World Rabies Day Knocks at the World Chen, Chih-Ping
September 8th , 2007 is World Rabies Day. WHO associates with Harris County Public Health and Environmental Services(HCPHES), World Organization for Animal Health (OIE) and Pan American Health Organization (PAHO) to raise the public awareness about the current worldwide rabies situation and its prevention through vaccines.
Rabies is infected through animals or patients with rabies infection since their saliva carry the virus. Rabies virus enters human bodies from those infected saliva by scratching and biting while sometimes via skin wound and mucosal. Thus, scratching by rabies infected animals is also dangerous and the reason is that animals will lick their feet. Rabies can transmit to any mammal. But the major infectious animals to human are cats, dogs, raccoons and bats. These animals have more chances to contact human beings especially cats and dogs while raccoons and bats are easier to encounter in the outdoor activities.
Nowadays one single person dies of rabies in every ten minutes on the world. It mainly happens in Asia and Africa especially in India and China. In fact, thanks too the current medical treatment, these people do not really have to face the death. Rabies vaccines can highly prevent the disease occurrence. On the other hand, as far as the infected mammals are concerned, the similar oral vaccines have been produced. For those animal threatened by rabies into extinction, probably this is another solution.
Although rabies is curable, still many people die of rabies on the world and the majority is children. Such a problem may not totally result from the medical problems but the accessible treatment for every possible infected person. It may result from the insufficient vaccines and the high medical price. Moreover, in China, the rapid growing of pet raising will increase the possibility of infection due to the insufficient awareness of public health, the lack of social ethics and the increase of stray dogs.
The record of rabies in Taiwan can be dated back to 1947 from Shanghai to Taiwan. After the first reported case in 1948, still some minor cases continued to happen. Then, the vaccination of pet dogs and the killing of stray dogs had been launched. Since 1959, human rabies no longer occurred. After January 1961, animal rabies no longer occurred as well. Taiwan so far is non-epidemic area. Only in 2002, one imported case from China was reported. Thus, the principal threat in Taiwan so far is from imported infection. Health inspection and quarantine will be the main prevention. However, due to the serious trafficking between Taiwan and China, there are still relatively huge chances to transmit the disease from imported cases or the origin of infection.
The important mission of World Rabies Day is to appeal the public awareness and attention to rabies and to make everyone understand the pathogenic mechanism and situation of such an exiting disease. Through the prevention and complete treatment, rabies is expected to become a noun in the history.
Data resources:
1. http://www.worldrabiesday.org/index_en.php
2. http://www.who.int/mediacentre/events/2007/world_rabies_day/en/index.html
3. http://www.economist.com/science/PrinterFriendly.cfm?story_id=8023437
4. http://www.cdc.gov.tw/index_info_info.asp?data_id=848
5. http://www.bbc.co.uk/dna/h2g2/A673599
6. http://www.avma.org/onlnews/javma/aug07/070815l.asp
7. http://news.bbc.co.uk/2/hi/asia-pacific/3235830.stm
The Unsolved Problems of Rabies in China Lee, Fang-Ying
Rabies is globally widespread especially in Asia, the major infectious area of rabies and death cases. Currently the incidence rate of rabies in China is only second to India, the second highest on the world while the difficulty in tackling rabies in both countries is slightly different. According to the statistics, in the first half of this year, 1400 people are infected rabies while about 1100 people die in China. Thus, after Taiwan initiated the small three links in Kinmen, the pandemic information in China should keep a more precise eye.
Rabies always stands for top three pandemics with high death rate in China. Facing this situation, the Chinese government does not really take some actions. For examples, every province has set up the regulation of pet raising and issued the permit of pet raising. However, the problem of rabies in China still remains unresolved. Where does the problem come from?
First, though the registration of the pet raising permit is regulated, the registration fee is too costly. For example, in Guanzhou, the registration fee is 10,000NTD? or RMB? and 6000 NTD or RMB is paid for annual inspection. Thus, some pet keepers are speculated and keep the ‘illegal’ dogs without applying for the permit.
Second, the quality of vaccines is unstable and the vaccination is not completed. Rabies vaccination is the most effective prevention from the disease. Selecting the most qualified rabies vaccines is the priority. However, not only the amount of the vaccines prepared in China is insufficient but also some fake vaccines killed people. Hence, Ministry of Health in PRC and State Food and Drug Administration issued the emergent notice to enhance the control and supervision of rabies vaccines and to stop the unexamined vaccines entering the operating sector. However, in the end of July, this year, one case of fake drug was investigated in HeiLongJiang Province, China including the fake rabies vaccines.
