>>> good afternoon, everybody,it's 1:00 and let's begin. this is a meeting about the dogand about the dogs. and the other thing that iedlike to point out, we'd like to take down all of your names sothat everybody can get a special award. given the number of meetings cdchas held today, this is an absolute record, 917. you all deserve special creditfor coming today. thank you.
in addition to talking aboutdogs, this is an event that will focus on direction of people,animals, and their environment. and you will hear from ourspeakers a lot more about this. i'd like to welcome those whoare on internal and external viewers and welcome them to ourpublic health grand rounds. i would like to remind you thatwe are tracking the number of viewers, and even though itseems like we're patting ourselves on the back, it seemslike roughly good number. we are getting several thousandpeople every time viewing us
outside of the auditorium andour colleagues in vision land. we're not necessarily doing asspectacular well on youtube, but then the topics are not exactlygeared toward youtube audience. i think we're still doing quitewell. i would like to remind you andmention one new piece of information that i may not havementioned before. all of you who want to getcontinuing education credits for these events, you need to usethe code phgr. public health grand rounds 10.
and it's always going to be thesame code. just to make sure that you canget the credit for attending. i would like to thank two of ourcolleagues who have provided selections for our science clipsthis month, and as you will see, there's a whole bunch of tommicscovered under the rain -- topics covered under the rabies sectionfor vaccine, rabies in latin america, so on, the very sametopics we're going to be discussing today. i'd like to point out that wehave published four mmwr pieces
on some of our topics, and wewill continue to do so. some of the upcoming topics, i'msure you will find as interesting as ones before, andto keep you interested in coming and attending, this is a list ofsome that we are working on for the next several months. so as i mentioned, this is -- ofall these events are really a true team effort and require alot of preparation, coordination, and rehearsals. and i really want to say thatthis was an unbelievable
wonderful group of colleagues towork with. i'm always humbled with theseworld known experts come here and really work with us in sucha wonderful cooperative spirit. i really want to point out howwonderful it was to work with them -- and charles. so the speakers today arecharles rubrick, our own charles, denver is lay fromusda, event nelson mandela oh lamas, and debbie restrictionsfrom global lines rabies control.
to say a couple of words aboutthem. this is a very passionate groupof people, not to mention that we have somebody from latinamerica. i was hoping this was going tobe the most passionate event that we've had ever. i googled him a little bit, andyou will see that he has his own academy of national tango, andhe let us know yesterday that he's a real tango fan anddancer. so i have seen that he anddebbie have actually been
practicing for this event. not to say that charles anddennis are any less special. i've been cheering them andbeing on their side. so you're in for a reallyspecial treat, and that includes a couple of comments from ourdirector. >> thank you all very much forbeing here, and thanks for our speakers for their work puttingthis together. rain czyz a-- rain czyz a neglected disease -- rabies is a neglecteddisease.
55,000 a year die from aterrible disease, one with implications for human health,animal health, and societal well-being and economicstability. as a former health commissioner,i can tell you that rabies is one of those things that youtake really seriously. it's complicated and difficultand challenging. i remember well one of ourexposures where we had a box of kittens had been left out forpeople to take. and had been brought back by acouple of individuals who were
involved in the illicit drug useindustry but also had happened to bring kittens back, and theywere rabid. and finding people who had hadinteraction with people who were selling drugs and may have petrabid kittens provided a particularly challengingsituation for the local health department. i think many of us deal with thechallenges of the real world, and rabies is as real world asit gets. it's also as one world as itgets because it does highlight
the interactions between humanand animal health that changes in our environment, that isreintroducing species into some areas, increasing species insome areas. so there's a lot of bothconsistency and evolution in the work of rabies prevention andcontrol going back to the first rabies vaccine, which wouldnever have gotten through an irb today, but saved a child's life. there is real progress possiblein rabies through education, through quarantine, throughinjectable vaccination programs
and oral vaccination programsand animal contraception and animal population control. all of these are possible. there has been success, there'ssome areas where there's been some falling back, but i thinkit's an area where we can both celebrate the success now andrecognize how much more progress is both necessary and possible. thank you very much. >> good afternoon, i'm charlesrupreck.
we thank you for the opportunityto share some of our thoughts about this high consequencepathogen. many misconceptions probablybased upon naivete is that this disease of nature is rare andthat there's little to nothing we can do about it. both of which could not befurther from the truth. by and large with rare kpepgdss,if you develop -- exceptions, if you develop clinical signs, youdie. one of the highest case fatalityrates of any conventional agent
and obviously because of itsimpact on human and veterinary public health, a global problem. distributed everywhere with theexception of antarctica and one of the oldest describeddiseases, in fact every major civilization from thebabylonians to the present time describe something akin at leastbased on their syndromic suggestions, the bite from ananimal suggestive of rabies. these are highly variable agentsin the family rabdoverity, bullet-shaped viruses.
