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Sri Lanka is among the top ten countries in the world that report the highest rate of human rabies deaths (2.8 per 1,000,000 in 2007) and animal bites requiring anti-rabies post-exposure treatment (PET) (755 per 100,000 in 2003). Dogs are the main reservoir and transmitters of rabies in Sri Lanka. Present study evaluates the effectiveness of dog ra...
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Context 1
... 9.7% free-roaming at variable distances from their owner’s house- hold). Main rabies control strategies adopted by the Ministry of Health, Sri Lanka, are: mass dog vaccination, dog population control and provision of post-exposure treatment (PET) for at risk animal bite victims. Dog rabies control is primarily the responsibility of the Public Health Veterinary Services (PHVS), Ministry of Health. Dog vaccination, first launched in 1975, is carried out annually; free of charge, by certified vaccinators in the district rabies control units. During these vaccination campaigns, vaccination of owned dog is carried out at pre-arranged temporary vaccination posts while stray dog vaccination is carried out using a special device called ‘Auto Plunger’. The owner is given a vaccination certificate. Animal rabies vaccines available in Sri Lanka are killed-virus vaccines and confer 1–3 years immunity (Perera et al., 2000). Elimination of stray dogs had been carried out since 1975 in Sri Lanka as a method of dog population control (Harischandra, 1997); however it was abandoned in 2005 and was replaced by surgical and chemical animal birth control (ABC) methods. Post-exposure treatment (PET) is provided free of charge to all eligible animal bite victims coming to government hospitals in Sri Lanka At present, 85% of patients seeking PET are administered tissue culture vaccine intradermally (Wimalaratne, 2007). It is estimated that about 375,000 animal bite victims seek treatment each year; out of which, about 200,000 are administered PET (Wimalaratne, 2007). Human rabies death rates, for the period of 1973–2007, were calculated using the published data: total number of human rabies deaths reported by the Public Health Veterinary Services and the midyear human population estimated by the Department of Census and Statistics, Sri Lanka, for each year. Calculations were carried out for the entire country and for administrative districts which correspond to the district Public Health units as presented in Fig. 1. For the purpose of calculating the annual coverage (percentage) of rabies control activities implemented in Sri Lanka, it was necessary to obtain an estimate for the total dog population. As data on the dog population for the districts or for the country are not available from veterinary or public health sources or published reports, our estimates were based on human: dog ratios. The ratio estimates for Sri Lanka are from sample surveys which do not represent the whole country (WHO, 1988; Matter et al., 2000), thus the dog population per year was estimated using ratios published for Asia by Knobel et al. (2005). This was considered equivalent to the ratio expected in Sri Lanka, given the fact that the authors have calculated the estimates based on all the available reports from Asia including the two from Sri Lanka. The mean ratio estimated for Asia is 9.5:1 (95% confidence interval 4.5:1–14.6:1). We assumed a con- stant human: dog ratio from 1975–2007. Dog population, estimated above, was used as the denominator for calculating the annual coverage (percentage) for rabies control activities implemented in Sri Lanka, based on the numbers reported for dog vaccination, dog elimination and dog animal birth control (ABC) by the Public Health Veterinary Services. Correlations were calculated between annual human rabies death rate and dog vaccination rate for the period of 1975–2007, and between annual human rabies death rate and dog elimination rate the period of 1975–2005. Geographic Information System (GIS) was also used to illustrate the district distributions of human rabies deaths and the estimated dog population density, aiming to identify areas of susceptibility (Fig. 2). Human rabies deaths have declined substantially in Sri Lanka from 310 deaths (22.2 per 1,000,000) in 1977 to 56 (2.8 per 1,000,000) in 2007; the 55 cases reported during 2005 were the lowest during the last 3 decades (Fig. 3). However, country wide surveillance data were not available for calculating the annual dog rabies death rates. Rate of mass dog vaccination had increased from 3.2% in 1975 to 49.3% in 2007. The rate of dog elimination was less than 10% throughout the period of 1975–2005. The highest rate of ABC achieved was 2.3% in 2006 (Fig. 4). Correlations between human rabies death rate and dog vaccination rate ( − 0.836; p < 0.01) for the period of 1975–2007 and between human rabies death rate and dog elimination rate ( − 0.589; p < 0.01) for the period of 1975–2005 were negative and statistically significant (Figs. 5 and 6). Since the ABC had been implemented for only few years there was not adequate data for calculating correlation between human rabies death rate and ABC rate. Country wide hospital data were not available for calculating the correlation between human rabies death rate and rate of PET administration to at risk animal bite victims. The GIS map of human rabies death rate showed an unequal distribution among the districts (Fig. 1). Districts of Mannar and Killinochchi had the highest human rabies death rates. Districts of Colombo, Kegalle, Pollonnaruwa, Puttlum, Badulla, Ampara, Vayniya, and Mullative had zero deaths. The GIS map for the estimated dog population showed an uneven distribution among the districts and did not directly correlate with the distribution of human rabies death rates (Fig. 2). A remarkable decline in the national incidence of human rabies deaths is observed since the establishment of the rabies control program in 1975. This downward trend could be due to many factors: dog rabies control measures implemented by the Public Health Veterinary Services such as mass dog vaccination and dog population control; increased availability of modern post exposure treatment (PET); increased treatment seeking by animal bite victims, their better management and accurate reporting of human rabies due to improved laboratory based diagnosis of deaths. However, similar to the situation reported in Thailand (Sintunawa et al., 2004), the reduction in human rabies deaths has masked the simultaneous and increasingly high economic burden due to the direct and indirect costs of PET. The annual cost to the Ministry of Health to provide rabies PET was equivalent to US$ 3 M in 2005 (Wimalaratne, 2007). Thus human rabies still remains a significant public health problem in Sri Lanka. Incidence of human rabies vary among districts. The highest rates observed in Mannar and Kilinochchi districts (Fig. 1) could be due to circumstances created by the war; increase in rabies incidence during war times has been documented elsewhere (Awerbuch-Friedlander, 2005). However these districts are bor- dered by districts with zero reporting. Zero incidence in Puttalam may reflect enhanced rabies control activities as shown by relatively high coverage for dog vaccination (77.7%) and dog population control (12.1%). However, zero incidence in Vavuniya, and Mullaitivu may reflect low human and dog densities or lack of data due to poor human and dog rabies surveillance. It is important to note that the districts carry out rabies control activities and surveillance independently. As shown in Fig. 2, district of Colombo, with zero incidence of human rabies had the highest estimated dog population density. This may be due to better dog vaccination and dog population control, achieved partly through a greater contribution by the