1. Rabies situation in Far East Asia Zhen F. Fu Department of Pathology University of Georgia

2. Africa 5000 – 15000 Cases < 500 000 PET North America/Europe <50 Cases < 100 000 PET Latin America <60 Cases < 500 000 PET Asia 35 - 55 000 >8 000 000 PET Rabies Incidence

3. 40 3209 2490 19000 76 44 2000 1100 24 248 30 Human rabies cases (>28,000) in Far East Asia in 2006

4. Human Rabies and Treatments, Far East Asia,2006 Post-exposure Country DeathsRate/millionTreatmentRate/mil India 19,00016.71,800,0001,768 Pakistan 2,4901769,000469 Bangladesh 2,0001260,000455 Myanmar 1,100235,000102 China 32092.58,000,0003,959 Philippines 2483.3102,1481,338 Indonesia 400.28,80043 Sri Lanka 76480,0004,200 Thailand 240.41200,0003,178 Vietnam 300. 38635,0008,105 Nepal 442.1725,0001,085 Cambodia 20.8012,0001,071 Lao People s Democratic Republic 21.263,000540 TOTAL28,2756.5 10,692,010 1,881

5. Rabies in the Far East Asian Not much has changed: Rabies free countries or regions: Japan, Singapore, HK, Taiwan. Endemic with slow increase: most of other countries Continued and sustained improvement: Thailand Dramatic changes: China South Korea: No human cases, but wildlife rabies spreads.

6. Reported Human Rabies Deaths in Thailand Veera Tepsumethanon National rabies centre, 1995 171 68 24

7. Rabies in China in the past 60 years

8. A neglected disease of the poor – rural areas For example: India Urban: 1,0585% Rural: 18,20195% Characteristics of rabies in Far East Asia

9. Rabies: a disease of childhood Children aged less than 15 years are involved in 40% of the cases 70 60 50 C PT 40 A AH M KA 30 B I I O C 20 SL INDIA D H TA 10 I I AN A N ND 0 A 0

11. Most of the human vaccines are locally produced and brain vaccines are still used in some countries HDCV: India PVRV: India, Columbia, China PCEC: India, Japan, Thailand, Philippines PDEV: India PHKC: China SMB: Vietnam, Cambodia Semple: India, Bangladesh, Nepal, Pakistan Blue are WHO recognized products Black are recognized locally only Red are WHO condemned products

12. The major reservoir is the domestic dog >90% human cases from dogs There is no dog registration There is no dog leash There is little dog vaccination

13. Anti-ABLV and the newly discovered lyssavirus antibodies have been found in bats in Thailand. Detection of RV antibodies in bats in China? Raccoon dogs spread RV in the Korean peninsula.

14. Dog vaccination coverage Countries (regions)Total #VaccinatedCoverage (%) Japan6.5 m4.8 m74 Vietnam6 m3 m50 Taiwan1.3 m0.6 m47 Sri Lanka2.5 m1 m43 Philippines0.84 m0.18 m21 China>100 m?<3 Myanmar0.11 m0.02 m2 Nepal1.9 m0.015 m<1 Laos?7248?

15. Rabies Control in Far East Asia Dog vaccination is the key!!!!! Establish infrastructure. Adapt methods of diagnosis and surveillance. Produce cheap dog rabies vaccines. National or regional campaigns. WHO/OIE/EC encouragement and assistance. As the economy improves in Asia, resources will become available. Many countries are initiating dog immunization programs.

16. ACKLOWLEDGEMENTS Dr. Yongzhen Zhang, China Dr. T. Hemachudha, Thailand Dr. S Takahashi, Japan Dr. Hyaw Sunn, Myanmar Dr. Dhan Raj Ratala, Nepal Dr. Davinio P. Catbagan, Philippines Dr. S. K. R. Amarasekara, Sri Lanka Dr. Huang-lin Kao, Taiwan Dr. Van Dang Ky, Vietnam