RABIES IN TUNISIA:Evolution and result of « National Program of Rabies Control »
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Transcript of RABIES IN TUNISIA:Evolution and result of « National Program of Rabies Control »
RABIES IN TUNISIARABIES IN TUNISIA
Evolution and result of Evolution and result of
« National Program of Rabies Control »« National Program of Rabies Control »
Kharmachi H., “National Reference Rabies Laboratory”, Institut Pasteur de Tunis – Tunisia”
With collaboration of the team of « National Commission of Rabies Control »:
Zaouia I., Khoufi S., Hrabech K., Mejri M., Turki I., Oukaïli K., Kortas J.
and the team of “National Reference Rabies Laboratory”:
Ben Maïz S., Bouslama Z., Ben Salem J., Basdouri N. and Handous M.
ContentsContents Epidemiology of Rabies in Tunisia
Animal Rabies Human Rabies
National Program of Rabies Control Role of I.P.T. in the epidemiological surveillance Impact of Control measures on the evolution
of rabies Conclusion
2
Epidemiology of Rabies in TunisiaEpidemiology of Rabies in Tunisia
Rabies is Enzootic and Endemic
Dog = « Reservoir and Vector » of Rabies
Other Domestic Animals = Victims
Wild Animals : Rares cases
Human = MAIN VICTIM of the disease
6
Dog
62,2%Cat
5,4%
Bovin
19,5%
Equin
6,2%
Sheep
5,2%
Goat
1,0%
Rodent
0,2%
Jackal
0,2%
Animal Rabies:
Species affected (2015)
Kair09N
Kef06N
Mon08N
Sil04N
kef08N
1Kef08N
Zag07N
sous05N
Kef09N
Bej04N
Zag09N
Med08N
Jend07N
1Jend06N
1Jend05N
Bej00N
Jend05N
Jend06N
1Sil06N
Sil05N
PV
Mokola
Ref: Amouri IK, Kharmachi H, Djebbi A, Saadi M, Hogga N, Zakour LB, Ghram A.
Molecular characterization of rabies virus isolated from dogs in Tunisia: evidence of two phylogenetic variants.
Virus Res. (2011 Jun); 158(1-2):246-50.
Cluster 1: N.O
Mokola
0.05
Cluster 2: N.C.S
Animal Rabies: Genotype1: Canine rabies strain = Two Phylogenic variants:
Ref: Amouri IK, Kharmachi H, Djebbi A, Saadi M, Hogga N, Zakour LB, Ghram A.
Molecular characterization of rabies virus isolated from dogs in Tunisia: evidence of two phylogenetic variants.
Virus Res. (2011 Jun); 158(1-2):246-50.
Mokola
0.05
Animal Rabies: Genotype1: Canine rabies strain = Two Phylogenic variants:
9
Animal Rabies: Animal Rabies:
Evolution of Rabies Incidence Evolution of Rabies Incidence
(2000 (2000 –– 2015)2015)
0
50
100
150
200
250
300
350
400
450
500
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
ANIMALS
DOGS
Rabies is Notifiable Disease:
Since 1969 (law 69/53 of 29/7/1969)
All cases are confirmed by Laboratory:
Rabies laboratory of IPT
Since 1961
Human (and Animal) rabies diagnosis
Only One laboratory for diagnostic in the country :
Methods used: FAT + RTCITFAT + RTCIT
12
Human RabiesHuman Rabies
Annual Incidence of Annual Incidence of
Human Rabies: 2000 Human Rabies: 2000 -- 20152015
2
0
2 2
3 3
1
2
4
0
2
1
3
6
3
6
0
1
2
3
4
5
6
Nu
mb
er L
abo
rato
ry c
on
firm
ed o
f C
ases
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015 Years
13
National Program of Rabies National Program of Rabies
Control (NPRC)Control (NPRC)
Strategy:
◦ Mass vaccination of dogs: Ministry of Agriculture
◦ Prevention of Human Rabies: Ministry of Health
◦ Control of dog population : Ministry of Interior
Management: by National Multidisciplinary
Commission of Rabies Control
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Mass Vaccination Campain: Mass Vaccination Campain: every yearevery year + Public education & public awareness+ Public education & public awareness
Rabies is Fatal Vaccinate me you protect meVaccinate me you protect me & you will be protected& you will be protected
PostPost--exposure Prophylaxyexposure Prophylaxy
Structures
◦ Number of centers: 206206 specific centres
(+emergency hospital services) = 310310 (total PEP c.)