private sector compared to other districts, and higher PET administration through enhanced access to medical facilities. On the other hand, Mannar which has one of the highest human rabies death rates is among the districts with the lowest dog population densities. Likewise districts with similar human rabies death rates have quite different dog population densities e.g.Gampaha vs Ratnapura; Gampaha vs Trincomalee. Although high dog population density has shown to be associated with endemic foci of rabies, where ownerless/stray dogs were predominant and the dog population turnover was relatively high (Beran and Frith, 1986), dog population density alone was not found to be a valid indicator of risk of dog rabies. Although our analysis showed strong correlations between incidence of human rabies deaths and mass dog vaccinations; as well as between incidence of human rabies deaths and dog population control by elimination, the measures taken until now were not sufficient to eradicate the risk of rabies to humans; suggesting that dog rabies control strategies should be based on a deeper understanding of the dog ecology. In Sri Lanka, the rabies virus predominantly circulates within the dog population, (Arai et al., 2001; Nanayakkara et al., 2003; Patabendige and Wimalaratne, 2003), therefore eradication of dog rabies is assumed to be the most logical solution to eliminate the risk of rabies to humans. Maintenance of rabies among dogs mainly depends on the size of the population of susceptible dogs. The natural transmission cycle of the disease can be interrupted by keeping the population of susceptible dogs below a threshold value (Baren, 1991). This can be done by developing and sustaining immunity among the dogs and/or by dog population control. As the natural infection is almost always fatal, immunity among dogs is almost exclusively achieved by vaccination (Bingham, 2005). Mass vaccination of dogs has been the mainstay of successful dog rabies control programs in various settings including those that lead to elimination of rabies in Malaysia and Japan and its control in Europe and North America (Cleaveland et al., 2006). It is stated that the most cost-effective, logical and ethical approach to reduce the susceptible dog population in resource-limited countries is through mass dog vaccination (Bogel and Meslin, 1990; Zinsstag et al., 2007). Unlike the control of wild life rabies with oral vaccine baits distributed to the wild animal population at large (Aubert et al., 1994; Awerbuch-Friedlander, 2005), dog vaccination ...
Context 2
... Lanka is among the top ten countries in the world that report the highest rate of human rabies deaths (2.8 per 1,000,000 in 2007) and potential rabid animal bites requiring post-exposure treatment (755 per 100,000 in 2003) (WHO, 2008). Human rabies deaths are reported from most of the 25 districts of Sri Lanka each year ( Fig. 1) (Public Health Veterinary Services (PHVS), 2008). In Sri Lanka, only 42.8% of human rabies deaths were confirmed with laboratory test- ing in 2007 (WHO, 2008). Due to the limited island wide surveillance on animal rabies by veterinary health authorities, the incidence of animal rabies is largely undetermined. Dogs are the main reservoir and transmitter of rabies in Sri Lanka, wildlife plays a much lesser role in transmission (Matter et al., 2000; Wimalaratne, 2007). Nearly 90.0% of rabies cases diagnosed in animals at the Medical Research Institute (MRI) during 1995–2005 were among dogs; proportion of wild animals such as mongooses and jackals were less than 5% and bat rabies was not reported (WHO, 2008). It is not known whether separate sylvatic rabies cycles occur in Sri Lanka; rabies among wild animals and domestic animals other than dogs and cats observed are stated as probably due to spill-over from rabies in dogs (Arai et al., 2001). As depicted by phylogenetic analysis by Arai et al. (2001) and Nanayakkara et al. (2003), in Sri Lanka, there are no lyssavirus other than the rabies virus. Among human rabies deaths notified during the years 2000–2006 to the Epidemiology Unit, deaths recalled as due to a dog bite varied from 62.6% to 85.4% and as due to a stray dog bite varied from 24.2% to 48.0% (Epidemiology Unit, 2000–2006). Data on dog ecology including their population densities, population structure and characteristics in different districts in Sri Lanka are scarce. A dog ecology study conducted in 1980s in Sri Lanka has revealed a dog: human ratio of 1:8 (WHO, 1988). Another study carried out in 1997 in Meerigama Divisional Secretariat area in Gampaha District, has found a dog: human ratio of 1:4.6 (95% 4.3; 5.0) (Matter et al., 2000). According to the same study, 19.4% (13.5, 25.4%) of the dogs were ownerless; among owned dogs older than 3 months, 39.6% were either chained up or locked, while 60.4% were free-roaming (50.7% free-roaming on the dog owner’s premises and 9.7% free-roaming at variable distances from their owner’s house- hold). Main rabies control strategies adopted by the Ministry of Health, Sri Lanka, are: mass dog vaccination, dog population control and provision of post-exposure treatment (PET) for at risk animal bite victims. Dog rabies control is primarily the responsibility of the Public Health Veterinary Services (PHVS), Ministry of Health. Dog vaccination, first launched in 1975, is carried out annually; free of charge, by certified vaccinators in the district rabies control units. During these vaccination campaigns, vaccination of owned dog is carried out at pre-arranged temporary vaccination posts while stray dog vaccination is carried out using a special device called ‘Auto Plunger’. The owner is given a vaccination certificate. Animal rabies vaccines available in Sri Lanka are killed-virus vaccines and confer 1–3 years immunity (Perera et al., 2000). Elimination of stray dogs had been carried out since 1975 in Sri Lanka as a method of dog population control (Harischandra, 1997); however it was abandoned in 2005 and was replaced by surgical and chemical animal birth control (ABC) methods. Post-exposure treatment (PET) is provided free of charge to all eligible animal bite victims coming to government hospitals in Sri Lanka At present, 85% of patients seeking PET are administered tissue culture vaccine intradermally (Wimalaratne, 2007). It is estimated that about 375,000 animal bite victims seek treatment each year; out of which, about 200,000 are administered PET (Wimalaratne, 2007). Human rabies death rates, for the period of 1973–2007, were calculated using the published data: total number of human rabies deaths reported by the Public Health Veterinary Services and the midyear human population estimated by the Department of Census and Statistics, Sri Lanka, for each year. Calculations were carried out for the entire country and for administrative districts which correspond to the district Public Health units as presented in Fig. 1. For the purpose of calculating the annual coverage (percentage) of rabies control activities implemented in Sri Lanka, it was necessary to obtain an estimate for the total dog population. As data on the dog population for the districts or for the country are not available from veterinary or public health sources or published reports, our estimates were based on human: dog ratios. The ratio estimates for Sri Lanka are from sample surveys which do not represent the whole country (WHO, 1988; Matter et al., 2000), thus the dog population per year was estimated using ratios published for Asia by Knobel et al. (2005). This was considered equivalent to the ratio expected in Sri Lanka, given the fact that the authors have calculated the estimates based on all the available reports from Asia including the two from Sri Lanka. The mean ratio estimated for Asia is 9.5:1 (95% confidence interval 4.5:1–14.6:1). We assumed a con- stant human: ...
