RABIES CONTROL IN SIKKIM Annual Mass Canine Rabies Vaccination Programme/Camp

DESCRIPTION: Roughly 36% of the worlds rabies deaths occur in India each year, most of those when children come into contact with infected dogs. (WHO Bulletin, Dec 2009). As we are aware that Rabies is caused by a virus that is transmitted to humans through the infected saliva of a range of animals. But most human deaths follow a bite by, or exposure to, an infected dog. Between 30% and 60% of the victims of dog bites are children under the age of 15 in countries where rabies is endemic. Rabies is endemic to Sikkim. Although some useful figures have been published with respect to humans, limited statistical information is available regarding disease incidence in domesticated animals and street dogs, and there is an extreme paucity of data regarding the populations of and Rabies prevalence in feral canids and other non-domesticated carnivores, including the jackal and the fox, which act as Rabies reservoirs Prior to the establishment of the SARAH Programme, Sikkimese authorities, confronted with the problem caused by ever-increasing numbers of dogs, resorted to mass shooting in the hope of finding a quick solution. However, as has been found in all parts of the world where such measures have been utilized, this inhumane and dangerous slaughter policy was totally ineffective in controlling street-dog numbers or rabies(1-2 cases of human rabies death annually) It is now accepted internationally that elimination of rabies in people, requires control of rabies in dogs. Animal Birth Control and rabies vaccination of dogs are the cornerstones of control of canine rabies. Background The SARAH Programme, commenced in 2006, has been undertaking an ABC-AR programme where dogs are collected from the streets, desexed, vaccinated, given veterinary treatment as needed, and then returned to their home location. The presence of the sterilised and vaccinated dogs, due to their natural territorial behaviour, helps prevent unknown roaming dogs from entering the locality and further prevents the transmission of sylvatic rabies to humans and other domesticated animals. Since the commencement of the SARAH programme, there has been a dramatic improvement in the health of the dogs in Sikkim, and a marked reduction in fighting and aggressiveness in dogs and problem dog behaviour. There is also a marked improvement in public health as human rabies is virtually under control in Sikkim since the programme started. We estimate there are 40,000-50,000 dogs in Sikkim. Justification:World Health Advice on Rabies

Based on WHO experience in rabies control, it is necessary to vaccinate 70% of the total dog population in a short period of time, and maintain that immune coverage. It is recommended an annual parenteral mass rabies vaccination program over 1-5 weeks and that the ABC programme be continued for the remaining eleven months of the year. A top-up vaccination program for puppies less than 6 months age should be conducted 6 months from the mass program. Achievement: In the last 2 years of annual mass ARV camp ,we have given 35,000 doses rabies vaccine over the period of 1 month covering every villages and town throughout the state.. Since the start of the program in 2006, we have given more than 80,000 doses of vaccine and desexed over 24000 animals. What we require; Inventory and documentation: Inventory of vaccines/medicines and other supplies

Programme banner AR camp record form Rabies Vaccine: buy in bulk from Pfizer Cool box and Ice Vaccination certificates Syringes: mainly 3ml but also a few 5ml & 10ml (reuse 3 ml syringes as often as possible, but a clean needle for each dog) Hypodermic Needles: 22 and 24g,21 for ivermectin Worm Stop: Pyrantel wormer for pups Ivermectin: Only use Ivermectin in severe skin disease and if owners are aware of the slight risk Donation tin & receipt book: No charge for exam and vacc, but ask for donation if wormers dispensed Cloth & table cleaner Sharps containers x 2 Surgical spirit Stethoscopes Thermometers Cotton Wool Muzzles Soap & Towels for hand washing Pens and paper Rubbish bag Leads, nets Humane animal handlers to handle aggressive dogs

First aid kit including topical Iodine i. amoxy LA ii. wormer iii. stitch up kit iv. euthanasia solution v. tool kit

Methodology: Planning: 6months before the campaign, we meet with Panchayats, Schools, Village Heads to inform them regarding upcoming campaign and its importance. There are 4 districts in Sikkim and 163 GPUs. In each district, we mobilise 6-8 vaccination teams. Within these teams we have sub-teams so that on any day we can cover many villages in the one GPU. A team consists of a vet, paravets/vet aides, and humane animal handlers. All our staff are skilled in dog catching and handling. We draw up a tentative state-wide schedule with venues for vaccination sites on the basis of 6-8 vaccination teams. 1 month before the campaign, we issue a departmental circular to different Animal Husbandry institutions regarding the upcoming campaign. We inform the dates of the campaign and tentative venue and ask for their assistance. We attach to this circular, a letter seeking cooperation from relevant government and non governmental agencies such as Panchayat, BDOs, police officials. 1-2 weeks before the campaign commences, we convene a meeting in each of the 4 districts inviting all the veterinary officials in charge of the veterinary institutions (veterinary hospitals and dispensaries, stockman centres). We tell them about the importance of the program and tentative schedule. We tell them how to encourage people to bring dogs, select suitable venues and demonstrate how to give the ARV vaccine. A suitable venue is for example a public structure such as a school playground or veterinary hospital. In some villages, there may be not available, and so it may be done on the roadside, or in front of shops, or private facilities such as empty shop or lawn of a residence if owner permits. We give officials posters for display, and copies of the tentative schedule, departmental circular and rabies information and ask them to put them up in a prominent place so that public have notice of the upcoming campaign. A massive radio, TV and newspaper awareness campaign and advertisements is commenced one month before the campaign. Radio works best in the rural areas.

We also air a live phone-in radio program for people to ask questions about anything but especially rabies control and prevention. We aim to disseminate information in both English and the local language. We train our staff to work in tandem with the officials of the veterinary institutions. Staff liaise with Panchayat, police and veterinary officials in each village. They are even trained to estimate travel time and how long they will need in each village. Staff are expected to deliver public education about rabies, animal welfare and the ABC program at every opportunity to villagers, townspeople and school children. We encourage people to bring their dogs for ABC when we next visit for ABC. All staff follow the protocol for giving the ARV including site of administration, new needle for each animal, ensuring vaccine cold chain is maintained, covering the dogs head, giving treats to entice dogs, recording owner/dog/location details. The dog and cat census data collected during the campaign is used for future planning of both the ABC program and the vaccination campaign in the following year. Operation We work 7 days a week during the campaign. We start at 7am and usually finish between 4-6pm. Every district has 1-2 vehicles, and teams are dropped off at sites and then travel between villages. The driver is kept busy each day, shifting teams from site to site. A megaphone is used to call people and inform them about the venues and program. We store vaccine in veterinary hospitals throughout the state. The teams stay in a given area during the campaign. They are given float money for fooding, lodging and other logistics such as fuel, stationery, etc. One or two teams are mobilised in the towns where stray dogs are present for a complete one month. They systematically catch and vaccinate stray dogs. We entice the dogs, use nets, and encourage the community to catch the dogs and bring them to us. On conclusion of the campaign, we have a de-briefing meeting where we analyse what went wrong, what needs to be done next time, and what worked. We send an appreciation letter to officials and other persons who have assisted us during the campaign.

Dr Thinlay N Bhutia

Programme Coordinator/SARAH Division