Progress towards a control policy in the Punjab

In June 2011, a series of significant steps were taken towards improved rabies control in the Punjab, Pakistan. Firstly, dog bite management workshops in Multan, Lahore and Islamabad were carried out, thanks to the cooperation of the Department of Health of the Punjab (DGHS Punjab), the World Health Organization (WHO) and the Government Bacteriologist of the Punjab. One focal person from each of the 36 district hospitals of Punjab, other private hospitals and Tertiary Care Hospitals attended. The workshops covered both theoretical and practical aspects of wound management, with opportunities to ask questions and to see a movie.

Next, WHO in collaboration with DGHS, Punjab held a meeting on 23rd June to develop a joint and comprehensive rabies control strategy for next two years. Also present were representatives of Local Government, Novartis, University of Veterinary Sciences, CDC and Bacteriologist Department.

The salient features of the strategy that evolved are:

1. Increased mass awareness of rabies transmission, prevention and self protection using cost effective means such as local government and community communication structures.
2. Establishment of rabies treatment centers at each District Headquarters Hospital where health care providers would be trained on management and treatment of dog bites with availability of anti rabies vaccine.
3. Ensuring the most cost effective and efficacious anti Rabies vaccines in designated Rabies treatment centers in all districts.
4. Enactment and enforcement of laws relating to vaccination of pet animals such as dogs and cats in order to decrease rabies incidence among them.
5. Mechanisms to decrease the stray dog population in the districts through the use of modern methods such as bait vaccination and dog elimination.
6. Developing a surveillance system to monitor dog bites, dog rabies and human rabies through the use of existing death reporting system under local government structures.
7. Close collaboration between the three Government departments in the control of Rabies.
8. Research on animal rabies and development of animal and human rabies vaccines by the University of Veterinary sciences, Lahore.

 

Finally on 24th June, a press conference in both English and Urdu was arranged at the Press Club, Lahore to publicise the strategy. Dr. Quaid Saeed of WHO, and Dr. Zarfishan Tahir of DGHS were joined by Dr. Babar Alam, Dr. Sajid, and Dr. Mubashir Malik and they started with a brief description of rabies in Pakistan.

According to the National Health Management Information System 2010 report there were more than 97,000 recorded cases of dog bites reported by Basic Health Units in Pakistan. This does not include those managed by secondary and tertiary care facilities, nor the estimated 80% that are managed by private practitioners, spiritual healers and Hakims. In the Punjab, there is one dedicated dog bite treatment center in the Institute of Public Health, Lahore that receives more than 200 cases of dog bites daily, for wound management and anti-rabies vaccine at subsidized rates.

However, most of the population are unaware of the risk of rabies when they are bitten by dogs or do not seek the right treatment for its prevention. In 2004, WHO estimated 17 deaths per million in Pakistan due to rabies. Inadequate surveillance, poor access to modern vaccine and immunoglobulin, weak political support and resources and ineffective collaboration have until now limited effective rabies control.

 

The press were then presented with a summary of the strategy developed, and questions were answered. The benefits of ID administration of vaccine were detailed by Dr. Saeed  and Dr. Malik also announced that the Government has procured an efficacious and WHO approved vaccine which will be available free of charge in all district hospitals.

Submitted by Dr. Zarfishan Tahir (DGHS Punjab). A newspaper article resulting from the press conference is available here.