Context 3
... Lanka is among the top ten countries in the world that report the highest rate of human rabies deaths (2.8 per 1,000,000 in 2007) and potential rabid animal bites requiring post-exposure treatment (755 per 100,000 in 2003) (WHO, 2008). Human rabies deaths are reported from most of the 25 districts of Sri Lanka each year ( Fig. 1) (Public Health Veterinary Services (PHVS), 2008). In Sri Lanka, only 42.8% of human rabies deaths were confirmed with laboratory test- ing in 2007 (WHO, 2008). Due to the limited island wide surveillance on animal rabies by veterinary health authorities, the incidence of animal rabies is largely undetermined. Dogs are the main reservoir and transmitter of rabies in Sri Lanka, wildlife plays a much lesser role in transmission (Matter et al., 2000; Wimalaratne, 2007). Nearly 90.0% of rabies cases diagnosed in animals at the Medical Research Institute (MRI) during 1995–2005 were among dogs; proportion of wild animals such as mongooses and jackals were less than 5% and bat rabies was not reported (WHO, 2008). It is not known whether separate sylvatic rabies cycles occur in Sri Lanka; rabies among wild animals and domestic animals other than dogs and cats observed are stated as probably due to spill-over from rabies in dogs (Arai et al., 2001). As depicted by phylogenetic analysis by Arai et al. (2001) and Nanayakkara et al. (2003), in Sri Lanka, there are no lyssavirus other than the rabies virus. Among human rabies deaths notified during the years 2000–2006 to the Epidemiology Unit, deaths recalled as due to a dog bite varied from 62.6% to 85.4% and as due to a stray dog bite varied from 24.2% to 48.0% (Epidemiology Unit, 2000–2006). Data on dog ecology including their population densities, population structure and characteristics in different districts in Sri Lanka are scarce. A dog ecology study conducted in 1980s in Sri Lanka has revealed a dog: human ratio of 1:8 (WHO, 1988). Another study carried out in 1997 in Meerigama Divisional Secretariat area in Gampaha District, has found a dog: human ratio of 1:4.6 (95% 4.3; 5.0) (Matter et al., 2000). According to the same study, 19.4% (13.5, 25.4%) of the dogs were ownerless; among owned dogs older than 3 months, 39.6% were either chained up or locked, while 60.4% were free-roaming (50.7% free-roaming on the dog owner’s premises and 9.7% free-roaming at variable distances from their owner’s house- hold). Main rabies control strategies adopted by the Ministry of Health, Sri Lanka, are: mass dog vaccination, dog population control and provision of post-exposure treatment (PET) for at risk animal bite victims. Dog rabies control is primarily the responsibility of the Public Health Veterinary Services (PHVS), Ministry of Health. Dog vaccination, first launched in 1975, is carried out annually; free of charge, by certified vaccinators in the district rabies control units. During these vaccination campaigns, vaccination of owned dog is carried out at pre-arranged temporary vaccination posts while stray dog vaccination is carried out using a special device called ‘Auto Plunger’. The owner is given a vaccination certificate. Animal rabies vaccines available in Sri Lanka are killed-virus vaccines and confer 1–3 years immunity (Perera et al., 2000). Elimination of stray dogs had been carried out since 1975 in Sri Lanka as a method of dog population control (Harischandra, 1997); however it was abandoned in 2005 and was replaced by surgical and chemical animal birth control (ABC) methods. Post-exposure treatment (PET) is provided free of charge to all eligible animal bite victims coming to government hospitals in Sri Lanka At present, 85% of patients seeking PET are administered tissue culture vaccine intradermally (Wimalaratne, 2007). It is estimated that about 375,000 animal bite victims seek treatment each year; out of which, about 200,000 are administered PET (Wimalaratne, 2007). Human rabies death rates, for the period of 1973–2007, were calculated using the published data: total number of human rabies deaths reported by the Public Health Veterinary Services and the midyear human population estimated by the Department of Census and Statistics, Sri Lanka, for each year. Calculations were carried out for the entire country and for administrative districts which correspond to the district Public Health units as presented in Fig. 1. For the purpose of calculating the annual coverage (percentage) of rabies control activities implemented in Sri Lanka, it was necessary to obtain an estimate for the total dog population. As data on the dog population for the districts or for the country are not available from veterinary or public health sources or published reports, our estimates were based on human: dog ratios. The ratio estimates for Sri Lanka are from sample surveys which do not represent the whole country (WHO, 1988; Matter et al., 2000), thus the dog population per year was estimated using ratios published for Asia by Knobel et al. (2005). This was considered equivalent to the ratio expected in Sri Lanka, given the fact that the authors have calculated the estimates based on all the available reports from Asia including the two from Sri Lanka. The mean ratio estimated for Asia is 9.5:1 (95% confidence interval 4.5:1–14.6:1). We assumed a con- stant human: dog ratio from 1975–2007. Dog population, estimated above, was used as the denominator for calculating the annual coverage (percentage) for rabies control activities implemented in Sri Lanka, based on the numbers reported for dog vaccination, dog elimination and dog animal birth control (ABC) by the Public Health Veterinary Services. Correlations were calculated between annual human rabies death rate and dog vaccination rate for the period of 1975–2007, and between annual human rabies death rate and dog elimination rate the period of 1975–2005. Geographic Information System (GIS) was also used to illustrate the district distributions of human rabies deaths and the estimated dog population density, aiming to identify areas of susceptibility (Fig. 2). Human rabies deaths have declined substantially in Sri Lanka from 310 deaths (22.2 per 1,000,000) in 1977 to 56 (2.8 per 1,000,000) in 2007; the 55 cases reported during 2005 were the lowest during the last 3 decades (Fig. 3). However, country wide surveillance data were not available for calculating the annual dog rabies death rates. Rate of mass dog vaccination had increased from 3.2% in 1975 to 49.3% in 2007. The rate of dog elimination was less than 10% throughout the period of 1975–2005. The highest rate of ABC achieved was 2.3% in 2006 (Fig. 4). Correlations between human rabies death rate and dog vaccination rate ( − 0.836; p < 0.01) for the period