Thursday, 27 July 2017

Review policy on rabies

MALAYSIA lost its rabies disease-free status in July 2015 after an outbreak of canine rabies which started in Perlis and later spread to Kedah and Penang.
The outbreak was resolved by November of the same year with emergency mass vaccination of dogs and short-term culling of strays in the affected states. We were fortunate that there was no human victim at that time.

The current rabies situation in Sarawak claimed its fifth human life earlier this week. It is very obvious that rabies-infected animals were in the affected areas for some time already. This is because a bitten victim usually takes two to three months to develop the disease.

The situation in Sarawak is worse as not only dogs but cats also tested positive for rabies. The Government’s effort to contain the outbreak, however, is really commendable at the moment.

Malaysia’s policy of vaccinating dogs in the immune belt to prevent the incursion of rabies from neighbouring countries where it is endemic was adopted a long time ago. We also take pride in our vast experience in controlling rabies outbreaks.

But is there a long-term strategy to prevent the sporadic occurrence of rabies or to handle the situation when emergency mass vaccination and culling of dogs fail to contain the outbreak?

We need to learn the lesson of Bali, Indonesia which had been free of rabies since 1884 until the outbreak in 2008 which claimed the lives of more than 130 people in the following three years because emergency vaccinations and culling of dogs failed to contain the outbreak. It was only in 2011 after the island practised a massive dog vaccination campaign, reaching 70% coverage, that a subsequent decline in rabies incidence and spread was achieved.

Unlike other zoonotic diseases, rabies is a completely preventable disease in animals and humans through vaccination. The federal and state authorities should work hand in hand to develop a long-term strategy for rabies prevention and control. Such strategy is particularly needed in animal vaccination, pending the risk assessment of the local area. This strategy should be adopted and implemented not only in areas that are in constant threat of the disease from neighbouring countries where rabies is endemic but also for those that are not along the border.

We have current dog bite reports in Melaka and Perak but what would our prevention strategy be for dog vaccination in non-border states?

For border states, if an immune belt policy is in place, 70% vaccination coverage should be achieved. This is to ensure that the population immunity of the animals at the immune belt zone is sufficient to prevent circulation of the rabies virus.

It is also important to note that an infected dog may not die immediately and a carrier status is known to exist in dogs infected with rabies. Hence, an active surveillance programme should also be in place to monitor the rabies virus circulation among the dog population in the immune belt.

In addition to vaccination, there are many other ways to prevent and control rabies, including awareness campaigns in the community and school, dog population control and responsible pet ownership. Tools, programmes and successful models are available from international organisations and countries for strategic long-term prevention and control of rabies.

Is Malaysia going to stand on the immune belt policy alone? It is timely for federal and state authorities to have an open mind and to consider reviewing the current rabies policy in order to initiate a proactive approach for prevention and control of the disease.

DR ONG BEE LEE

Faculty of Veterinary Medicine

Universiti Malaysia Kelantan

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