Third, due to the increasing amount of pet dogs and the stray dogs in the suburb and rural areas, it is hard to collect data and to control the exact amount of dogs and the situation. This makes the public lack of awareness including the government.
‘As far as I understand, rabies is not increasing in China. China is a huge country. It is normal that some cases appear in rural areas.’stated Mr. Jiang Zuojun, vice minister of Ministry of Health in a press conference.
Additionally, due to the lack of professional management and detention centers, people do not know where to apply for the permit. Even though there are many illegal dogs, no one appeals and even no one deals with it. Under the circumstance of the unorganized management, and the ignorance of the regulation, the related regulation is like a blank sheet.
From those above mentioned problems, China should change the policy toward the decrease of rabies. Currently the Chinese government usually uses the so-called management, vaccination and killing to deal with stray dogs. However, it is not successful and many pet dogs are forced to or mistaken to be killed. This appeals many objections from animal protection groups. In fact, the brutal killing should not be launched but the principal management to tackle the rabies since it always depends on keepers’ determination and social ethics. The most principal reason for dog trouble is that irresponsible dog keepers do not keep their own dogs well. Thus, the legislation restricts those keepers. What important is that the legislation must be enforced precisely. There was no special legislation in the past. However, many loopholes happen because of the loose enforcement. For example, huge dogs are transferred to somewhere else during the check. After the check is finished, they can be moved back. In addition, some packaged policy should be launched to lower down the registration fee and annual checking fee, to manage the dog market, to strengthen the animal disease prevention and the function of control center, to provide free rabies vaccines or to launch pet-raising regulatory group in order to supervise dog keepers in the neighborhood. In conclusion, promoting civilized pet raising for keepers without bothering some other else and following the regulation will be the efficient and principal ways to tackle rabies.
Data resources:
http://www.39kf.com/focus/zt/Rabies/
http://www.cdc.gov.tw/
The Booming India. The Highest rabies Infection Wu, Chia-Cheng
Vaccination and animal control project can prevent from rabies 100%. However, India is still highly dangerous for rabies. Due to the expensive vaccines and medicine, time-consuming and painful vaccination treatment and large amount of stray dogs suffering from rabies, rabies disease in that country remains on top. According to the neighborhood survey in 2003 by APCRI, about more than 20,000 people in every 100,000 people are estimated to suffer from rabies and most of them are male adults living in rural areas without any vaccination.
The animal prevention area is only short-term effective.
The prevention way of animal rabies include that the public is forced to do the pet registration and pet vaccination. Otherwise, the pets would be dealt as stray dogs. The number of stray dogs should be controlled and dogs are induced to be fed the oral rabies vaccine. Meanwhile, those which are infected rabies should be caught and killed. Then, the regular inspection or the killing of suspicious stray dogs should be carried out. All the above-mentioned strategies only apply to the last prevention in a small area. Thus, the effect can be paid off in a short time. However, due to the huge mobility of stray dogs, the control of funding and the difficult resource of vaccines, the rabies can not be prevented in a longer term. The long-term governmental animal prevention strategy should start to investigate the origin of all the stray dogs, to launch dog castration in order to stop the growth of stray dogs. Meanwhile, the education of rabies prevention should be strengthened on publics. The public should get away from stray dogs. They should also take their own pets to do the castration and vaccination in animal clinics and even should not abandon their pets to increase the member of stray dogs. Thus, the problems of dog rabies infection can really eliminate from the bottom.
The value of the importance of vaccine prevention.
The Indian government should cooperate with the drug sector.
Though the dog bite is the major reason for rabies infection in India, apart from the animal prevention to control the disease, medical staffs in India indicate that due to the expensive vaccines and medical treatment, and the 14 day vaccination, most of the patients do not complete the treatment and a loophole occurs in the rabies prevention.
According to the first chapter Rabies Vaccines in India in the first part Is it just vaccines? in New Technologies in Public Health – Who pays and who benefits？published by Indian National Coordination Committee and JSA(Jan Swasthya Abhiyan) in 2007, the Indian government is accused of using the outdated, expensive and unsafe rabies vaccines prepared with sheep brain. Indian drug controllers never negotiate with MNC pharmaceutical company to lower down the price of safer and new cell-cultured vaccines and to generalize it. The Intra Dermal route of new vaccines can lower down the dose for money saving and security reason. However, two brands of MNC pharmaceutical company, Rabipur and Verorab, are never registered for this technology. Thus, in India, more dose of intramuscular vaccination is widely applied.