of 1975–2007 and between human rabies death rate and dog elimination rate ( − 0.589; p < 0.01) for the period of 1975–2005 were negative and statistically significant (Figs. 5 and 6). Since the ABC had been implemented for only few years there was not adequate data for calculating correlation between human rabies death rate and ABC rate. Country wide hospital data were not available for calculating the correlation between human rabies death rate and rate of PET administration to at risk animal bite victims. The GIS map of human rabies death rate showed an unequal distribution among the districts (Fig. 1). Districts of Mannar and Killinochchi had the highest human rabies death rates. Districts of Colombo, Kegalle, Pollonnaruwa, Puttlum, Badulla, Ampara, Vayniya, and Mullative had zero deaths. The GIS map for the estimated dog population showed an uneven distribution among the districts and did not directly correlate with the distribution of human rabies death rates (Fig. 2). A remarkable decline in the national incidence of human rabies deaths is observed since the establishment of the rabies control program in 1975. This downward trend could be due to many factors: dog rabies control measures implemented by the Public Health Veterinary Services such as mass dog vaccination and dog population control; increased availability of modern post exposure treatment (PET); increased treatment seeking by animal bite victims, their better management and accurate reporting of human rabies due to improved laboratory based diagnosis of deaths. However, similar to the situation reported in Thailand (Sintunawa et al., 2004), the reduction in human rabies deaths has masked the simultaneous and increasingly high economic burden due to the direct and indirect costs of PET. The annual cost to the Ministry of Health to provide rabies PET was equivalent to US$ 3 M in 2005 (Wimalaratne, 2007). Thus human rabies still remains a significant public health problem in Sri Lanka. Incidence of human rabies vary among districts. The highest rates observed in Mannar and Kilinochchi districts (Fig. 1) could be due to circumstances created by the war; increase in rabies incidence during war times has been documented elsewhere (Awerbuch-Friedlander, 2005). However these districts are bor- dered by districts with zero reporting. Zero incidence in Puttalam may reflect enhanced rabies control activities as shown by relatively high coverage for dog vaccination (77.7%) and dog population control (12.1%). However, zero incidence in Vavuniya, and Mullaitivu may reflect low human and dog densities or lack of data due ...
Context 4
... year; out of which, about 200,000 are administered PET (Wimalaratne, 2007). Human rabies death rates, for the period of 1973–2007, were calculated using the published data: total number of human rabies deaths reported by the Public Health Veterinary Services and the midyear human population estimated by the Department of Census and Statistics, Sri Lanka, for each year. Calculations were carried out for the entire country and for administrative districts which correspond to the district Public Health units as presented in Fig. 1. For the purpose of calculating the annual coverage (percentage) of rabies control activities implemented in Sri Lanka, it was necessary to obtain an estimate for the total dog population. As data on the dog population for the districts or for the country are not available from veterinary or public health sources or published reports, our estimates were based on human: dog ratios. The ratio estimates for Sri Lanka are from sample surveys which do not represent the whole country (WHO, 1988; Matter et al., 2000), thus the dog population per year was estimated using ratios published for Asia by Knobel et al. (2005). This was considered equivalent to the ratio expected in Sri Lanka, given the fact that the authors have calculated the estimates based on all the available reports from Asia including the two from Sri Lanka. The mean ratio estimated for Asia is 9.5:1 (95% confidence interval 4.5:1–14.6:1). We assumed a con- stant human: dog ratio from 1975–2007. Dog population, estimated above, was used as the denominator for calculating the annual coverage (percentage) for rabies control activities implemented in Sri Lanka, based on the numbers reported for dog vaccination, dog elimination and dog animal birth control (ABC) by the Public Health Veterinary Services. Correlations were calculated between annual human rabies death rate and dog vaccination rate for the period of 1975–2007, and between annual human rabies death rate and dog elimination rate the period of 1975–2005. Geographic Information System (GIS) was also used to illustrate the district distributions of human rabies deaths and the estimated dog population density, aiming to identify areas of susceptibility (Fig. 2). Human rabies deaths have declined substantially in Sri Lanka from 310 deaths (22.2 per 1,000,000) in 1977 to 56 (2.8 per 1,000,000) in 2007; the 55 cases reported during 2005 were the lowest during the last 3 decades (Fig. 3). However, country wide surveillance data were not available for calculating the annual dog rabies death rates. Rate of mass dog vaccination had increased from 3.2% in 1975 to 49.3% in 2007. The rate of dog elimination was less than 10% throughout the period of 1975–2005. The highest rate of ABC achieved was 2.3% in 2006 (Fig. 4). Correlations between human rabies death rate and dog vaccination rate ( − 0.836; p < 0.01) for the period of 1975–2007 and between human rabies death rate and dog elimination rate ( − 0.589; p < 0.01) for the period of 1975–2005 were negative and statistically significant (Figs. 5 and 6). Since the ABC had been implemented for only few years there was not adequate data for calculating correlation between human rabies death rate and ABC rate. Country wide hospital data were not available for calculating the correlation between human rabies death rate and rate of PET administration to at risk animal bite victims. The GIS map of human rabies death rate showed an unequal distribution among the districts (Fig. 1). Districts of Mannar and Killinochchi had the highest human rabies death rates. Districts of Colombo, Kegalle, Pollonnaruwa, Puttlum, Badulla, Ampara, Vayniya, and Mullative had zero deaths. The GIS map for the estimated dog population showed an uneven distribution among the districts and did not directly correlate with the distribution of human rabies death rates (Fig. 2). A remarkable decline in the national incidence of human rabies deaths is observed since the establishment of the rabies control program in 1975. This downward trend could be due to many factors: dog rabies control measures