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Tuesday, 16 October 2012

9th AREB meeting in Yogyakarta, Indonesia

Rabies experts from 12 Asian countries gathered for 3 days in Yogyakarta for the 9th annual meeting of the Asian Rabies Expert Bureau (AREB). They discussed the rabies situation in their respective countries, as well as strategies to achieve elimination of dog-transmitted human rabies and how to implement them. Successful pilot projects were presented, emphasizing the need for multisectoral collaboration, including community active involvement and empowerment, as well as commitment and cooperation of the ministries of Health (MOH) and Agriculture (MOA). 

This strategy has proved effective in Bali. "Coordination mechanisms have been established at the provincial and district/municipality levels between the MOH, MOA and the Ministry of Internal Affairs (MOIA); joint teams of the MOH and MOA are investigating rabies cases; 58 rabies prevention centers for animal bite management have been established in Bali, and health workers have been trained to rabies vaccination of bite victims," Dr Rita Kusriastuti, director of VBDC MoH Indonesia, said. 

"In order to prevent and control rabies at the source, mass vaccination campaigns of dogs have been carried out with dog populations through humane management and promotion of pet ownership responsibility," Dr Pudjiatmoko, director of animal health in DG of Livestock and Animal Health MoA, added. Communities were empowered through information, education and communication. As a result, the number of human rabies cases has been dramatically reduced. Several "success stories" from different Asian countries were presented. The Bohol Rabies Project, a landmark field project in the Philippines supported by the Global Alliance for Rabies Control (GARC), has demonstrated that rabies can be eliminated and children saved by empowering communities to take responsibility, and bringing different sectors of society (educators, physicians, veterinarians, government officials, community leaders and the general public) to work on a common goal. 

In Bohol, thanks to coordinated initiatives, over 70 per cent of dogs have been registered and vaccinated, and education on rabies prevention and responsible dog ownership has beenintegrated into elementary school curriculums. The Bohol model hasbeen recognized by the President of the Philippines for its excellence (Galing Pook award, 2011) and is being adapted to other rabies endemic areas in South East Asia. 

In Indonesia, for example, the CARE (Communities Against Rabies Exposure) Project, derived from the Bohol model, has been recently launched in Nias Island, North Sumatra and is expected to contribute to rabies elimination using a similar intersectoral approach. "Nias project will concentrate on dog vaccination, work collaborativelly with Directorate General of livestock and animal health MOA, as well as on prevention of human rabies with MoH in a concept of One Health," explained Dr Rita Kusriastuti. Another example came from India, with the Adopt a Village Project, carried out in several villages in the rural area southeast of Bangalore. An education and awareness program was conducted for people living at daily risk of rabies. 

This involved communicating facts about rabies via messengers (school teachers, health care workers, local leaders) and media (posters, television, etc.) to dispel myths and encourage behaviour changes. School children took part in a drawing competition and learned about rabies playing specially developed games. Numerous initiatives have been undertaken to convey rabies knowledge to the general population: educational videos shown regularly in the local television network and in schools, murals displaying key messages painted on houses, and many others. Local leaders and women from Self Health Groups were recruited to implement these activities in their own villages, and their continued involvement is crucial in sustaining anti-rabies activities now that the project has been completed. 

On 8-10 Oct 2012, Indonesia commemorated World Rabies Day. The celebrations, led by a priest and members of the church, took place in Maumere, Sikka District, East Nusa Tenggara Province, where several innovative anti-rabies actions have been taken. A few recommendations to prevent rabies: - In case of a dog bite: stop the infection in its tracks: wash thewound with soap and water for 15 minutes, and get to the nearest rabies prevention center to receive appropriate preventive care as soon as possible (vaccination, and, if necessary, rabies antibodies); - Dog bite prevention: teach children how to avoid being bitten; - Protect your dog from rabies: dogs are the 1st victims of rabies, as well as the main transmitter to humans. By having your dog vaccinated, you protect it, and you protect yourself and your relatives. 

About rabies: Rabies is one of the most deadly diseases in the world today that affects both humans and animals. Rabies has the highest case fatality rate of any known infectious agent. It is caused by a virus that is transmitted through a bite, scratch, or lick of an infected animal. Once the symptoms occur, death is almost always certain. However, if a specific treatment is provided rapidly after exposure, the patient's life can be saved. This treatment (post-exposure prophylaxis or PEP) includes immediate and extensive washing of the wound with soap and water, followed by local administration of rabies immunoglobulin (rabies antibodies) and immunization with a safe and effective vaccine. 

Rabies PEP ensures both immediate and long-lasting protection. About the "One Health" approach: The "One Health" concept is a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment. "One Health" unites human and veterinary medicine through collaboration between scientists, physicians, veterinarians, nurses and other healthcare workers. [Ref: The One Health Initiative:

 The Asian Rabies Expert Bureau (AREB), founded in 2004, is an informal network of rabies experts from 12 countries: Bangladesh, Cambodia, China, India, Indonesia, Lao PDR, Myanmar, Pakistan, Philippines, Sri Lanka, Thailand, and Viet Nam. AREB is committed to contributing to rabies elimination in Asia. AREB members meet annually to present and discuss the rabies situation in their respective countries, share experiences, address specific problems encountered in clinical practice, and find practical solutions.

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