Rabies
Rabies is a zoonotic (transmitted to humans from animals) disease that causes acute encephalitis .It is caused by a virus. Rabies infects animals (domestic and wild) and is spread to people via infected saliva.
Rabies is always fatal if post-exposure prophylaxis is not administered prior to the onset of severe signs and symptoms. All over the world more than 55 000 people die of rabies each year. Majority of human deaths (About 95%) occur in Asia and Africa. About 31 000 people die from dog rabies in Asia each year.
 
The rabies virus is the type species of the Lyssavirus genus of the Rhabdoviridae family. It has a cylindrical morphology and are enveloped and have a single stranded RNA genome with negative-sense.
 
Patients develop malaise, headache and fever as early symptoms of rabies and later develop violent movements, uncontrolled excitement, hydrophobia and finally death due to respiratory failure.
 
Dogs are most likely to infect people in Sri Lanka. But Rabies infections from other mammals like cats, mongoose, jackals and bandicoot also had occurred
 
In Sri Lanka 50 to 60 deaths occurs due to rabies and mainly due to exposure to infected Dogs
 
The main reasons for deaths in Sri Lanka are non vaccination of dogs against rabies and not getting post exposure treatments. If treated properly immediately after infected animal bite it is 100% preventable and post exposure vaccine and serum freely available at government hospitals.
 
Annual rabies vaccination of All Dogs above six weeks is recommended by Sri Lankan rabies control authorities
 
Rabies control measures launched in Sri Lanka since 1975 have had a tremendous effect on the incidence of human rabies. The number of human rabies deaths declined from 377 in 1973 to 58 in 2009. Table 1 shows reduction of human deaths in Sri Lanka from 1969 to 2009.
 

   Table 1: Reduction of human deaths in Sri Lanka from 1969 to 2009.


    Sri Lanka achieved above target by using following strategies.


  - Awareness campaigns on Responsible dog/Pet ownership
  - Vaccination of all different groups of dogs.
  - ABC Program to reduce most susceptible stray dogs.
  - Habitat control
  - Humane disposal of Rabid and suspected animals.
  - Continuous Monitoring and Evaluation.
 
 
 
Public Health Veterinary Services
(Rabies Control Programme)
History of Rabies control activities in Sri Lanka
 
There is a strong evidence to suggest that the menace of rabies had been in existence in Sri Lanka as the Colonial Rulers had been compelled to adopt legislation to combat the disease. The Rabies Ordinance of 1893 and the Dog Registration Ordinance of 1904 are clear indicators of this.
 
 
Rabies Post Exposure Treatment for Human
 
Production of anti rabies vaccines for post exposure treatment of persons bitten by rabid and suspected animals had commenced at the Medical Research Institute (MRI) several decades back. Goat brain tissue rabies vaccine (Semple type) which is produced here was distributed to Government Medical Institutions for post exposure treatment.
 
1953
On the recommendation of WHO consultant, late Dr. Earnest Tierkel a Veterinary Public health (V.P.H.) Unit was established under the Ministry Of Health, headed by a public health veterinarian.
   
29-10-1956 Minister of Agriculture and Minister of Health jointly agreed that the Department of Health Services should take over the responsibility for controlling rabies in Sri Lanka.
   
1959 Even though in 1959, the Eradication of Rabies – Short term Plan and in 1963, Five year plan for eradication of Rabies were formulated, they were not implemented.
   
1965 The first Anti rabies Dog Vaccination campaign was conducted in the Western province with an imported vaccines to control an outbreak in Wattala and Ja Ela areas.
   
1971 Rabies was declared as a nortifiable disease
   
1973 Record of 377 human deaths due to rabies which was the highest number in 70s
   
1975 Cabinet approval was given to launch of island wide 5 year Rabies Eradication Programme (1976-1980) with the assistance of WHO. Major protion of the assistance was set to establish a laboratory for production of Fleury type anti Rabies vaccine for animals at Veterinary research Institute of Ministry of Agriculture in Peradeniya.
   
1981 The public Health Veterinary services was elevated to the status of a specialized campaign
   
1981-1985 Second Five year Rabies Control programme. Priority was given for the activities of the elimination of stray dogs.
   
1985-1991 AGFUND/RB/WHO Assisted Rabies Control project to eliminate human rabies in 7 districts. (Kurunegala, Gampaha, Colombo, Kalutara, galle, Matara and Hambantota)
   
1989 Decentralization of Rabies Control activities under the provincial council system
   
1995 Due to increase of human rabies again to 154, another team of WHO consultants led by DR. Wanderlar visited and conducted a dog population survey in Meerigama area. This study revealed that the dog population had increased from 1:8 in 1985 to 1:4 in 1997 and about 44% of dog population is in accessible for routine rabies mass vaccination programmes.
   
Since 1998 Dr. P.A. L. Harischandra commenced innovation of strategies to reach inaccessible dogs with rabies vaccination. First choice was oral rabies vaccines. Vaccinia recombinant oral rabies vaccine was piloted in Puttlam district and it was possible to demonstrate that the ability of reaching over 75% coverage in 2003 in the district..
   
In 2004 a new device to vaccinate stray dogs at a distance called auto vaccinator was introduced and stray dog vaccinations with parenteral rabies vaccines were commenced. These strategies resulted in reduction of human rabies deaths to 55 in 2005.
   
Since 2007 Administration of animal birth control injections and surgical sterilization to minimize the proliferation of the dog population.
   
Since 2001 production of goat brain vaccine was discontinued and currently all the vaccines are much safer cell culture vaccine.
   
In 2002 the circular on Guide lines on Prevention of Rabies by anti Rabies post exposure therapy (PET) was distributed among the hospitals.
   
 
National Program objectives
 
01 To ensure protection for those exposed to suspected rabies infection
   
02 To ensure protection for those who are at a higher risk of contacting rabies
   
03 To establish herd immunity in animal reservoirs with special emphasis on dogs
   
04 To control the population of animal reservoirs with special emphasis on dogs through appropriate methods
   
05 To remove all rabies suspected dogs humanely
   
06 To reduce the transmission of Japanese Encephalitis in pig population
   
 
Major Activities
 
01 Provision of Post Exposure Treatment for rabid and rabies suspected animal bites
   
02 Mass immunization of dogs against rabies
   
03 Mass Animal Birth Control programmes
   
04 Mass awareness programmes
   
05 Training of all stake holders of rabies control
   
06 Research and surveys
   
07 Monitoring and evaluation of on going rabies control activities
   
08 Strengthen the Rabies surveillance system
   
09 Enforcement of rabies control legislation
   
10 Mass immunization of pigs against Japanese Encephalitis infection
   
 
 
Achievements
Rabies control measures launched in Sri Lanka since 1975 have had a tremendous effect on the incidence of human rabies. The number of human rabies deaths declined from 377 in 1973 to 58 rabies deaths in the country in 2009.
 
 
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