Fifth Asian Rabies Expert Bureau Meeting


The Fifth Asian Rabies Expert Bureau (AREB) Meeting was held in Ho Chi Minh City, Vietnam on 'November 17-20, 2008'. Two rabies experts from Karachi Dr. Naseem Salahuddin, Infectious Disease Consultant at Indus Hospital and Dr Seemin Jamali Deputy Executive Director and In charge emergency JPMC attended the 3-day conference. Other countries represented were Vietnam, Thailand, Indonesia, Bangladesh, India, SriLanka and Phillipines. These 8 countries including Pakistan had participated in a Rabies Awareness Survey in 2007. Each country presented its findings. The cumulative report of 4377 case studies concluded that rabies is highest in the younger population (62% in under- 18 year’s age), the poor, the illiterate, the unemployed and rural population. Wound care and proper treatment were done improperly in many countries, mainly from lack of awareness and poor financial resources.

India reported the highest incidence in the world with one bite occurring every 2 seconds and one death from rabies every half hour, adding up to over 17 million bites and 20,000 deaths a year. Thailand, Sri Lanka and Phillipines have controlled rabies reasonably well, reporting only a few deaths per year through mass awareness, because of which dog bite victims seek early and proper medical care.
 
Nerve tissue vaccine (sheep brain) is used only in Pakistan, Bangladesh and Myanmar, whereas all other countries use exclusively modern cell culture vaccine which is safe and efficacious. These countries were urged to discontinue nerve tissue vaccine production and use only cell culture vaccine. Intradermal schedule must be encouraged where patient numbers are large through teaching workshops. Lapses in technique can prove fatal for the victim.

Other issues discussed were on vaccine potency  for intradermal regimen; modalities of treatment of rabies is as yet unsuccessful once the symptoms of rabies have begun; pre- exposure prophylaxis with vaccine should be encouraged in areas of high dog density as it saves lives; vaccine dose in immune suppressed persons must be better studied.

In summary, since it is very difficult for Asian countries to be able to control dog population successfully, mass awareness is the best way to protect against animal bites. Animal vaccination on large scale should be promoted. Awareness programs in schools and hospitals, through newsprint, radio and television are the best media. World Rabies Day on September 28, in which Pakistan was an active participant, was considered an excellent means of raising the awareness level among the general public.

It was announced at the AREB meeting that the second Rabies in Asia Conference (RIACON) will be held in Karachi in February 2009, where all Asian country experts will be invited to present scientific papers on rabies.