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ProMED翻訳情報(260回) ~バリ島での狂犬病対策(FAOの関与)~


Date: April 15, 2014   Source: FAO

Key facts
The 1st cases of rabies in Bali were reported in 2008. FAO established a technical assistance project with the Government of Indonesia with the aim of supporting national efforts to control the disease on Bali. This was to be achieved by establishing an effective programme to coordinate and facilitate rabies control with government agencies and partner organizations. As a result of the programme, human rabies cases were reduced from 11 per month in 2010 to just one per month the following year [2011]. Following a mass vaccination of dogs, there was another major reduction in 2012 and 2013, bringing the number of reported cases down to only one human case in all of 2013. The model developed in Bali is now being modified as appropriate and used in other affected parts of Indonesia to progressively control and eliminate the virus from the entire country.

Rabies is an acute and nearly always fatal viral disease that affects both animals and humans. If left unchecked, it can have a traumatic effect on both public health and the local economy. This is especially true in the Indonesian island of Bali, where dogs play a considerable role in the culture. They are kept as pets for companionship and the protection of property, and they carry spiritual significance in the Hindu religion, resulting in a large canine population, many of which roams freely. When the 1st cases of rabies infection were reported in November of 2008, it posed a dire threat. In addition to the risk of infection to individuals, the spread of the disease had the potential to harm both the livelihood of locals and the national economy. If domestic animals such as goats, cattle or horses died, many households lacked the funds to replace them, and therefore lost an important asset for farming and transportation. When foreign governments, such as Canada, Australia and the UK issued travel advisories warning against traveling to the region, Bali’s tourism industry (which accounts for 40 percent of Indonesia’s tourism revenue) suffered as a result.

FAO’s Crisis Management Centre for Animal Health conducted a mission to Bali in December of 2008. Initial efforts by government to control the disease, while well intentioned, were ultimately not effective in preventing further spread of rabies across the island. When these methods proved insufficient, the government requested further assistance from FAO starting in 2011. A project was rapidly established, the aim of which was to enhance coordination of control efforts, capacity building, and rapid outbreak response, with the ultimate goal of establishing a national rabies control programme through the combined efforts of the government and other partner organizations.

The results of the control strategy centered on mass dog vaccination, supplemented by rapid response and integrated bite case management, are evident. Cases of human rabies were reduced from 11 per month in 2010 to one per month the following year [2011]. Following further mass dog vaccination campaigns, there were further reductions in 2012 and 2013, brining the rate down to only one human case in all of 2013.
Since August 2012, only 3 cases have been reported, and similar reductions have been seen in the number of animal cases detected. The success of the campaign has lead to further investment in rabies control on behalf of the government, and reduced the need of continued FAO funding. By 2013, 95 percent of funding for control measures was provided by the government.

Crucial to the programme’s success has been the cooperation between animal and human health services. For example, in a village in the Bangli district, a 5-year-old boy was bitten by a rabid dog while playing in his yard. His aunt then washed the wound with running water and took him to the nearest clinic. Following the Integrated Bite-Case Management protocol, a nurse at the hospital called the local rapid response team, who located the rabid dog and had it tested for the rabies virus. When the results came back later that day indicating that the dog had tested positive for rabies, [the boy] was given a course of post-exposure prophylactic vaccination and anti-rabies serum. The veterinarian in charge conducted an emergency vaccination of all the dogs in the immediate area. [The boy] has completed his course of vaccinations, and is now in good health.

The outputs of this project are being incorporated into a national Master Plan for Rabies Control, which is currently being finalized by the Director of Animal Health. In the future it will be implemented on a national scale, and serve as the model for rabies control and elimination in the other twenty-three provinces of Indonesia in which rabies is endemic. In addition, the strategy is now being adopted by several other countries in Asia, and is expected to make a considerable contribution to rabies control policy in Southeast Asia and the ASEAN Road Map for Rabies Control by 2020. It is the hope and expectation of FAO that the continuation of these policies will ultimately lead to the elimination of the virus from Indonesia, and improved rabies control throughout Asia.

[This optimistic report from Rome does not match the bleak earlier report from Bali. The key sentences in the above report are: “Since August 2012, only 3 cases have been reported, and similar reductions have been seen in the number of animal cases detected. The success of the campaign has lead to further investment in rabies control on behalf of the government, and reduced the need of continued FAO funding. By 2013, 95 percent of funding for control measures was provided by the government.”

There have been no animal reports of rabies on Bali to OIE, Paris, since December 2012, and by “no reports” I mean an absence of reporting. The ongoing vaccination is now the responsibility of the Balinese government and is theoretical at this time as human cases have reappeared. FAO might have to reconsider its claim of victory. Canine rabies vaccination has to be aggressive.