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

Africa 5000 – Cases < PET North America/Europe <50 Cases < PET Latin America <60 Cases < PET Asia > PET Rabies Incidence

Human rabies cases (>28,000) in Far East Asia in 2006

Human Rabies and Treatments, Far East Asia,2006 Post-exposure Country DeathsRate/millionTreatmentRate/mil India 19, ,800,0001,768 Pakistan 2, , Bangladesh 2, , Myanmar 1,100235, China ,000,0003,959 Philippines ,1481,338 Indonesia ,80043 Sri Lanka 76480,0004,200 Thailand ,0003,178 Vietnam ,0008,105 Nepal ,0001,085 Cambodia ,0001,071 Lao People s Democratic Republic , TOTAL28, ,692,010 1,881

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.

Reported Human Rabies Deaths in Thailand Veera Tepsumethanon National rabies centre,

Rabies in China in the past 60 years

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

Rabies: a disease of childhood Children aged less than 15 years are involved in 40% of the cases 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

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

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

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.

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?

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.

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