implemented by the Public Health Veterinary Services such as mass dog vaccination and dog population control; increased availability of modern post exposure treatment (PET); increased treatment seeking by animal bite victims, their better management and accurate reporting of human rabies due to improved laboratory based diagnosis of deaths. However, similar to the situation reported in Thailand (Sintunawa et al., 2004), the reduction in human rabies deaths has masked the simultaneous and increasingly high economic burden due to the direct and indirect costs of PET. The annual cost to the Ministry of Health to provide rabies PET was equivalent to US$ 3 M in 2005 (Wimalaratne, 2007). Thus human rabies still remains a significant public health problem in Sri Lanka. Incidence of human rabies vary among districts. The highest rates observed in Mannar and Kilinochchi districts (Fig. 1) could be due to circumstances created by the war; increase in rabies incidence during war times has been documented elsewhere (Awerbuch-Friedlander, 2005). However these districts are bor- dered by districts with zero reporting. Zero incidence in Puttalam may reflect enhanced rabies control activities as shown by relatively high coverage for dog vaccination (77.7%) and dog population control (12.1%). However, zero incidence in Vavuniya, and Mullaitivu may reflect low human and dog densities or lack of data due to poor human and dog rabies surveillance. It is important to note that the districts carry out rabies control activities and surveillance independently. As shown in Fig. 2, district of Colombo, with zero incidence of human rabies had the highest estimated dog population density. This may be due to better dog vaccination and dog population control, achieved partly through a greater contribution by the private sector compared to other districts, and higher PET administration through enhanced access to medical facilities. On the other hand, Mannar which has one of the highest human rabies death rates is among the districts with the lowest dog population densities. Likewise districts with similar human rabies death rates have quite different dog population densities e.g.Gampaha vs Ratnapura; Gampaha vs Trincomalee. Although high dog population density has shown to be associated with endemic foci of rabies, where ownerless/stray dogs were predominant and the dog population turnover was relatively high (Beran and Frith, 1986), dog population density alone was not found to be a valid indicator of risk of dog rabies. Although our analysis showed strong correlations between incidence of human rabies deaths and mass dog vaccinations; as well as between incidence of human rabies deaths and dog population control by elimination, the measures taken until now were not sufficient to eradicate the risk of rabies to humans; suggesting that dog rabies control strategies should be based on a deeper understanding of the dog ecology. In Sri Lanka, the rabies virus predominantly circulates within the dog population, (Arai et al., 2001; Nanayakkara et al., 2003; Patabendige and Wimalaratne, 2003), therefore eradication of dog rabies is assumed to be the most logical solution to eliminate the risk of rabies to humans. Maintenance of rabies among dogs mainly depends on the size of the population of susceptible dogs. The natural transmission cycle of the disease can be interrupted by keeping the population of susceptible dogs below a threshold value (Baren, 1991). This can be done by developing and sustaining immunity among the dogs and/or by dog population control. As the natural infection is almost always fatal, immunity among dogs is almost exclusively achieved by vaccination (Bingham, 2005). Mass vaccination of dogs has been the mainstay of successful dog rabies control programs in various settings including those that lead to elimination of rabies in Malaysia and Japan and its control in Europe and North America (Cleaveland et al., 2006). It is stated that the most cost-effective, logical and ethical approach to reduce the susceptible dog population in resource-limited countries is through mass dog vaccination (Bogel and Meslin, 1990; Zinsstag et al., 2007). Unlike the control of wild life rabies with oral vaccine baits distributed to the wild animal population at large (Aubert et al., 1994; Awerbuch-Friedlander, 2005), dog vaccination requires individual injections. Usually multiple injections are given since a single vaccine injection would not result in long lasting neu- tralizing antibodies (Seghaier et al., 1999; Wilde et al., 2005). As a result, the success of a mass dog vaccination programs in achieving the desired immunity in the dog population depends on both, the coverage and frequency of vaccination. The critical percentage of dogs needed to be immunized to prevent or control an outbreak of rabies is estimated to be 70% (WHO, 1992) with 95% confidence intervals for the upper limit estimated between 55% and 7l % (Coleman and Dye, 1996). On the other hand, if the vaccination coverage is not maintained, a sufficient susceptible population rebuilds and rabies is re-established rapidly (Baren, 1991; Cleaveland et al., 2006). As suggested by Fekadu (1991), vaccination coverage of at least 80% may be necessary to break transmission, as in the case of Sri Lanka due to the presence of ownerless/stray dogs and unrestricted owned dogs (Harischandra, 1997; Matter et al., 2000) whose destruction is not practiced any- more. The estimated annual dog vaccination coverage in Sri Lanka, with the so far achieved highest 49.3% in 2007, seems to be inadequate to break the natural transmission cycle, but the coverage rates vary among districts, from 0.0% in Trincomalee, Batticaloa, Ampara to 128.1% in Polonnaruwa (PHVS, 2008). Failure to achieve the recommended vaccination coverage could be attributed to logis- tic ...
Context 5
... Lanka is among the top ten countries in the world that report the highest rate of human rabies deaths (2.8 per 1,000,000 in 2007) and potential rabid animal bites requiring post-exposure treatment (755 per 100,000 in 2003) (WHO, 2008). Human rabies deaths are reported from most of the 25 districts of Sri Lanka each year ( Fig. 1) (Public Health Veterinary Services (PHVS), 2008). In Sri Lanka, only 42.8% of human rabies deaths were confirmed with laboratory testing in 2007 (WHO, ...
Context 6
... number of human rabies deaths reported by the Public Health Veterinary Services and the midyear human population estimated by the Department of Census and Statistics, Sri Lanka, for each year. Calculations were carried out for the entire country and for administrative districts which correspond to the district Public Health units as presented in Fig. ...
