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presentation1.4 Mb pdf
RABIES IN TUNISIA: Epidemiology and Control Ichraf ZAOUIA (Primary Health Care - MH) Samy KHOUFI and Habib KHARMACHI (Institut Pasteur de Tunis) Contents National Program of Rabies Control Epidemiology of rabies in Tunisia Animal rabies Human rabies Conclusion 2 Geographical Location & demographics Tunisia 10982,754 65,9 % 34,1 % Habitants (7/2014) Urban zones Rural zones 3 NATIONAL PROGRAM OF RABIES CONTROL (NPRC) National Program of Rabies Control (NPRC, since 1982) Strategy : Mass vaccination of dogs : Ministry of Agriculture Prevention of Human Rabies : Ministry of Health Control of dog population : Ministry of Interior 5 National Program of Rabies Control (NPRC) Management : National Multidisciplinary Commission of Rabies Control (physician, veterinary, public collectivity …) Regional and Local Commities in each departement (Epidemiological Bulletin/twice a year) One Health concept 6 National Program of Rabies Control (NPRC) Indicators : Dog vaccination coverage (62.5 % in 2013) and dog population management Post-Exposure Prophylaxis rate (482/100.000 h) Incidence of Human and Animal Rabies 7 Epidemiological surveillance VETERINARY Specimen Collect Information National Ref. LABORATORY I.P.T. Medical Health Primary Health Centers Public Collectivities (Control of Dog Population ) 8 ANIMAL RABIES 9 Animal Rabies : Incidence of Animal Rabies (2000 - 2014) 500 ANIMALS DOGS 450 400 350 300 250 200 150 100 50 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 0 10 Animal Rabies : Species affected (2014) Goat 1,5% Sheep 6,7% Camel 0,2% Jackal 0,2% Equin 10,5% Cow 18,5% Dog 58,8% Cat 3,6% 11 Animal Rabies : Geographical Distribution : 2013 & 2014 2013 2014 HUMAN RABIES 13 Epidemiology of Human Rabies Rabies is Notifiable Disease : Since 1969 (law 69/53 of 29/7/1969) Autopsy for each rabies suspected death Role of National Commission of control against rabies All cases are confirmed by Laboratory : Rabies laboratory of IPT Since 1961 Only One laboratory for diagnostic in the country : Methods used : FAT + RTCIT 14 6 3 2014 2013 3 2012 1 2011 2 2010 0 2009 2008 2 2007 2006 3 2005 2004 2 2003 2 2002 2001 2000 Number Laboratory confirmed of Cases Incidence of Human Rabies : 2000 - 2014 6 5 4 4 3 3 2 2 1 1 0 0 Years 15 Prophylaxy : pre-exposure Preventive vaccination: Obligatory : staff of rabies Laboratoty staff of mass vaccination campaing Vaccine : supplied by the Ministry of Health 16 Prophylaxy : post-exposure Rabies Immunoglobuline (RIG) Type : Equine (Fab’2) Availability : always available 20 000 vials / year Free of charge 17 Prophylaxy : post-exposure Rabies Vaccine : Vaccine used: Cell Culture (PCEC, Vero Cells Vaccine) Origin: importation Availability: always available Protocol used: Essen / Zaghreb Average : 2,4 doses / PEP ; 100 000 doses / year Free of charge 18 Prophylaxy : post-exposure Structures : Number of centers : 206 specific centres (+ hospital emergency services) = 360 (total PEP c.) Localisation : All regions of country Management : Ministry of health 19 Prophylaxy : post-exposure Information of Public : Risk of Rabies Location of PEP Centers Tools : - Health services - Posters, leaflets - Media: prevention spots (Tv, Radio) 20 Conclusion Critical points to improve : Improvement of vaccination coverage of dogs (actually 50 % - 60 % ; Objective: to reach 70 % of canine population) Better management of dog’s polpulation Improvement of education and public awerness about rabies Rigourous application for recommmendations of PEP protocols 21 THANKS FOR YOUR ATTENTION 22