RABIES IN TUNISIARABIES IN TUNISIA

Evolution and result of Evolution and result of

« National Program of Rabies Control »« National Program of Rabies Control »

Kharmachi H., “National Reference Rabies Laboratory”, Institut Pasteur de Tunis – Tunisia”

With collaboration of the team of « National Commission of Rabies Control »:

Zaouia I., Khoufi S., Hrabech K., Mejri M., Turki I., Oukaïli K., Kortas J.

and the team of “National Reference Rabies Laboratory”:

Ben Maïz S., Bouslama Z., Ben Salem J., Basdouri N. and Handous M.

ContentsContents Epidemiology of Rabies in Tunisia

Animal Rabies Human Rabies

National Program of Rabies Control Role of I.P.T. in the epidemiological surveillance Impact of Control measures on the evolution

of rabies Conclusion

2

Epidemiology of Rabies Epidemiology of Rabies

in Tunisiain Tunisia

3

Epidemiology of Rabies in TunisiaEpidemiology of Rabies in Tunisia

Rabies is Enzootic and Endemic

Dog = « Reservoir and Vector » of Rabies

Other Domestic Animals = Victims

Wild Animals : Rares cases

Human = MAIN VICTIM of the disease

Animal RabiesAnimal Rabies

5

6

Dog

62,2%Cat

5,4%

Bovin

19,5%

Equin

6,2%

Sheep

5,2%

Goat

1,0%

Rodent

0,2%

Jackal

0,2%

Animal Rabies:

Species affected (2015)

Kair09N

Kef06N

Mon08N

Sil04N

kef08N

1Kef08N

Zag07N

sous05N

Kef09N

Bej04N

Zag09N

Med08N

Jend07N

1Jend06N

1Jend05N

Bej00N

Jend05N

Jend06N

1Sil06N

Sil05N

PV

Mokola

Ref: Amouri IK, Kharmachi H, Djebbi A, Saadi M, Hogga N, Zakour LB, Ghram A.

Molecular characterization of rabies virus isolated from dogs in Tunisia: evidence of two phylogenetic variants.

Virus Res. (2011 Jun); 158(1-2):246-50.

Cluster 1: N.O

Mokola

0.05

Cluster 2: N.C.S

Animal Rabies: Genotype1: Canine rabies strain = Two Phylogenic variants:

Ref: Amouri IK, Kharmachi H, Djebbi A, Saadi M, Hogga N, Zakour LB, Ghram A.

Molecular characterization of rabies virus isolated from dogs in Tunisia: evidence of two phylogenetic variants.

Virus Res. (2011 Jun); 158(1-2):246-50.

Mokola

0.05

Animal Rabies: Genotype1: Canine rabies strain = Two Phylogenic variants:

9

Animal Rabies: Animal Rabies:

Evolution of Rabies Incidence Evolution of Rabies Incidence

(2000 (2000 –– 2015)2015)

0

50

100

150

200

250

300

350

400

450

500

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

ANIMALS

DOGS

Animal Rabies:

Geographical Distribution:Geographical Distribution:

20132013 20142014 20152015

11

Human RabiesHuman Rabies

Rabies is Notifiable Disease:

Since 1969 (law 69/53 of 29/7/1969)

All cases are confirmed by Laboratory:

Rabies laboratory of IPT

Since 1961

Human (and Animal) rabies diagnosis

Only One laboratory for diagnostic in the country :

Methods used: FAT + RTCITFAT + RTCIT

12

Human RabiesHuman Rabies

Annual Incidence of Annual Incidence of

Human Rabies: 2000 Human Rabies: 2000 -- 20152015

2

0

2 2

3 3

1

2

4

0

2

1

3

6

3

6

0

1

2

3

4

5

6

Nu

mb

er L

abo

rato

ry c

on

firm

ed o

f C

ases

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015 Years

13

National Program of National Program of

Rabies Control Rabies Control

National Program of Rabies National Program of Rabies

Control (NPRC)Control (NPRC)

Strategy:

◦ Mass vaccination of dogs: Ministry of Agriculture

◦ Prevention of Human Rabies: Ministry of Health

◦ Control of dog population : Ministry of Interior

Management: by National Multidisciplinary

Commission of Rabies Control

15

Mass Vaccination Campain: Mass Vaccination Campain: every yearevery year + Public education & public awareness+ Public education & public awareness

Rabies is Fatal Vaccinate me you protect meVaccinate me you protect me & you will be protected& you will be protected

PostPost--exposure Prophylaxyexposure Prophylaxy

Structures

◦ Number of centers: 206206 specific centres

(+emergency hospital services) = 310310 (total PEP c.)