Context 7
... GIS map of human rabies death rate showed an unequal distribution among the districts (Fig. 1). Districts of Mannar and Killinochchi had the highest human rabies death rates. Districts of Colombo, Kegalle, Pollonnaruwa, Puttlum, Badulla, Ampara, Vayniya, and Mullative had zero deaths. The GIS map for the estimated dog population showed an uneven distribution among the districts and did not directly correlate with the ...
Context 8
... of human rabies vary among districts. The highest rates observed in Mannar and Kilinochchi districts (Fig. 1) could be due to circumstances created by the war; increase in rabies incidence during war times has been documented elsewhere (Awerbuch-Friedlander, 2005). However these districts are bordered by districts with zero reporting. Zero incidence in Puttalam may reflect enhanced rabies control activities as shown by relatively high coverage ...
Citations
... In this regard, ensuring vaccination of the maximum canine population can help reduce disease spread in communities . This is hard to achieve in Pakistan because it is costly, so developing a cheaper and more effective vaccine is needed to fight this disease ( (Kumarapeli and Awerbuch-Friedlander 2009)). Therefore, it is essential to vaccinate animals in high-epidemic areas (Barecha et al., 2017;Knobel et al., 2013). ...
Rabies is a contagious but preventable disease. While canine rabies remains the predominant mode of
transmission in Pakistan, there are other under-recognized reservoirs and routes of exposure to rabies
that pose a significant public health threat. This chapter delves into these neglected routes of rabies
transmission, urging a comprehensive approach to rabies control and prevention. Bat-transmitted
rabies, mongoose-transmitted rabies, and rabies transmitted through wildlife to human beings are also
significant contributors to this disease. Fruit bats have wide-ranging foraging patterns that emerge as
potential sources of fruit-borne transmission incidents. Interactions with wildlife are also a cherished
aspect of Pakistani culture and warrant scrutiny. Transmission of rabies through professional activities
also causes transmission to health care professionals and veterinarians. Ritual activities such as dog
fights also spread this disease; fighting dogs also spread this disease ultimately to human beings.
Rodents that are present in almost every region and contaminate every household in Pakistan also
transmit this disease to human beings. Bites or scratches from seemingly docile or playful animals such
as foxes, jackals, mongooses, etc. can spread the rabies virus. Public education initiatives emphasizing
responsible wildlife interactions and prompt post-exposure prophylaxis are crucial in the prevention of
rabies transmission. Ignoring these non-canine transmission pathways hinders effective rabies control.
This chapter advocates for a multifaceted approach encompassing expanded surveillance of diverse
animal reservoirs, targeted interventions tailored to specific transmission routes, and heightened public
awareness about neglected vectors. Only through such holistic approaches can Pakistan effectively
combat the multifaceted threat of rabies.
... Close contact and physical interactions between these stray and pet categories of dogs are common across the island. The average population density of 384 people per km 2 [17] in Sri Lanka was recorded to be proportional to the dog population density in several studies [18][19][20], meaning that a higher number of dogs resides in densely populated regions of the country. Accordingly, eight veterinary clinics/hospitals across the three geoclimatic zones ( Figure 1) were selected based on veterinarians' willingness to participate in the study. ...
Vector-borne pathogens (VBPs) cause significant diseases in dogs in the tropics. In Sri Lanka, the scarce availability of previous studies on canine VBPs has hampered an accurate evaluation of their prevalence in pet dog populations. In this study, we collected demographic, clinical, and environmental data together with whole blood from 423 pet dogs from three geoclimatic zones in Sri Lanka. All blood samples were screened using a previously validated multiplex qPCR assay to detect the six most prevalent canine VBPs in tropical Asia. Multivariable logistic regression models were used to investigate environmental and host factors as predictors of VBP infections. Overall, 254 dogs (60.1%, 95% CI: 55.3-64.6%) were infected with one or more VBPs. Babesia gibsoni was the most prevalent VBP with 37.4% (95% CI: 32.7-42.2%) of dogs infected followed by Hepatozoon canis (21.04%, 95% CI: 17.25-25.24%), haemotropic mycoplasmas (10.2%, 95% CI: 7.5-13.4%), Babesia vogeli (5%, 95% CI: 3.2-7.5%), Ehrlichia canis (4.5%, 95% CI: 2.7-6.9%), and Anaplasma platys (3.8%, 95% CI: 2.12-6.1%). Predictors of VBP infections included tick infestation for H. canis (p = 0.05) and A. platys (p = 0.01), as well as age for B. gibsoni (p = 0.01) and H. canis (p = 0.05) infection. Local breed (p = 0.004), male dogs (p = 0.001) and flea infestation (p = 0.04) were significantly associated with haemotropic mycoplasma infections suggesting direct-blood exchange through fighting and fleas as a possible means of transmission for these pathogens. Clinical results suggest that B. gibsoni and E. canis caused clinically significant disease, especially in exotic breeds such as German shepherds and Rottweilers compared to the local breeds (p<0.001). Measures such as educating pet dog owners on the importance of being vigilant on ectoparasite infestation of their pets, preventing pet dogs from interacting with stray or community dogs, and the compliant use of effective ectoparasiticides will be crucial for effective control of VBPs in pet dogs in Sri Lanka.
... This information is needed to determine the interval between dog vaccination campaigns to maintain appropriate vaccination coverage. A study by Kumarapeli and Awerbuch-Friedlander (2009) showed that more frequent than annual vaccination campaigns are required in populations with a high proportion of free-roaming and ownerless dogs due to their rapid population turnover and shorter lifespan. ...
Although an effective human rabies vaccine has existed since 1885, rabies continues to kill an estimated
59,000 people every year. Sixty per cent of these human deaths occur in Asia. The number of animals,
especially dogs, who die of rabies is uncalculated. To work towards the global target of eliminating dogmediated human rabies deaths, the rabies community is applying the One Health approach by jointly
focusing on humans and dogs.