Rabies disease in India is still very popular. It not only influences the domestic progress in politics and economics but also becomes a huge loophole for the global disease prevention. Before the international organizations force the government to conduct the precise control, if the drug controllers can focus on the problems of the expensive price of vaccines and the outdated vaccination skills and negotiate in a proper political way, India can be shown as a real country with cultures, economic boom and humanism worth of the global investment and respect.
Data resources:
1. Indian doctors want cheaper rabies drugs ,http://news.bbc.co.uk/2/hi/south_asia/822457.stm
2. The safety and efficacy of the oral rabies vaccine SAG2 in Indian stray dogs , F. Cliquet, J.P. Gurbuxani, H.K. Pradhan,Vaccine ,Volume 25, Issue 17, 30 April 2007, Pages 3409-3418
3. Human rabies in India: epidemiological features, management and current methods of prevention. Dutta JK. Trop Doct. 1999 Oct;29(4):196-201
4. Epidemiology of dog bites: a community-based study in India. Agarwal N, Reddajah VP. Trop Doct. 2004 Apr;34(2):76-8.
5. http://phm-india.org/pdf/nha2/New_technologies.pdf ,New Technologies in Public Health – Who pays and who benefits?
Does Taiwan Face the Potential Outbreak of Rabies? Yen, Chi-Hao
Since 1959, there has been no human rabies case in Taiwan while since 1961, there has been no animal rabies case. The term, rabies, for young Taiwanese generation, is rather unknown. But it may not be known that Taiwan is one of the seven non-epidemic countries on the world. The rest of the six are Japan, the UK, Sweden, Australia, New Zealand and Iceland. It may be more unclear that rabies in fact is a disease sharing between animals and human beings. The major infection is among warm-blooded hosts. People usually are infected by the bite, scratches and wound licking from rabies infected cats and dogs. Though there are rabies vaccines, it is useless to inject the vaccines until the infection. The death rate of rabies is almost 100 percent. Though currently Taiwan is a non-epidemic area, Taiwan faces several hidden worries of the outbreak of rabies which are the most neglected parts by the public.
1. The insufficient resources of international health information
Due to the restriction of international political situation, Taiwan is not eligible to participate in the important international health organization like World Health Organization as a member state. An outbreak of a serious pandemic in Taiwan will affect Taiwan to obtain the disease-related information on time and also the international aids will be restrained because of that. The most apparent example is in the beginning of 2003, when the outbreak of SARS occurred in Taiwan, not only the related information and samples were not easily obtained but also due to some reasons even the experts from WHO could only arrive at Taiwan to help until May when the disease had been controlled. If the outbreak of rabies occurred in Taiwan, probably the similar situation like SARS would repeat.
2. The non-transparent disease information in China and the booming trafficking in the islets
According to the statistics from Ministry of Health, China, the first half of this year, 1400 people are reported to be infected rabies while about 1100 people died in China. In this January, 217 reported rabies cases and the number of the death cases were 182. The fatality rate reached 83.87 percent. In the serial eight months, rabies stands the highest number of death among Chinese legal infectious diseases, far more than the second one, tuberculosis(94 cases). Thus, China has become the important rabies disease area. For Taiwan, adjacent to China, is a worry. Two following situations are even more threatening to Taiwan. First, the Chinese government is always trying hard to hide their domestic disease information. For example, several years ago, SARS expanded from the regional disease to the global pandemic. One important reason was that the Chinese government hided the disease information and lied to the WHO inspectors. In addition, many rural areas far away in China lack of the resources and their external transportation connection are not that available. Those health statistics collected by the central government might neglect those areas and influence the value of those statistics. Second, Chinese coastlines are very close to Taiwanese islets. The bilateral people contact each other very often. The trafficking is also common. In fact, those imported cats and dogs should be inspected by Bureau of Animal and Plant Health Inspection and Quarantine, Council of Agriculture, Executive Yuan, Taiwan and install the chips inside of them. However, these measures are applied to those legally-imported animals. If they are from the trafficking and also not inspected by the custom, the loophole will be very worrying.
3. The problems of stray dogs in Taiwan
Stray animals in Taiwan are always a complicated issue. It has caused some problems of environment and personal safety. Once Taiwan unluckily happened to be the rabies epidemic area, those stray dogs would become the individual virus carriers. It would cause a huge impact on the public’s daily life. Moreover, some people do not respect the life and do not consider about their personal condition to adopt the pets. When they get bored of them, they just throw them. It makes the problem of stray animals can not really resolved effectively and also increases the complication of the prevention.
