A WEAK link in the existing rabies disease control programme resulted in the recent outbreak in Perlis, Kedah and Penang.
Let us take note of the circumstances that led to the outbreak, review the strength and weakness of existing control programmes and take mitigation steps to prevent further outbreaks.
Rabies is one of the most deadly zoonoses (diseases that can be transmitted from animals to humans). According to the World Organization for Animal Health (OIE), the number of annual deaths from rabies is around 70,000 worldwide.
Rabies is also a transboundary animal disease (TAD) and because it is a notifiable disease, it is mandatory that every single case in any country must be reported to the OIE immediately.
> With immediate effect, Malaysia lost its rabies disease-free status which it achieved in 2012. Malaysia is only the third country in this region to have attained this status. The other two are Singapore and Brunei.
The last case of confirmed rabies here was in 1999 and it took us 13 years to achieve this status. We do not know when we can regain it and the rabies technical committee in OIE will now impose more stringent import and export regulations on Malaysia. Technical compliance and more frequent surveillance and monitoring reports on rabies control have to be sent to the OIE in future.
This certainly does not augur well for us. In this region, Malaysia has often been recognised as a country with the least infectious diseases because many of these diseases are under control. We were proud to have a functional National Disease Control Programme. For example, at the Asean Sectoral Working Group on Livestock (ASWGL), Malaysia has been the Chair for the Highly Pathogenic Avian Influenza (HPAI) Committee for a number of years. Our Manuals and Protocols for HPAI control are often used to benchmark disease control programmes in other countries.
> The rabies outbreak resulted in more stringent regulations and compliance adherence from importing countries. Singapore and some other countries recently suspended imports of dogs and cats from Malaysia. Losses from this suspension can be substantial and will affect the livelihood of people in this business.
Preventing diseases is always a better option as disease control measures are very expensive. For example, in the Nipah outbreak in 1999, losses of exports from Malaysia were estimated at US$20mil. The three HPAI outbreaks in 2004, 2006 and 2007 resulted in a loss of RM10mil. According to a World Bank Report, losses of up to US$3tril worldwide were recorded during the H5N1 outbreak in early 2000.
> Malaysia cannot delay the purchase of vaccines. It is a time-consuming process as vaccines may not be readily available. In addition, request for technical assistance from international partners like the OIE, FAO, and WHO must be made early in the diagnosis, prevention and control of the outbreak.
> The Department of Veterinary Services (DVS) has to keep a database of the dog population especially in the border states where outbreaks of rabies are more likely to happen. This database should be updated regularly and should include owners’ particulars and identification of their pets. This repository will serve as an important ready source of information for future disease control prevention and eradication strategies.
> DVS must establish clear disease control strategies that are socially acceptable. In disease control, there are often multiple approaches and implications. In some countries, ethnic and religious issues do not come into play and disease control measures can be easily implemented.
The situation in Malaysia is different and disease control strategies must be socially acceptable to all stakeholders. The DVS should provide clear guidelines and if there are any reforms, these should be instituted immediately after the first case or outbreak to reduce tension among dog owners, other stakeholders and relevant authorities. Disease control interventions are national strategies that are managed by the DVS as the custodian of all animals. DVS should provide clear guidelines on the best approach and forbid individual heads of states to make their own decision.
In the late 70s, when the first Foot and Mouth Disease (FMD) outbreak occurred, the DVS embarked on a slaughter policy which was later changed to a vaccination policy following pressure from certain groups. The vaccination policy for FMD is still being followed now.
> Revive technical bulletins on important diseases in Malaysia. In the early 80s, the DVS published many technical bulletins on major diseases, including FMD, brucella, salmonella, and rabies. There were also numerous technical manuals on various aspects of animal health and production, including laboratories, slaughter houses, agronomy, herd health, farm management, zoonosis, import-export guidelines and protocols. These manuals provided valuable information to all players in the animal industry. In recent years, the importance of animal health issues including disease surveillance, preparedness, early warning systems/emergency response, laboratory diagnostic capabilities and capacity, legislation and policy and enforcement has declined drastically. Any effective disease control programme cannot ignore these key components.
> The recent outbreak has brought greater interagency collaboration among different ministries like the Health Ministry (MOH) and the Agriculture and Agro-based Industry (MOA), local councils, Customs, police, animal welfare groups and NGOs. Such inter-sectoral collaboration among the public and private sector and other stakeholders is the right move towards the advocacy for ONE HEALTH. This public-private partnership will ensure that the role of the private sector is complimentary to the efforts of the public sector.
> Revive the programme for annual laboratory examination on the brains of stray dogs at border areas. This was a highly effective mechanism for rabies surveillance. Before 1991, confirmation of all suspected rabies cases, whether in humans or animals, were done at the Institute of Medical Research. An agreement between the MOH and MOA was finalised in 1991 where all confirmation for rabies in animals were to be done at the central Veterinary Research Institute in Ipoh. The annual surveillance methods proved very effective and were also used to effectively verify that there were no flaws in the testing methods and the reagents used.
> Hitherto, conducting mass vaccination of dogs was the accepted policy. In the current outbreak, there were different responses as to whether to cull or vaccinate the dog population. International organisations like WHO, OIE and the Centre for Disease Control (CDC) advocate vaccination. However, one must remember that targeted vaccination will only be effective if at least 70% of the dog population is vaccinated to break the cycle of transmission of the virus from dogs to humans. In this respect, statistics on dog population in each of the affected states becomes important. In one report, it was estimated that in Penang, there are about 25,000 stray dogs. No such figures are available in Kedah and Perlis.
Speed is vital in any disease control and eradication programme. Thus, greater efforts should be undertaken to increase resource personnel to reduce the turnaround time for the complete vaccination protocol.
> Vaccination for humans engaged in the outbreak is mandatory. We must remember that 90% of dog bites from confirmed rabid dogs ultimately result in death.
Veterinary Services including aspects on disease control and eradication are considered a global public good. As such, good governance is of paramount importance in the delivery of such services.
DATUK DR P. LOGANATHAN
Small Animal Practitioner
Ex-DVS Head of Disease Control & FAO Consultant
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