◦ Localisation : All regions of country

◦ Management : Ministry of health (free of charge)

17

Role of Pasteur Institute Role of Pasteur Institute

Rabies LaboratoryRabies Laboratory

18

19

National Ref.National Ref. LABORATORYLABORATORY

I.P.T.I.P.T.

VETS

(CRDA)

Prime Health

Centers

Public Collectivities

(Control of Dog Population )

Specimen

Collect Information

Epidemiological surveillance of Animal RabiesEpidemiological surveillance of Animal Rabies

20

Epidemiological surveillance of Animal Rabies:Epidemiological surveillance of Animal Rabies:

458415 423

282

627

952

11481055

0

200

400

600

800

1000

1200

19

95

-

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

Years

Evolution of number of samples tested

_ m:

Impact of Impact of

Control Measures in the Control Measures in the

Evolution of RabiesEvolution of Rabies

21

Impact of actions of N.P.R.C. on the evolution of

Humaine Rabies incidence

16/an

5 5

0

8

10

3

5

11

25

6

45

7

3

1 12

0

2 23 3

12

4 (+2c)*

0

21

3

6 (+1c)*

3

6

0

5

10

15

20

25

No

mb

re d

e ca

s co

nfi

rmés

au

Lab

ora

toir

e

1960-1

982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Années

Start of

NPRC

Stop of

Mass Vaccination

Campaigns for Dogs

Re-start of

Mass Vaccinations

Camoaigns for Dogs

16/an

5 5

0

8

10

3

5

11

25

6

45

7

3

1 12

0

2 23 3

12

4 (+2c)*

0

21

3

0

5

10

15

20

25

Nom

bre

de ca

s con

firm

és a

u La

bora

toire

1960

-198

2

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Années

16/an

5 5

0

8

10

3

5

11

25

6

45

7

3

1 12

0

2 23 3

12

4 (+2c)*

0

21

3

0

5

10

15

20

25N

ombr

e de

cas c

onfir

més

au

Labo

rato

ire

1960

-198

2

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Années

N=N=66; ; S=S=19 19

M=M=33,,22

N=4; S=44;

M=M=1111,,00 N=N=2020; ; S=S=54 54

M=M=22,,77

Program Program AchievementsAchievements.

= Saved lives

16/an

5 5

0

8

10

3

5

11

25

6

45

7

3

1 12

0

2 23 3

12

4 (+2c)*

0

21

3

0

5

10

15

20

25

Nomb

re de

cas co

nfirm

és au

Labora

toire

1960

-1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

Années

N=6; N=6; S=19 S=19

M=3,2M=3,2

N=4; S=44;

M=11,0M=11,0

N=20; N=20; S=54 S=54

M=2,7M=2,7

6x16=966x16=96

9696--1919==77

2020xx1616==320320

320320--5454==266266

ConclusionConclusion

Rabies is endemic and enzootic in Tunisia

National Rabies Control Program reduces rabies incidence

during many years (1983 to 1988 and 1993 to 2010)

Actually: Increase in the incidence (2012 to 2015)

NRCP need improvements:

Improvement of vaccination coverage of dogs:

- Actually 50%-60%;

- Objective: to reach75% of canine population

Better management of dog’s polpulation

Improvement public education and awerness about rabies

Rigourous application for recommendations of PEP protocols

26

ConclusionConclusion

Pasteur Institute Rabies Laboratory (National Reference

Laboratory of Rabies) plays a leading role in

epidemiological surveillance of rabies in Tunisia

NRLR contributes in the national commission to evaluate

the actions of rabies control.

NRLR conducts applied research program to propose

solutions to improve control of rabies

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THANKS FOR YOUR THANKS FOR YOUR

ATTENTIONATTENTION

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