RABIES CONTROL AND PREVENTION IN GEORGIA : CURRENT STATUS AND PERSPECTIVES P. IMNADZE, M. D. Ph. D V. Surguladze, T. Tushishvili, L. Baidoshvili National Centre for Disease Control www. ncdc. ge 9, M. Asatiani street 0177, Tbilisi Georgia OIE/WHO/EC 2 nd International Conference on Rabies Paris, 27 -30 May 2007
RABIES CONTROL AND PREVENTION IN GEORGIA n INTRODUCTION The incidence of rabies post-exposure prophylaxis (PEP) in Georgia is very high and continuously increasing : - From 547, 8 up to 698, 9 and to 876, 3 in 2004, 2005 and 2006 per 100 000 population respectively. - While, by comparison, 200 PEP/100, 000 persons per year between 1996 and 2001 in a rabies endemic region of Thailand [Kamoltham T, Singhsa J, Promsaranee U, et al. Elimination of human rabies in a canine endemic province in Thailand: five-year program. Bull WHO 2003; 81: 375 -381].
RABIES CONTROL AND PREVENTION IN GEORGIA Increasing cases of human rabies : n n n 40 cases reported between 1986 and 1995 Average of 10 cases/year reported from 1996 to 2006 Almost all cases caused by dog bites (major risk factors : large population of stray dogs and unvaccinated pets) Number of human rabies cases reported per year in Georgia : 1986 through 2006
RABIES CONTROL AND PREVENTION IN GEORGIA The incidence of rabies : 0. 28 cases/100, 000 in 2004 0. 23 cases/100, 000 in 2005 0. 16 cases/100, 000 in 2006 Which is higher than the incidence in other countries of the former Soviet Union Incidence of human rabies in Georgia compared to other countries: 2002 -2005
RABIES CONTROL AND PREVENTION IN GEORGIA OBJECTIVE The objective of this study was : - to collect rabies case and post-exposure prophylaxis (PEP) information - to assist in improving PEP policy and practice - to determine priorities for national rabies control and surveillance METHODS Collection of data on PEP of rabies and suspected rabies exposure reported to the National Center for Disease Control Communicable Disease Surveillance Guidelines http: //www. phrplus. org/ids_pubs. html http: //www. ncdc. ge – Georgian (cover VPDs, Diarheal diseases, Viral Hepatitis, Meningitis, Rabies) Includes: ü standard case definitions; case registration, notification, reporting requrements; ü data analysis; case/outbreak investigation and response; ü feedback and supervision of surveillance activities. ü protocols for sample collection, storage and transportation for lab investigation.
RABIES CONTROL AND PREVENTION IN GEORGIA n RESULTS o o 47, 831 admissions for exposure or suspected exposure to potentially rabid animals in 2006; 39, 799 - in 2005; and 33, 889 in 2004; an increase of 17 -20% annually. 38, 569 PEP after exposure to potentially rabid animals In 2006, compared to 30, 254 in 2005 and 23, 712 in 2004; an increase of 21. 6 -27, 5% annually From total PEP initiated in 2004 - 16, 568 (69. 9%) were discontinued due to the animals remained healthy during observation; 23, 106 (76. 4%) were discontinued in 2005; and 30, 254 (78, 4%) - in 2006. PEP was determined not to be required in 10, 180 admissions (30%) , 9, 945 admissions (25%) and 9, 262 admissions (19%) in 2004, 2005 and 2006, respectively.
RABIES CONTROL AND PREVENTION IN GEORGIA Admissions following potential rabies exposure and the PEP received Number of cases 2004 2005 2006 Incidence/100 000 2004 2005 2006 Annual increasing rate % 2005 2006 Admission to special care centers after exposure or suspected exposure to potentially rabid animal 33892 39799 47831 782. 9 919, 4 1086, 7 +17, 4 +20, 1 30254 382. 7 533, 4 687, 4 +39, 5 +30, 9 7148 8315 165. 0 165, 1 188, 9 +0, 06 +16, 3 30254 38569 547. 8 698, 9 876, 3 +21, 6 +27, 5 Discontinued PEP received 16568 23106 Complete PEP received 7144 Total PEP received 23712
RABIES CONTROL AND PREVENTION IN GEORGIA The number of reported admissions for treatment following exposure or suspected exposure to potentially rabid animals has increased each year since 2000, along with an increase of discontinued PEP The number of admissions to special care centers following exposure or suspected exposure to potentially rabid animals and the PEP received
RABIES CONTROL AND PREVENTION IN GEORGIA n Possible obstacles to delivery and surveillance of PEP o o Concerns on the safety and /or the availability of antirabies immunoglobulins In some cases, uncertainty how to use vaccines and immunoglobulins from different manufacturers in national guidelines
RABIES CONTROL AND PREVENTION IN GEORGIA n CONCLUSIONS q q q For effective control of rabies, the national veterinary programs should be improved Stray dog population control measures adequately updated according to international standards Clear national guidelines for use of available rabies vaccines and immunoglobulins for PEP should be revised and implemented
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