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CONTRÔLE DE LA RAGE EN AFRIQUE DU NORD
RABIES CONTROL IN NORTH AFRICA
IXe Réunion du Comité Permanent Conjoint du REMESA IXth Meeting of the Joint Permanent Committee
Tunis, 03-04 Novembre 2014
Malek Zrelli – DGSV - Tunisie
Acknowledgments
Data provided by:
• OIE : Rabies meeting, Tunis, June 17-19
• FAO: GCP/RAB/2002/FRA project
• RABMEDCONTROL project
• Centre de Veille Zoosanitaire, Tunisia
• Veterinary Services
Sommaire/Contents
☞ Introduction
Historique/ Historical & Importance
☞Rage en Afrique du Nord/ Rabies in
North Africa: General review
☞Stratégies de contrôle/ Control
strategies
☞Contraintes & Perspectives/ Constraint
& Prospects
☞Conclusion
L’Afrique du Nord / North Africa region
Superficie/Total area: 4 millions Km2
Pays/Countries: Morocco – Algeria - Tunisia & Libya
Habitants/Inhabitants: 90 millions
45 % rural population
Elevage/ Livestock : 70 millions large animals
Population canine/Dog estimated population: 4-5 Millions
Historique/Historical & Importance
✑Depuis antiquité /Since antiquity
VI siècle/Century « Hydrophobie »
✑IBN EL JAZAR (Kairouan 898-980)
The Viaticum translated into Latin (XVI)
« Empoisonnement » « Poisoning »
✑XIXe : Maladie émergente/ Emerging disease
✑ Rage / Rabies
✑ Kala Azar / Leishmaniosis
✑ Kyste hydatique / Hydatidosis
Actuellement/ Currently
North Africa : Rabies endemic area
Rabies financial Impact (Estimation)
(PEP cost: 90 US $/ person X 150 000)
Menace pour les pays européens/ Threat to western european countries
Year Pays/Country Origin
2007 Finlande Inde Chiot/Puppy
2007 Belgique Maroc Chiot
2008 France Maroc Chien
2008 Belgique/France Gambie Chien
2008 Royaume Uni (UK) Sri Lanka Chiot 10 sem.
2008 France Maroc Chiot 3 mois
2008 Allemagne Croatie Chiot 3 sem.
2009 France Afghanistan Chien
2010 Allemagne Bosnie-Herzégovine Chiot 8 sem.
2011 France Maroc Chiot 3 mois
2012 Hollande Maroc Chiot 8 sem.
(Source DGSANCO)
Plupart des cas de rage importés d’Afrique du Nord /Human &
animal cases mostly imported from North Africa (5 / 11)
Sommaire/Contents
☞ Introduction
Historique/ Historical & Importance
☞Rage en Afrique du Nord/ Rabies in North Africa: General review
☞ Stratégies de contrôle/ Control strategies
☞ Contraintes & Perspectives/ Constraint & Prospects
☞ Conclusion
Données générales/ General review
National dog rabies control strategy
North Africa countries developed plans
for eliminating human rabies:
☞Implementation of sustained campaigns to
immunize dog populations
☞Provide Post-Exposure Prophylaxis (P.E.P)
to people to have been exposed to
suspected rabid dogs
Programmes nationaux de contrôle
Global epidemiological situation
☞Principal réservoir & vecteur (40
à 70% cas notifiés/notified cases)
Main reservoir & vector
Global epidemiological situation
☞Dog population dynamic:
☞Young population : 2 – 3 years
☞18 – 30 % < 1 year
☞Sex ratio : 60 – 70 % Males
☞High mortality rate first year
☞Majority accessible to vaccination (> 90%)
Source: RABMEDCONTROL project 2007-08
Turn over rate
Global epidemiological situation
Urban Rural
Maroc 0,6 1,16
Algérie 1,8 2,6
Tunisie 1,3 2,1
Source: RABMEDCONTROL project 2007-08
Dog density
Dog ratio/householder
Global epidemiological situation
Bizerte (Tunisie) Sétif (Algérie)
☞ Phenomenon of stray dogs/ Chiens errants
Global epidemiological situation
☞85 % cas/cases : zones
rurales/rural areas
☞Provinces du Sud
indemnes/Southern desert
provinces :Free
85
15
Rural Urban
Source: RABMEDCONTROL project 2007-08)
Animal rabies in North Africa
1525 1608
1434 1527
1425 1530
1456 1576
1744
1201 1045
1321 1409 1398
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Moyenne : 1442 cas/ an
Global epidemiological situation
Bovins 32%
Chiens 40%
Ovins/ Cp 7% Equidés
13% Faune sauvage
1%
Chat 7%
Source OIE 2012
Ruminants & Equidés : principales victimes/ Main victims
Human rabies in North Africa
75
49 48
36
50
34
46 49
31
44
63
37
67
50
39
30
37
46
53
75
49 48
36
50
34
46 49
31
44
63
37
67
50
39
30
37
46
53
0
10
20
30
40
50
60
70
80
Moyenne : 46,5 +/- 13,2
☞ 86 % unvaccinated
☞ 14 % interrupted PEP
☞ 89 % due to dog
bites Source: RABMEDCONTROL project 2007-08)
Human rabies in North Africa
☞ Children:
majors
victims of
dog rabies
0 5 10 15 20 25 30
0 - 9
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
≥ 60
25
29
8
10
6
5
17
Age distribution of human rabies
Source: RABMEDCONTROL project 2007-08)
Phylogeny of rabies isolates
• No exchange between North
Africa & Sahel region
• Limited diffusion between
North African countries
Talbi et al,2010
National action can be effective
In coordination with regional action
Sommaire/Contents
☞ Introduction
Historique/ Historical & Importance
☞ Rage en Afrique du Nord/ Rabies in North Africa: General review
☞Stratégies de contrôle/ Control
strategies
☞ Contraintes & Perspectives/ Constraint & Prospects
☞ Conclusion
Very little
information available
“FREE”
Rabies in Libya
Last case reported in 1963
2008 : 3 human cases (after dog bites)
Rabies control plan: Mass vaccination of dogs
Stray dogs control
Public awareness
Improve labs activity
✏IMPLEMENTATION ? !