at least a dozen species thatcause this disease and anagenic variation in some of them giveus pause to concern because of the lack of cross reactiontivityof any veterinary or human biologiics in the world. additional pathogen discovery isexpected over the rest of this century. all mammals are susceptible, butvariance are adapted particularly to carnivores andto bats. the quintessential neurorespecttoic -- neurotropic agent
through bite or inhalation orwhen the donor's not suspected through transplantation, thevirus enters from the periphery, replicates into the centralnervous system, and is found in just about every intervatedorgan as well as the exit portals, the saliva. hence, intervention needs to beprompt and practical and proper. timely based upon local events. while the virus is still in theperiphery and, hence, raidies immune glob -- rabies immuneglob lynn and wound care,
washing with soap and waterprior to active immunity to multiple doses of vaccine overthe first two-week time. otherwise, once the virusagainst access to cns, death is all but inevitable. incubation period is quitevariable from days to years, on average four to six weeks. very nonspecific prodromalstage. the acute neurologic has hydrophobia and arophobia. shoeshtly thereafter the patientlances into a coma.
with the exception of onehistorical survivor without any prior vaccination, death resulta s a few days later. a relatively easy disease todiagnose if you have a history of exposure to a rabid animaland these classic clinical signs. it can be a challenge. laboratory diagnosis, the goldstandard, is the direct flores fluorescent antibody test.
standardized is the nationalprotocol here at cdc in the year 2000. with regular training providedthrough the national laboratory training network. in humans, when an exposure isnot thought, anti-mortem diagnosis can be challengingbased upon the detection of rabies virus ants en -- antigensand antibodies prior to death. tens of millions of exposuresand tens of thousands of human cases -- in fact, since we'vebegun, at least one child has
succumbed to the disease. most of these occurring,unfortunately, in developing countries of africa and asia. with a domestic dog still as themajor reservoir throughout the world, and where it has beencontrolled wildlife serving as important. for example, in the unitedstates. exposures are not uncommon. it's in our back yard, it's inour houses, sometimes in terms
of reservoirs. 20,000 to 40,000 people exposedher per year, resulting in one to eight cases of rabiesannually. there's just as much now as wheni was a child, it's just different. now it's in wildlife. when i was a child, we still haddogs as our major reservoir. today we are talking aboutraccoons and skunks and foxes and mongoose distributed inevery state but hawaii.
we know this because ofdecentralized surveillance, more than 100 laboratories, and morethan 100,000 suspect animals examined locally. why focus on dogs? because most of our exposuresare due to dogs, most of our cases are due to dogs. because of the important publichealth role of animals such as dogs invited into our homes overthe last few millennia. as many as 1% estimates ofemergency room visits being due
to animal bites or pediatrichospitalizations. there are obstacles to success. in countries like the unitedstates, dog rabies transmission has been interrupted and thatparticular virus has been extripated. oral vaccination may offer onepotential source of management over time. regardless, the focus is uponheard immunity -- evacuation night dogs whether in adeveloped or developing country,
and human cases fall. focus upon animals for diagnosisand animals for control and the human health benefits areobvious. hence, immunity and vaccinationen masse,mintmization through hegz education of humanexposures when exposures do occur. prompt wound care, infiltrationof immune globulin and cell culture are all but assuredsurvivorship after such exposures.
and obviously after maintainingcontrol and for some places rabies-free status, vigilance tomaintain your rabies-free status as well as to effect promptcontrol when it does enter. our panel today will emphasizetopics such as dr. slate, how do we counter the emergence ofviruses from wildlife to domestic species and intohumans? how do we develop more humanemethods of animal population control? dr. leanis from paho will betalking about the translation of
such work from developed todeveloping countries on a regional basis. and dr. briggs will beaddressing the issue of how do we maintain advocacy and dynamicpartnerships for a disease that's been with us formillennia. and without further adieu, we'llturn to dr. slate from usda wildlife services. >> thank you, doctor. and good afternoon.
my presentation will focus onrabies along the human-animal interface. some of the key challenges weface in promising novel approaches to enhanced rabiescontrol in dogs as well as carnivores. dr. ruprick covered points tostress the impact of dog rabies on humans. i'd like to add that here in theu.s., even though rabies was declared -- even though u.s. wasdeclared rabies free, here in
the u.s. we have dog rabiesstill in the source of this rabies is in wildlife. these are not canine true cases,but were the result of raccoons, stunks, foxes -- skunks, foxes,or species that are responsible for over 0% of the casesreported in the u.s. the events draw attention to therabies transmission along the dog-wildlife interface whichcannot be completely discounted when we're establishingeffective dog rabies control programs.
