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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
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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
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THANKS
FOR YOUR ATTENTION
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