Suspected Human cases
2009 5
2010 4
2011 21
confirmed Dog Camel Sheep Goats
2008 2 2 1
2009 1 1
2010 1 1
Infected area
Animal rabies in Morocco
• Rabies : Endemic
• All provinces affected (varying degrees)
except southern desert Source ONSSA 2013
Animal rabies in Morocco
474
572
446 467
425
360 335
351
313 294
269
230
300 295 16
26
23
17
19
25
23
31
24
17
19
18 19
24
0
100
200
300
400
500
600
700
0
5
10
15
20
25
30
35
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Animale
Humaine
☞Animal rabies Cases reported : Average 367 / year
☞Human rabies cases : Average 22 / year
☞Evolution curve of human rabies follows that of animal rabies
Animal rabies in Morocco
Dogs 39%
Bovine 27%
Cats 8%
Equids 20%
Small Rts 5%
Others 1%
☞Ruminants : Main victims
☞Dogs: Sources of all contamination Moyenne 95-2007
Control strategy in Morocco
450917
110208
43125
70641
572
295
0
100
200
300
400
500
600
700
0
100000
200000
300000
400000
500000
600000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Vaccination Extermination Animal rabies
1986 : Rabies National Control Program
2003 : New rabies control strategy
- Stray dog population control
- Vaccination of domestic carnivores
- Public education
Average of:
170 000 dogs vaccinated
41 000 eliminated
Vaccination coverage : 20%
Control strategy in Morocco
• 2013: Update control strategy
– New rules (July 2013): Accountability of dog
owners
– Immunization, awareness strengthening
– Alternative method of controlling stray dogs
Animal rabies in Algeria
• Rabies : Endemic
• Regions most affected : Center & costal areas
• South free of rabies
Répartition des cas rage animale 2006 (DSV)
Répartition des cas rage animale 2013 (DSV)
Animal rabies in Algeria
☞ Animal rabies cases reported : Average 890 / year
0
200
400
600
800
1000
1200
1400
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
793 881
834
954 941 981 941
1113
1212
782
656
809 827 743
Animal rabies in Algeria
Canine 49% Feline
4%
Bovine 26%
Ov/Cp 11% Asine
8%
Equine 1%
Autres 1%
☞ Dog : Main reservoir of disease (50% reportable cases)
☞Bovine : Main victims Source DSV Moyenne 98-2008
Human rabies in Algeria
16
20
24
12
22
35
13
34
22
16
9
17
23 22
53177
69616
76765
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
0
5
10
15
20
25
30
35
40
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Human cases
PEP
☞ Human rabies cases : Average 20,3 / year
☞PEP : + 44 % Source: GCP/RAB/2002/FRA project
Human rabies in Algeria
☞Consultation after rabies
exposure:
☞ 8 % immediately
☞ 8 % after 24 h.
☞ 24 % after 48 h.