◦ Localisation : All regions of country
◦ Management : Ministry of health (free of charge)
17
19
National Ref.National Ref. LABORATORYLABORATORY
I.P.T.I.P.T.
VETS
(CRDA)
Prime Health
Centers
Public Collectivities
(Control of Dog Population )
Specimen
Collect Information
Epidemiological surveillance of Animal RabiesEpidemiological surveillance of Animal Rabies
20
Epidemiological surveillance of Animal Rabies:Epidemiological surveillance of Animal Rabies:
458415 423
282
627
952
11481055
0
200
400
600
800
1000
1200
19
95
-
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
Years
Evolution of number of samples tested
_ m:
Impact of Impact of
Control Measures in the Control Measures in the
Evolution of RabiesEvolution of Rabies
21
Impact of actions of N.P.R.C. on the evolution of
Humaine Rabies incidence
16/an
5 5
0
8
10
3
5
11
25
6
45
7
3
1 12
0
2 23 3
12
4 (+2c)*
0
21
3
6 (+1c)*
3
6
0
5
10
15
20
25
No
mb
re d
e ca
s co
nfi
rmés
au
Lab
ora
toir
e
1960-1
982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Années
Start of
NPRC
Stop of
Mass Vaccination
Campaigns for Dogs
Re-start of
Mass Vaccinations
Camoaigns for Dogs
16/an
5 5
0
8
10
3
5
11
25
6
45
7
3
1 12
0
2 23 3
12
4 (+2c)*
0
21
3
0
5
10
15
20
25
Nom
bre
de ca
s con
firm
és a
u La
bora
toire
1960
-198
2
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Années
16/an
5 5
0
8
10
3
5
11
25
6
45
7
3
1 12
0
2 23 3
12
4 (+2c)*
0
21
3
0
5
10
15
20
25N
ombr
e de
cas c
onfir
més
au
Labo
rato
ire
1960
-198
2
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Années
N=N=66; ; S=S=19 19
M=M=33,,22
N=4; S=44;
M=M=1111,,00 N=N=2020; ; S=S=54 54
M=M=22,,77
Program Program AchievementsAchievements.
= Saved lives
16/an
5 5
0
8
10
3
5
11
25
6
45
7
3
1 12
0
2 23 3
12
4 (+2c)*
0
21
3
0
5
10
15
20
25
Nomb
re de
cas co
nfirm
és au
Labora
toire
1960
-1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Années
N=6; N=6; S=19 S=19
M=3,2M=3,2
N=4; S=44;
M=11,0M=11,0
N=20; N=20; S=54 S=54
M=2,7M=2,7
6x16=966x16=96
9696--1919==77
2020xx1616==320320
320320--5454==266266
ConclusionConclusion
Rabies is endemic and enzootic in Tunisia
National Rabies Control Program reduces rabies incidence
during many years (1983 to 1988 and 1993 to 2010)
Actually: Increase in the incidence (2012 to 2015)
NRCP need improvements:
Improvement of vaccination coverage of dogs:
- Actually 50%-60%;
- Objective: to reach75% of canine population
Better management of dog’s polpulation
Improvement public education and awerness about rabies
Rigourous application for recommendations of PEP protocols
26
ConclusionConclusion
Pasteur Institute Rabies Laboratory (National Reference
Laboratory of Rabies) plays a leading role in
epidemiological surveillance of rabies in Tunisia
NRLR contributes in the national commission to evaluate
the actions of rabies control.
NRLR conducts applied research program to propose
solutions to improve control of rabies
27