RABIES CONTROL AND PREVENTION IN GEORGIA : CURRENT STATUS AND PERSPECTIVES P. IMNADZE, M.D.Ph.D V.Surguladze, T.Tushishvili, L.Baidoshvili

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RABIES CONTROL AND PREVENTION IN GEORGIA
CURRENT STATUS AND PERSPECTIVESP. IMNADZE,
M.D.Ph.DV.Surguladze, T.Tushishvili,
L.Baidoshvili

• National Centre for Disease Control
• www.ncdc.ge
• 9, M. Asatiani street
• 0177, Tbilisi
• Georgia

OIE/WHO/EC 2nd International Conference on
Rabies Paris, 27-30 May 2007
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RABIES CONTROL AND PREVENTION IN GEORGIA

• 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
  200381375-381.

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RABIES CONTROL AND PREVENTION IN GEORGIA

• Increasing cases of human rabies
• 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

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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
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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
• standard case definitions case registration,
  notification, reporting requrements
• data analysis case/outbreak investigation and
  response
• feedback and supervision of surveillance
  activities.
• protocols for sample collection, storage and
  transportation for lab investigation.

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RABIES CONTROL AND PREVENTION IN GEORGIA

• RESULTS
• 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.

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RABIES CONTROL AND PREVENTION IN GEORGIA

• Admissions following potential rabies exposure
  and the PEP received

  Number of cases Number of cases Number of cases Incidence/100 000 Incidence/100 000 Incidence/100 000 Annual increasing rate Annual increasing rate
  2004 2005 2006 2004 2005 2006 2005 2006
Admission to special care centers after exposure or suspected exposure to potentially rabid animal Admission to special care centers after exposure or suspected exposure to potentially rabid animal Admission to special care centers after exposure or suspected exposure to potentially rabid animal Admission to special care centers after exposure or suspected exposure to potentially rabid animal Admission to special care centers after exposure or suspected exposure to potentially rabid animal Admission to special care centers after exposure or suspected exposure to potentially rabid animal Admission to special care centers after exposure or suspected exposure to potentially rabid animal Admission to special care centers after exposure or suspected exposure to potentially rabid animal 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
Discontinued PEP received Discontinued PEP received Discontinued PEP received Discontinued PEP received Discontinued PEP received Discontinued PEP received Discontinued PEP received Discontinued PEP received Discontinued PEP received
  16568 23106 30254 382.7 533,4 687,4 39,5 30,9
Complete PEP received Complete PEP received Complete PEP received Complete PEP received Complete PEP received Complete PEP received Complete PEP received Complete PEP received Complete PEP received
  7144 7148 8315 165.0 165,1 188,9 0,06 16,3
Total PEP received Total PEP received Total PEP received Total PEP received Total PEP received Total PEP received Total PEP received Total PEP received Total PEP received
  23712 30254 38569 547.8 698,9 876,3 21,6 27,5
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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
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RABIES CONTROL AND PREVENTION IN GEORGIA

• Possible obstacles to delivery and surveillance
  of PEP
• 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

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RABIES CONTROL AND PREVENTION IN GEORGIA

• CONCLUSIONS
• 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