To sum up, in order to eliminate those above-mentioned worries, the government can strengthen the cooperation regarding the health issues with the diplomatic allies and participate in the related events and conferences in WHO in the international community with Taiwanese disease prevention experience and technology to support developing countries for the visibility of Taiwan in the international community.
In the daily life, the government should promote the prevention and inspection- related knowledge to the public and stress on the inspection of trafficking and penalty. Our nationals should respect life and do not traffic those un-inspected animals back to Taiwan. Pet keepers should fulfill their duty as well. Those pets should be taken to animal clinics or animal disease control centers in any county and city to do rabies vaccination. If keepers can not afford raising the pets, they should contact official institutions such as cleaning units and animal detention centers to arrange some available keepers to take on without producing other social problems.
Data resources:
1. http://www.doh.gov.tw/cht2006/index_populace.aspx
2. http://tw.news.yahoo.com/article/url/d/a/070804/5/i99i.html
3. http://web.kinmen.gov.tw/371022800g/news/news16.htm
4. http://www.baphiq.gov.tw/mp.asp?mp=1 (農委會動植物防檢局)
5. http://www.cdc.gov.tw/index.asp (疾病管制局)
Past, Present and Future about Rabies in Taiwan Lin, Min-Hao
It is believed that rabies was transmitted from Shanghai to Taiwan in 1947 while according to some documents, some rabies cases were discovered in Taiwan during the Japanese colonial time. The first human rabies case in Taiwan was diagnosed by Doc. Lin, Tzeng-Yi in National Taiwan University Hospital on April 15th 1948. Then some disease cases occurred and rabies reached the climax between 1951 and 1952. In these two years, there were 238 and 102 cases respectively. Until 1959, there was no human rabies. After 1961, there was no longer animal rabies. But in 2002, one imported case was discovered and stunned the public health sector in Taiwan.
According to Dog Rabies Inspection Survey in Taiwan in 2003 conducted by Animal Health Research Institute, Council of Agriculture, Executive Yuan, no rabies cases were discovered after the investigation. Thus, Taiwan is still non-epidemic area. Taiwanese dogs’ positive rate of antibody is about 50.4 percent. (Please refer to the table one. Lee, Shu-Hui et al., 2003). However, lots of efforts still need to be done for the lowest positive rate maintenance between 54% and 62% according to WHO’s standard.
In Asia, apart from Japan and Taiwan are non-epidemic areas, other countries are still epidemic areas. Nowadays, the transportation is so convenient that there might be some loopholes. What’s more, the bilateral trafficking is booming. Thus, in future, dogs in Taiwan should be stressed on the improvement of the positive rate of antibody and the government should expand the scale of rabies vaccination to increase Taiwanese dog group immunity. Only this can avoid the outbreak of rabies in Taiwan in future.
Second, apart from the current Statue for Prevention and Control of Infectious Animal Disease, the legislation of pet management should be launched. The legislation should force pet keepers to register chips into their pets and also include the regular inspection and vaccination. Thus, the related management can be supported by the legislation. The consciousness of keepers should no longer be relied on to make a loophole of the prevention. Moreover, the last outbreak of rabies in Taiwan was over half of century ago. The young generation might know very little about rabies and even do not think that it would occur in Taiwan. Thus, the government should keep educating the related prevention of rabies to the public in order to increase the public awareness of the risk and the active cooperation.
Last but not least, rabies supervising system should be set up. For stray dogs, pets and other warm-blooded animals, the supervising system should be built up and collected the tissues, blood samples and clinical symptoms of all warm-blooded animals. The databank of epidemiology should be set up to realize the change of the disease and to take some proper actions.
In the past, the prevention made Taiwan become one of the seven non-epidemic countries on the world. If the prevention can be carried on more thoroughly in the future, it is believed that rabies can be officially declared that it is extinct in Taiwan as another great achievement of public health in Taiwan.
Table One: the examination result of dog rabies vaccine antibody ELISA
Origin Amount of Serological Test Positive Number(Positive Rate)
Pets 1,559 980 (62.9%)
Stray dogs 2,099 863 ( 41.1%)
Total 3,658 1,843 (50.4%)
Data Resource：Dog Rabies Inspection Survey in Taiwan in 2003, Animal Health Research Institute, Council of Agriculture, Executive Yuan
Data Resources:
1. http://vettech.nvri.gov.tw/Articles/report/886.html
2. http://www.adccyl.gov.tw/Animal_Dise/rabies/rabies.htm
3. http://www.cdc.gov.tw/index.asp (疾病管制局)
4. http://www.rabies.com/
沒有留言:
張貼留言