☞ 60 % after clinical signs Source: GCP/RAB/2002/FRA project
Control strategy in Algeria
☞Program initiated in 1984
☞Reduction of stray animal population
☞Vaccination domestic carnivores
☞Vaccination cattle (since 2003) & Equines
(since 2012)
☞PEP to people exposed & Health education
Control strategy in Algeria
☞Dog vaccination : average 46 703 / year
☞Cattle vaccination : average 385 461 / year (Sanitary
mandate)
76316
51855
63544 67212
26795
21327 18607
21768
26045
49538
57919
27597
80251
65080
777238 802770
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Dog/Cat Bovine
Control strategy in Algeria
STRAY DOGS CONTROL
☞Euthanasia of stray dogs
Animal rabies in Tunisia
• Enzootic
• Expansion to the South
2008 2013
Animal rabies (1983-2013)
120
360
69
199
0
100
200
300
400
500
600
700
Rage Animale
Rage canine
Moyenne annuelle :
282 cas dont 108 chiens (38,3%) & 174 Autres animaux
Répartition des cas selon l’espèce
8%
18%
8%
6%
59%
1%
Feline
Bovine
Equine
Ov/Cp
Canine
Faune sauvage
DGSV 2012 Ruminants & Equidés : principales victimes/ Main victims
Programme National de lutte contre la rage
Programme
national de lutte
contre la rage
Démarrage
vaccination
annuelle
Situation ? Vaccination
péri-focale
1961 1981 1987 1992
Evolution de la stratégie de lutte
Evolution de l’incidence de la rage animale & humaine
360
7
0
5
10
15
20
25
30
35
40
0
100
200
300
400
500
600
700
cas de rage animale
cas rage humaine
Année 92
581 cas
25 cas humains
96 cas
4,1 cas 166 cas/an
2,75 cas 131 cas
6,6 cas 210 cas/an
16,3 cas An.
H.
Vaccination annuelle V.périfocale Démarrage
Programme National de lutte contre la rage
COMPOSANTES
Programme National de lutte contre la rage
Incidence de la Rage canine & Vaccination des chiens
438 488
382 362
419546
121
360
0
100
200
300
400
500
600
700
0
50 000
100 000
150 000
200 000
250 000
300 000
350 000
400 000
450 000
500 000
Vaccination CN
Rage Animale
Moy.139 000 /an Moyenne : 418 300 /an
Malgré programme depuis 30 ans
☹ Pourtant éradication non obtenue
☹Malgré efforts « soutenus »
☹ Pourquoi échec « relatif » ?
☹ Pourquoi recrudescence ?
☹Mesures urgentes
☹ Bilan campagne vaccination 2012
Recrudescence POURQUOI ?
– Dépôts d’ordure
– Couverture vaccinale
– Population chiens « errants »
Avenue Bourguiba 04/2014 Place Bab Saadoun 04/2014
Mesures urgentes 2014
• Awareness campaign
• Stray dog “control”
Mesures urgentes 2014
• Awareness campaign
Bilan campagne 2012
< 1 17%
1 - 3 41%
> 3 42%
M 81%
F 19%
0
5
10
15
20
25
30
J F M A M J J A S O N D
Répartition mensuelle (2012)
Age des chiens enragés
Sexe des chiens enragés
Source: CNVZS 2014
Bilan campagne 2012
Owned dog 68%
Stray dog 28%
unknown
4%
Unvaccinated
86%
Vaccinated 10%
Unknown 4%
Source: CNVZS 2014
Statut vaccinal chiens enragés
(à propriétaire)
Répartition chiens enragés
Causes de non vaccination (%)
Achat après campagne 8
Propriétaire ignore période vaccination 25 Propriétaire non informé date période
vaccination 22
Autres:
Refus vaccination
Chien non abordable
Zone non atteinte par vaccination
45
Source: CNVZS 2014
Bilan :Appréciation gestion des foyers
Vaccination périfocale
010
2030
4050
60
J O
J 1 - 5
J 6 - 10
J 11 - 20
J > 21
6,8 59,1
13,6
13,6
6,8
Source: CNVZS 2014
Taux réalisation : 71 %
Délai vaccination périfocale/Prélèvement:
Abattage animaux contaminés
Abattage 32%
Vaccination 11%
Proposition abattage
1%
Aucune mesure 56%
Sommaire/Contents
☞ Introduction
Historique/ Historical & Importance
☞ Rage en Afrique du Nord/ Rabies in North Africa: General review
☞ Stratégies de contrôle/ Control strategies
☞Contraintes & Perspectives/
Constraint & Prospects
☞ Conclusion
Rabies Control program limits
Enzootic Rabies
Inadequate coordination
involved departments
Shortage financial/human
resources
Rabies Control program limits ☹ Vaccination coverage not enough to break transmission cycle ☹ Poor surveillance/ underreporting ☹ Labs diagnostic
☹ Insufficient dog owners participation ☹ Inadequate stray dog population management ☹ household waste management/ Slaughter…
☹ Deficiency in public/health education/awareness ☹ Limited availability / Interruption PEP
☹Research into disease dynamics, effective delivery mechanisms
Conclusion
✑Epidemiological cycle of rabies seems simple
✑Limited diffusion between N.A countries
✑Dogs:
✑Main reservoir & vector
✑Majority accessible to vaccination
✑ PEP : Highly effective
Conclusion
Merci pour votre attention...
Thank you...
شكرا
Max