What have we achieved since Kiev: Looking forward

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What have we achieved since Kiev? Looking forward

• Deborah J Briggs, PhD
• College of Veterinary Medicine
• Kansas State University

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• Epidemiology
• Rabies diagnosis
• Animal rabies control
• Human rabies prevention
• Vaccinology and immunology
• Bat rabies

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Epidemiology

• Surveillance increased sample submission,
  variant identification in Europe becomes
  sporadic or non-existent further East
• Increasing data on submissions, negative and
  positive
• Rabies in Europe Bulletin increased reporting
  and support by most European countries
• Fox rabies disappeared in W Europe
• Epidemiological data becomes sporadic or
  non-existent farther east
• Threat of re-emergence of rabies by raccoon dog

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Rabies Diagnosis

• Increasing number of Rabies Reference
  Laboratories
• Collaboration and cooperation in EU rabies
  laboratories EU very active in support of
  rabies diagnoses
• Exchange of samples WHO/OIE CCs
• Research begun into geographical host species and
  chronology in Europe
• Need to expand diagnostic capabilities into
  rabies endemic zones farther east

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Animal Rabies Control

• Eastern Europe dramatic decrease in rabies
• ORV Eastern Europe and sporadically in Asia
• EU funding opportunities for control programs
• Minimum financial cost for Rabies control in
  Europe 10.04 16.84 mio Euros annually
  Reduce? Stop?
• Strategy for vaccinating raccoon dogs
• New models 60 herd immunity could be a useful
  target in rabies control and save 1/3 of applied
  resources opportunities to design a new strategy

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Human rabies and prevention

• Recent human rabies survival in the US Why?
• NTV replaced in India
• Long lasting memory cells after CCV
• Increase usage of low dose intradermal regimens
  where cost of PEP is prohibitive
• Can PreP regimen be reduced?

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Vaccinology and Immunology

• Transfer of vaccine production technology
• ELISA for serological testing for animal export
• New ORVs under development
• Less expensive ORV

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Bat Rabies

• Widespread surveillance through Europe
  increasing attention to bats across Eurasia,
  Africa
• Establishment of data base for bat viruses
  ability to determine bat species through DNA
  analyses
• Need protocol standards to compare results
• Spillover into other wildlife species
• Need to know species of both positive and
  negative submitted samples habitat range
• Need for increased surveillance, analyses of
  genetic diversity data documentation,
  pathogenesis, sharing samples

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MED VET NET WP05 EBLV Database
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• Changing focus
• elimination of rabies
• Broader vision
• Cooperation and collaboration
• Development of new strategy bigger picture
• Expanding region Asia, Africa
• Rabies is higher on the list of important
  diseases across the world more press coverage

Responsibility
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Looking toward our futureProblems or
Opportunities?

• Low priority
• No major funding
• Lack of education awareness on all levels
• Passive immune products limited availability
• Treatment in human cases is it possible?

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Opportunities
Are we willing to take them?
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Working together for success

• A house divided cannot stand

Photo S Scholand
Photo BJ Mahendra
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Working together for success

• Agriculture and Health Ministries must work
  together
• International, Regional, National, Local levels
• One medicine approach

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Vaccinating dogs in Mexico
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Thailand, years 1995-2004
RIG
PEP
RIG 6 to 11 of PEP
Source Bureau of General Communicable Diseases,
Department of Disease Control, Ministry of Public
Health.
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Opportunities
Can we find money to fund projects?
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Funding strategies

• What do we want to fund?
• Who has that much money that might be willing?
• How can we achieve funding?

Pilot project to eliminate canine rabies from a
specific region
GATES
Organized commitment together
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Opportunities
Can we find a treatment for human rabies?
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Human rabies treatment

• Survival of Wisconsin case raised many
  questions Can human rabies be treated?
• Need for animal models to validate/extend current
  observations on fundamental pathogenesis
• 1. BH4 deficiencies with associated
  neurotransmitter deficiencies now in 3/3
  patients - confirm, timing/importance (whether
  early/primary/ causal of disease or
  late/secondary), fixed vs wildtype?2.
  Vasospasm confirm, stick in a flow probe, fixed
  vs wildtype?

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Human rabies treatment

• Need anti-virals that work no effect of
  ketamine/amantadine/ribavirin on salivary viral
  load until serum neutralizing antibodies are
  present
• Given absence of antivirals, how can we
  accelerate immunity, safely?     Are vaccines
  safe or not in active disease?     Are newer
  attenuated (double G) constructs different or
  safer (fixed vs new wildtype/attenuated)?

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Opportunities
Can we find a solution for limited availability
of passive immune products?
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• PEP often delayed medical education poor in many
  regions
• Rabies immunoglobulin is given to less than 3 of
  patients with severe bites in Asia and Africa

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Passive immunity product replacement

• Availability extremely limited
• Quality and effectiveness
• Pepsin digested heat treated products have lower
  half life
• Testing in vivo not always conducted
• Mabs for passive immunity in PEP currently
  undergoing clinical trials

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Passive immunity product replacement
de Kruif et al. Annu. Rev. Med. 2007, 58359-68
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Opportunities
How can we put rabies on the radar screen of
the world?
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WORLD RABIES DAYSeptember 8, 2007
Together we can make rabies history
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World Rabies Day Facts

• WHAT A day of recognition for the ongoing
  tragedy of rabies
• WHO OIE (World Animal Health Association), ARC
  (Alliance for Rabies Control)
• WHERE Numerous places throughout the world
• WHY To increase global awareness of rabies
• WHEN September 8, 2007 and annually thereafter

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Partners

• Support from OIE
• Pasteur Institute
• Canadian Food Inspection Agency (CFIA)
• American Veterinary Medical Association (AVMA)
• American Animal Hospital Association (AAHA)
• World Society for the Protection of Animals
  (WSPA)
• Commonwealth Veterinary Association
• Association for the Control of Rabies in India
  (APCRI)
• Rabies in Asia Conference Foundation (RIACON) in
  India

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Sponsors/Partners

• Merial
• Intervet
• Sanofi
• Novartis
• Berna Biotech/Crucell
• Pfizer
• Virbac

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WRD - Objectives

• To improve global awareness of rabies and promote
  prevention at the local and community level
• To mobilize resources for local projects -
  coordinate global veterinary and medical
  resources to work together to use one medicine
  approach to fight rabies
• To produce and support education initiatives
  concerning rabies prevention including
  responsible pet ownership

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World Rabies Day

• Involve 55,000 participants around the world
• - One for every death that need not have occurred

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World Rabies Day - Opportunities

• To increase educational awareness and save human
  lives
• To work together toward elimination of canine
  rabies press, veterinarians, medical
  professionals, governments, international
  organizations
• To develop and implement national and regional
  rabies prevention strategies