Global Alliance for Rabies Control, international partnership

Report of the workshop 15 Rabies is not notifiable in most countries and if it is notifiable, it is not functional in technical terms. Different stakeholders are involved in rabies control and they often work in isolation and dog rabies control is underfunded or not prioritized by the animal health sector. Surveillance and laboratory diagnosis is another key area. Among countries of the Region, human and animal rabies is notifiable in two countries and not notifiable in five. Most human and animal rabies cases were reported on clinical background in all countries. No standard surveillance system exists in most countries. Public health laboratories in most countries have no rabies diagnostic facility. Veterinary laboratories are active in rabies diagnosis, and rapid diagnostic test is used at the peripheral level. Though adequate laboratory professionals have been trained, the retention of trained manpower is a problem. Dog rabies surveillance does not exist in six countries. Human rabies prophylaxis is an important area for rabies control. All countries in the Region use rabies vaccine of tissue culture origin or egg embryo origin. The high cost along with availability and affordability issues of rabies vaccine for intramuscular use are a challenge, and cost-effective ID vaccination schedule has been practised in Bangladesh, India and Sri Lanka. WHO has facilitated training on application of intradermal rabies vaccination in Afghanistan, Bhutan, Nepal and Pakistan. The number of people taking PEP is increasing every year in all countries. The use of rabies immunoglobulin RIG is limited even in category-III bites in most countries due to various factors. Rabies vaccine and quality control is also a critical area. Although the drug regulatory authorities are responsible for vaccine quality control it is rarely done for rabies vaccine. In countries of the SAARC Region, rabies vaccine is purchased following the government procurement policy and managed by the logistics unit. Among SAARC countries, only India produces commercial rabies vaccines, which are marketed in neighbouring countries. Shortage of vaccine and RIG and delay in release of government budget are key challenges in this regard. Dog rabies control is not a priority programme under the animal health and is underfunded. In most countries, dog rabies control is the responsibility of different stakeholders. However, the availability of dog rabies vaccine from OIE is an incentive to initiate dog vaccination