourism.

WSPA, in collaboration with GARC and PAHO, presented the newly developed educational materials entitled the “Five keys for dog bite prevention”.  Together with training of medical personnel on risk assessment for post exposure prophylaxis, these have  role to play in reducing the large proportion of funds allocated to rabies control currently still spent on PEP, especially where areas are close to elimination Dog bites, regardless the rabies risk, seem to be a rising public health issue and prompted discussions on to the difficulties of implement existing legislation on responsible dog ownership.

The network decided to enhance its activities between meetings through reinforcement of technical working groups (on epidemiologic surveillance, laboratories, prevention, communication and education) to accelerate the implementation of the action plan.

The REDIPRA has proven again that it is a solid network which has not only the necessary technical expertise, but also the long term ability to effectively coordinating across borders, to maintain an excellent spirit of trust among the participating countries and individuals, including solidarity and assistance to the weakest within the region.

Contributed by Lea Knopf, Institutional Relations for GARC who attended the REDIPRA meeting.