International Collaboration for Canine Rabies Elimination in Latin America.

The control of canine rabies across Latin America is the largest-scale recent success story in rabies control, and international agreements have been key  to its success. Since a regional initiative was launched in 1983 to eliminate canine rabies, the average number of cases of human and dog rabies in the region has undergone a reduction of over 95%. Human deaths due to canine rabies have fallen from almost 300 per year in the 1980s to 16, 13, 6, and 24 (13 in an outbreak in Haiti), in the years 2008 to 2011. This is based on a strategy of mass dog vaccination,timely provision of post exposure prophylaxis, education and surveillance.

A resolution signed in all PAHO countries in October 2009 set a goal for elimination from the region by 2015. Regular international meetings of both medical and veterinary ministries, and meetings of all the rabies program country directors have been vital in keeping the program moving towards elimination. Chile, Uruguay, some areas of Peru and Mexico have already declared themselves rabies-free,  Costa Rica and Nicaragua are in the process and 5 other countries are programmed for this self-declaration. PAHO is helping countries to apply for official WHO-sanctioned canine rabies free status(satisfying the criteria of 2 years without a rabies case). As canine rabies deaths decline, maintaining vigilance is both more critical and more difficult,so many former rabies control centers have been converted into zoonoses control centers to widen their remit and avoid capacity being lost altogether where canine rabies is no longer perceived as a problem.

The PAHO model stands as an excellent example of international co-operation and assistance, with all governments committing to the joint agreements and more developed countries assisting there source-poor countries. For example, Brazil has donated 20,000 doses of rabies vaccine and 1,000 vials of RIG to Haiti, and has technical cooperation agreements with several other countries. In July 2011, a canine vaccination campaign on the Peru/Bolivian border was carried out by teams from both countries (see picture) and another cross-border campaign is planned for Honduras/El Salvador border areas.

As the number of cases fall, the reduction to cases to zero becomes the challenge. The majority of cases now are in Bolivia and Haiti, and 16 hot spots of canine rabies transmission have been identified so that efforts can be focused towards elimination from the continent. These hot spots are often in very remote areas with many challenges but the reporting of cases from these hot spots is being strengthened to provide accurate data.

It is clear that whilst canine rabies is declining, in countries such as Brazil, Ecuador and Peru, wildlife (primarily vampire bat) transmitted rabies is present. In 2004 and for the first time, more people died as a result of exposure to wild animals, especially bats, than to dogs in South America. PAHO recently recommended the incorporation of Pre-Exposure Prophylaxis against rabies into the Expanded  Programme of Immunizationfor high risk Amazonian areas where the population is far from medical help, and this is now being carried out in some areas of Peru.

Contributed by the zoonosis team; Dr Marco Vigilato, Dr Ottorino Cosivi, Dr Alfonso Clavijo, Dr Hugo Tamayo and Dra Zaida Yadón at PANATFTOSA (the Pan American Center for Foot and Mouth Disease), The Pan American Health Organization.