Written by a multidisciplinary group of scholars and rabies control programme specialists, this book is a
collection of experiences and observations on the challenges and successes along the path to rabies
control and prevention in Asia. The book:
-grounds chapters in solid scientific theory, but retains a direct, practice-focused and inspirational
approach;
-provides numerous examples of lessons learned and experience-based knowledge gained across
countries at different levels of rabies elimination;
-brings together and highlights the practices of a strong, international rabies network that works according
to the One Health concept.
Covering perspectives from almost a dozen Asian countries and a wide range of sectors and disciplines,
such as healthcare facilities, veterinary services, laboratories, public health institutes, wildlife research
centres and academia, this book is an invaluable resource for rabies practitioners and scholars, but also
those working in the wider fields of disease control and cross-sectoral One Health.
For details go to; 978-1-80062-295-1
... This information is needed to determine the interval between dog vaccination campaigns to maintain appropriate vaccination coverage. A study by Kumarapeli and Awerbuch-Friedlander (2009) showed that more frequent than annual vaccination campaigns are required in populations with a high proportion of free-roaming and ownerless dogs due to their rapid population turnover and shorter lifespan. ...
... This information is needed to determine the interval between dog vaccination campaigns to maintain appropriate vaccination coverage. A study by Kumarapeli and Awerbuch-Friedlander (2009) showed that more frequent than annual vaccination campaigns are required in populations with a high proportion of free-roaming and ownerless dogs due to their rapid population turnover and shorter lifespan. ...
Although an effective human rabies vaccine has existed since 1885, rabies continues to kill an estimated 59,000 people every year. Sixty per cent of these human deaths occur in Asia. The number of animals, especially dogs, who die of rabies is uncalculated. To work towards the global target of eliminating dog-mediated human rabies deaths, the rabies community is applying the One Health approach by jointly focusing on humans and dogs.
Written by a multidisciplinary group of scholars and rabies control programme specialists, this book is a collection of experiences and observations on the challenges and successes along the path to rabies control and prevention in Asia. The book:
grounds chapters in solid scientific theory, but retains a direct, practice-focused and inspirational approach;provides numerous examples of lessons learned and experience-based knowledge gained across countries at different levels of rabies elimination;brings together and highlights the practices of a strong, international rabies network that works according to the One Health concept.
Covering perspectives from almost a dozen Asian countries and a wide range of sectors and disciplines, such as healthcare facilities, veterinary services, laboratories, public health institutes, wildlife research centres and academia, this book is an invaluable resource for rabies practitioners and scholars, but also those working in the wider fields of disease control and cross-sectoral One Health.
... This information is needed to determine the interval between dog vaccination campaigns to maintain appropriate vaccination coverage. A study by Kumarapeli and Awerbuch-Friedlander (2009) showed that more frequent than annual vaccination campaigns are required in populations with a high proportion of free-roaming and ownerless dogs due to their rapid population turnover and shorter lifespan. ...
... The successful prevention of human rabies depends on the effective control of the disease in domestic dog populations [6,7]. Dogs are considered the principal reservoirs responsible for the overwhelmed reported animal and human rabies cases [6,[8][9][10]. A rabies control program should take both technical and socio-cultural frameworks into account [7]. ...
The situation of human rabies in Thailand has gradually declined over the past four decades. However, the number of animal rabies cases has slightly increased in the last ten years. This study thus aimed to describe the characteristics of animal rabies between 2017 and 2018 in Thailand in which the prevalence was fairly high and to quantify the association between monthly rabies occurrences and explainable variables using the generalized additive models (GAMs) to predict the spatial risk areas for rabies spread. Our results indicate that the majority of animals affected by rabies in Thailand are dogs. Most of the affected dogs were owned, free or semi-free roaming, and unvaccinated. Clusters of rabies were highly distributed in the northeast, followed by the central and the south of the country. Temporally, the number of cases gradually increased after June and reached a peak in January. Based on our spatial models, human and cattle population density as well as the spatio-temporal history of rabies occurrences, and the distances from the cases to the secondary roads and country borders are identified as the risk factors. Our predictive maps are applicable for strengthening the surveillance system in high-risk areas. Nevertheless, the identified risk factors should be rigorously considered and integrated into the strategic plans for the prevention and control of animal rabies in Thailand.
... A multi-center study carried out in India has revealed 20,565 human deaths occur in India (6). In Sri Lanka, although there is a steady decline in deaths due to human Rabies from the mid-1970s, Rabies is still endemic (7). The number of deaths due to Rabies had been declined over the past few years with nearly 20-30 death annnually in 2018. ...
Introduction: Rabies is a zoonotic disease that is endemic in Sri Lanka and the main vector of human rabies is the dog. The county invests a huge portion of its annual health budget to prevent this deadly disease. The treatment following dog bite has an important place in the prevention of human rabies, which consists of the provision of first aid and Post Exposure Therapy (PET). The objective of the study was to describe knowledge on human rabies and treatment following dog bites (TFDB) and their associated factors among persons aged 20-59 years in a semiurban Medical Officer of Health area in Sri Lanka Method-A community-based cross-sectional study was carried out among a random sample of 340 participants, aged 20-59 years in a semi-urban Medical Officer of Health area, Sri Lanka by using probability proportionate to the population size cluster sampling technique. Data were collected by using a pre-tested interviewer-administered questionnaire by two trained pre intern doctors and analyzed using SPSS 22 software. Results-Response rate was 94.7% (322/340). The mean age was 38.1 years (SD=11.2 years). Of the participants, 94% were Sinhalese (n=303): 87% Buddhists (n=280); 74.2% married (n=239); 64.6% employed (n=208); 82% lived in own house (n=264) with a median income of Rs. 38,000.00 (IQR=Rs. 38,000/=). Only 11.5% (n=37) were dog owners. Overall knowledge on rabies was good in 64.9%, (n=209): 70.8% (n=228) knew the route of entry of virus but < 45% knew cat & bat are also reservoirs. The factors associated with good knowledge on rabies were Sinhala (OR=3.4, 95% CI-1.3-8.9,p=0.01); having higher level of education (OR=18.7, 95% CI-9.7-35.8 ,p<0.001), being employed (OR=2.3, 95% CI-1.4-3.6 p<0.001), having a higher income level (OR=4.8, 95% CI-2.9-7.9, p<0.001);owning dog (OR=2.7, 95% CI-1.6-4.4, p<0.001). Overall knowledge on treatment following dog bite was good in 61.2 %,(n=197):89.6%,(n=288) on first aid but < 30% knew the importance of noticing offending dog's health, observability, and what to do if a dog is suspected to have rabies. The factors associated with knowledge on the treatment following dog bite were: ever-married(OR=1.7, 95% CI-1.1-3.2, p=0.02); having a higher level of education (OR=13.3, 95% CI-7.5-23.5, p<0.001); having a higher level of monthly income (OR=3.0, 95% CI-1.9-4.8, p<0.001); being employed (OR=2.2, 95% CI-1.4-3.5, p<0.001); owning a dog (OR=27.7, 95% CI-3.7-205.0, p<0.001). Conclusions and Recommendations: The majority of the study participants had good overall knowledge of rabies and treatment following a dog bite. In general, knowledge on non-canine reservoirs of rabies and treatment following dog bites on specific events were deficient. There is a need to give holistic knowledge with regard to rabies as well as treatment following a dog bite to the general public.