in 2007, it was estimated that37.2% of u.s. households owned an average of 1.7 dogs, puttingthe u.s. population at 72 million dogs. and a 2001 estimate of theglobal dog population was put at 400 million dogs. that's a lot of dogs. only recently a free roamingdog's been studied from an ecological perspective. the structure and dynamics thiscomponent of the overall dog
population is not wellunderstood. nor are estimates widelyavailable for these relative population size of thesefree-roaming dogs. relative abundance of roamingdogs in the united states is also unknown. but they are common on nativeamerican lands where extremely low rabies vaccination rates arealso suspected. the major dog rabiestransmission pathways are shown here and illustrate thatperpetuation of canine rabies is
possible in specific wildcarnivores. the episode that occurred incoyotes as well as dogs and wildlife in south texasbeginning in the 1980s as a result of spillover of caninevirus variant in dogs in mexico represents a well-documentedexample of virus transmission along this -- along thedog-wildlife interface. some of the key challenges weface are achieving the 50% to 70% population immunity requiredto prevent dog-to-dog transmission of rabies.
the free-roaming dog segment ofthe population is difficult to vaccinate and may require novelapproaches such as oral rabies vaccination to achievemeaningful herd immunity levels. i'm going to talk a bit moreabout this later on, bun study not yet published -- one studynot yet published suggests that herd immunity among dogs can beincreased with vaccination, with additional evaluation of theeffective orv strategies is warranted. rabies spillover from dogs intowild carnivores has had impacts
to rare species. it's led to perpetuation ofcanine variance in closely related species such as thecoyote as i mentioned. examples of the two majorconsequences of rabies transmission along thedog-wildlife interface are that it maim pact our ability toachieve both rabies control in dogs and wild carnivores. such as the virus spilloverevent that i just mentioned in texas.
it also may have profoundimpacts on threatened -- rare and threatened species. two of the world's mostendangered wild carnivores, the ethiopian wolf and african wilddog, are threatened with either local extripation or extinctionas a result of rabies spillover in dogs. in the u.s., the compendium ofrabies control serves as a basis for animal prevention andcontrol programs throughout the united states, and to facilitatestandardization of procedures
among jurisdictions. guidance in the compendiumextends to novel approaches, such as oral vaccination orcontra sthaepgz may be incorporated in futuredog-rabies control programs where injectable vaccination isthe central tactic. and for the remainder of mypresentation, i'm going to focus on these novel approaches, oralrabies vaccination and contraception. a fundamental tenet of oralrabies vaccination is that it
supplied to establish herd orpopulation immunities is not a means of vaccinating individualanimals. oral vaccination works toestablish herd immunity to prevent rabies transmission. baiting occurs at the landscapescale by air but may include distributing baits from groundvehicles or by walking. in europe, canada, and the u.s.,the primary areas involved in the rabies vaccination targetingwild carnivores, over 42 million doses were distributed in 2009alone.
within the u.s., oral rabiesvaccination programs are directed at rabies control inthe raccoon, gray fox, and coyote. the u.s. was declared caninerabies free in 1997. but this doesn't addressspillover of canine virus into wild coyote populations whichare abundant in south texas and are distributed throughout theunited states. oiv was integrated intoconventional rabies control programs that targeted dogs.
and through strategic creationof orb zones, first to prevent the northward spread, rabies waseliminated from the u.s. in 2007, with the last documentedcase occurring in 2004 along the border near laredo, texas. that was in a dog. surveillance is an enhanced --surveillance is an essential component of oral rabiesvaccination programs, and any effective rabies control programfor that matter. the cdc developed direct rapidimmunohista mi ne test
throughout an accurate diagnosiscan be received in one hour, has led to a shift of which higherlevels of surveillance are achieved to support higherrabies programs in the u.s. since field implementation ofdrit or drit as it's called in 2005, more than 40,000 sampleshave been taken -- tested near orb zones in the u.s. to assessprogram progress and to make adjustments in management. an evaluation of handout modelon the navajo nation in arizona resulted in good batix amongfree-roaming dogs, with 1/3 of
the dogs showing post orv virus,rabies virus antibodies with the use of the org as a vaccine. while additional research iswarranted, the handout model as drem straightdemonstrated amodel to exhibit a greater portion of thedog population within a community. limiting dog reproduction toenhanced rabies control is a huge challenge. surgeries are highly effective,but it's time consuming and
difficult to apply on a largescale. the injectable contraceptive maybe available as an option in some areas, but its use islimited to males. immunocontraceptive vaccinegonacon has experimentally been shown to be effective in severalspecies but is currently only registered for use in deer inthe u.s. given that this vaccine hascontraceptive effects in males and females, it holds promisefor reducing dog fucundity. long range oral consumptionwould constitute free-roaming.
