Elimination of Human Rabies in a Canine Endemic Province in Thailand: Five-Year Programme. (Policy & Practice)

By Kamoltham, T.; Singhsa, J. et al. | Bulletin of the World Health Organization, May 2003 | Go to article overview

Elimination of Human Rabies in a Canine Endemic Province in Thailand: Five-Year Programme. (Policy & Practice)


Kamoltham, T., Singhsa, J., Promsaranee, U., Sonthon, P., Mathean, P., Thinyounyong, W., Bulletin of the World Health Organization


Introduction

Canine rabies is endemic in Thailand and is an especially serious health problem for people living in more rural areas of the country. The number of human deaths attributed to tables has decreased dramatically in the past decade in Thailand through the increased use of highly purified tissue culture rabies vaccines (TCV), which is supplied free of charge by the Thai Ministry of Health and the Thai Red Cross to patients unable to pay for post-exposure treatment. In the 1980s, medical professionals in Thailand recognized the serious complications associated with and low effectiveness of the use of nerve tissue vaccines. In 1993, the Ministry of Public Health in Thailand decided to replace the use of nerve tissue vaccines with more efficacious TCV. The projected cost of vaccinating the general population by following the original Essen post-exposure treatment regimen (1.0 ml administered intramuscularly on days 0, 3, 7, 14, and 30) was, however, too high a financial burden for the Thai government to undertake and maintain (1-3). A reduced dosage intradermal post-exposure treatment regimen was adopted on the basis of numerous intradermal rabies vaccination studies conducted in the 1980s and 1990s (2, 4-8). The success of these and other more recent studies led WHO to acknowledge and promote the use of 0.1 ml per dose of purified vero cell rabies vaccine (PVRV) and purified chick embryo cell rabies vaccine (PCECV) and of 0.2 ml per dose of purified duck embryo cell rabies vaccine (PDEV), in what has become known as the traditional Thai Red Cross intradermal or "2-2-2-0-1-1" regimen (9-11). In this regimen, 0.1 ml of PVRV or PCECV is administered intradermally at two sites on days 0, 3, and 7; no vaccine is given on day 14; and vaccine is administered atone site on days 30 and 90. Intradermal regimens have reduced the cost of post-exposure treatment considerably, because of the smaller amount of vaccine needed per treatment (4-8).

Although the number of human deaths from rabies has declined dramatically throughout Thailand in recent years, unnecessary human deaths still occur. In fact, 50-70 human deaths from rabies continue to be reported each year in Thailand, and 25 deaths were reported in the northern province of Phetchabun between 1989 and 1996.

In order to prevent human deaths from rabies in Phetchabun province, a rabies control programme was initiated in March 1993, with the specific aim of eliminating human rabies throughout the province by 2000. The programme targeted the elimination of human rabies through several strategies including: increasing the accessibility of post-exposure treatment for humans exposed to animals potentially or confirmed as rabid; increasing coverage of post-exposure treatment in humans; increasing awareness of rabies through advocacy in provincial schools, television programmes, and newspapers; reducing canine rabies by monitoring the dog population and implementing vaccination and sterilization programmes; increasing cooperation between the Ministries of Public Health, Agriculture, and Education on a provincial level; and finally assessing the impact of the programme through intensified follow-up of patients exposed to both suspected and laboratory-confirmed rabid animals. Increased use of post-exposure treatment in humans was achieved by expanding the use of the 0.1 ml dose per site of the TRC regimen with PCECV and PVRV and implementing post-exposure treatment immediately for all cases of human contact without the need to observe a dog after the exposure for 10 days.

Post-exposure treatment was documented through the use of a reporting form that attending medical staff completed for every patient who presented at clinics and hospital emergency rooms. The canine population was monitored through the Phetchabun Livestock Department of the Ministry of Agriculture. In addition, a canine vaccination project was initiated in 1996.

This article summarizes the results of the strategic rabies prevention programme implemented in Phetchabun province between 1997 and 2001. …

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