... Also, Human rabies has been a notifiable disease since 1971 (9). A study has shown a negative and statistically significant correlation between human rabies death rate and dog vaccination rate as human deaths had been declined and dog vaccination had been increased over the years (10). ...
Introduction-Rabies is a 100% vaccine-preventable and 100% fatal zoonotic, viral illness. Dogs are the source of nearly all the deaths from rabies in Sri Lanka. Annually nearly 20-30 persons die due to human rabies and the health system provides post-exposure prophylaxis for 300,000 individuals in the country. One of the main strategies in the prevention of rabies in the country is the promotion of responsible dog ownership (RDO). This study was done with the aim of describing the knowledge, attitude, and practice on Responsible Dog Ownership and their associated factors among persons aged 20-59 years in a semi-urban Medical Officer of Health (MOH) area in Sri Lanka Method-A community-based cross-sectional study was carried out among a random sample of 340 participants, aged 20-59 years in the MOH area Maharagama, Sri Lanka by using probability proportionate to the population size cluster sampling technique. Data were collected by using a pre-tested interviewer-administered questionnaire by two trained pre intern doctors and analyzed using SPSS software. Results-Response rate was 94.7% (322/340). The mean age was 38.1 years (SD=11.2 years).Of the participants, 94% were Sinhalese (n=303): 87% Buddhists (n=280); 74.2% married (n=239); 64.6% employed (n=208); 82% lived in own house (n=264) with a median income of Rs. 38,000.00 (IQR=Rs. 38,000/=). Only 11.5% (n=37) were dog owners. Overall knowledge on Responsible Dog Ownership (RDO) was good among 69.3% (n=223) with: > 50% knew about rabies vaccine and breeding control but < 40% knew about parvo & distemper vaccines. Overall attitudes on RDO were favorable in 73.3% (n=236) with: >95% on dog vaccination against rabies but <30% on caring of dogs. >60% had practiced: immunization; de worming but < 40% had practiced breeding control. The factors associated with good knowledge on RDO: age 20-39 years (OR=1.7, 95% CI-1.1-2.8 ,p=0.01); being Sinhalese (OR=2.7, 95% CI-1.01-6.8, p=0.03); being Buddhists (OR=2.1, 95% CI-1.01-4.0, p=0.03), having higher education (OR=21.4, 95% CI-10.2-44.9, p<0.0001); having higher income (OR=3.5, 95% CI-2.1-5.8, p<0.001), being employed (OR=2.7, 95% CI-1.6-4.4, p<0.001) and owning dog (OR=18.9, 95% CI-2.5-139.7, p<0.001) .The factors associated with favorable attitudes on RDO: age 20-39 years (OR=2.6, 95% CI-1.6-4.3, p<0.001); being Sinhalese (OR=2.6, 95% CI-1.03-6.7, p=0.04);being Buddhists (OR=2.3, 95% CI-1.2-4.6, p=0.01); being unmarried (OR=2.5, 95% CI-1.2-5.2, p=0.01); having higher education (OR=1.7, 95% CI-1.1-2.9,p=0.02). Practices on RDO among dog owners: having a higher level of education was associated with hygienic disposal of dung (OR=12.8, 95% CI 2.1-78.6, p<0.01) and expression of ownership (OR=8.1, 95%CI-1.7-38.6,p=0.01). Being employed was associated with measures taken to prevent pet dog becoming a public nuisance (OR=6.6, 95% CI 1.3-32.5, p=0.04). Conclusions and Recommendations: The majority of study participants had good knowledge, attitudes, and practices with regard to the prevention of Rabies. However, their knowledge, attitudes, and practices on other elements of RDO are not as good. Responsible Dog Ownership should be introduced as a regulation for the general public by the Ministry of Health in order to further reduce deaths due to Rabies in Sri Lanka .
... Free-roaming domestic dogs (FRDD) are known to be the main source of human rabies, a disease which is responsible for an estimated 60,000 yearly human deaths worldwide (Hampson et al., 2015). It has been repeatedly shown that mass vaccination of dogs can eliminate rabies from dog populations and therefore prevent human deaths (Kumarapeli and Awerbuch-Friedlander, 2009;Zinsstag et al., 2009;Mindekem et al., 2017;Zinsstag et al., 2017). The World Health Organization (WHO) currently recommends a random vaccination of at least 70% of dogs in susceptible dog populations. ...
Although African swine fever (ASF) is a major concern for global food security, the understanding of the main drivers of ASF virus (ASFV) transmission is limited due to the lack of epidemiological data in most affected areas. By combining data generated by ASF surveillance on pig farms and in wild boars and nationwide GPS-tracked data for vehicles associated with pig production and health, this study assessed the role of vehicle movements and wild boar populations in the spread of ASFV to pig farms in Korea. Movements of vehicles from infected premises were associated with a higher probability of ASFV incursion into a farm than proximity to ASFV-infected wild boar populations. While ASFV could spill-over into farms from infected wild boars, vehicles played a significant role in spreading infection between farms, despite rapid on-farm detection and culling, highlighting the need for interventions targeting both farm-to-farm and wildlife-to-farm interfaces.