recognizing that rabies has nopolitical boundaries, a north american rabies management planwas signed in 2008, actually signed on this stage during therabies and americas conference in 2008. this plan provides a continentalframework for collaboration among the u.s., canada, mexico,and the navajo nation to advance the state of science for rabiessurveillance and control it has been a springboard forthe collaboration, cooperative research on gonacon on captivedogs in mexico that i mentioned.
and it -- as dog rabies, as wellas dog rabies initiatives referenced earlier on the navajonation. and in surveillance control andresearch initiatives between canada and the u.s. on raccoonrabies. this plan represents afunctional model of one to be adapted to other regions whereinterjurisdictional collaboration is essential toachieve rabies-control objectives. to conclude, preventing rabiestransmission to humans through
their long-standing bond withdogs represents a challenge we must overcome to reduce theimpact this ancient disease still has on humans in the 21stcentury. advances and novel approachessuch as oral vaccination would allow us to more comprehensivelyaddress rabies control elimination where free-roamingdogs and carnivores play a key role in virus dynamics. advances in contraceptivemethods will be critical so that dog population control may bemore fully integrated into --
into rabies, dog rabies controlprograms. and clearly, an overarching goalis to work to enhance cost effectiveness so it would bepractical for application through programs designed toreach the developing world where rabies still takes its greatesttoll. thank you very much, and i'llturn it over to our next speaker, dr. leanis. >> to everybody here on theinternet and to the dog, i am -- i'm not a tango dancer.
as she wants me to be. and i will talk about theapproach to rabies elimination in latin america. bajo is original office in theamericas and see has 36 member states fighting gaibs againstrabies and -- for health in washington, d.c. and the regions as shown on themap. i will address politicaldecisions and mandates for rabies immunization, trends, andthe strategy states are
following for elimination ofrabies in latin america. main political mandates andinternational agreements for the elimination of rabies in latinamerica are the program for rabies elimination launched in1983, fostering national plans in member countries. then we have 2008, urging theelimination of human rabies transmitted by dogs by 2012,next year. then we have country by countryfollowup given by the network of rabies national director formember states, partners, and
science backed by cdc. national plans are very simpleand are based on surveillance of rabies and rabies exposures,timely pro- lyly lyly prophylaxis. member countries consider theprevention of elimination of human rabies an ethicalcommitment. for example, health care topersons exposed to rabies is a basic human right which isguaranteed without cause by all member states to all inhabitantsof the americas.
as you can see in the chart, thetrend in our hemisphere is one of the most successful in theregions. toward rabies elimination. from 1970 to 2009, there weremore than 7,000 human cases with an estimated 60% transmitted bydogs. as you can see, the originalprogram has been effective in reducing the incidence of humanand dog rabies. there were more than 300 humancases per year when the regional program was launched in 1983.
in 2009, the number of humancases of rabies and rabies dogs diminishes significantly, butthere still were 19 cases in 2009. 11 were transmitted by dogs. regarding specifically the humanrabies transmitted by dogs from 2000 to 2009, there were 239human cases. the number of cases picked, asyou see in 2001, and is declining in all the regionsreaching 11 cases in 2009. this map was produced andidentifies in yellow countries
certified interruption ofcirculation of rabies among dogs, areas of low risk. in light blue, no cases of dograbies but with pending certification. and areas with sustained andcirculation of rabies among dogs and a high risk of human rabies. dog-transmitted rain czyz aconsequence of -- rabies is a consequence of poor development,but member countries can prove to the world that interventionsfor dog rabies elimination are
achievable even in developingcountries with current economic resources. as you can see, for example,case in nicaragua, peru, many countries have succeeded in theelimination of dog rabies. the network of nationaldirectors, i mention today before, recommended very simplecorrective actions to each country to achieve zero cases ofrabies transmitted by dogs by the year 2012. vis-a-vis four main remainingchallenges.
in six countries, dogvaccination programs was not achieved due to insufficientprovision of vaccines causing human deaths. patients bitten by rabid dogsreceived no proper prophylaxis in centers in guatemala anddominican republic. due to lack of localcoordination for mass dog vaccination campaigns, dograbies persisted in areas of mexico, venezuela, and brazil. and also dog rabies was atransboundary health hazard in
several country borders as seenon the map, requiring better combination between countries. well, to many numbers here --but rabies transmitted is a particular condition of theamericas. and also a major remainingchallenge. 462 cases of human rabies wereclassified by rescission voyeur species through clinic or cdcantibodies from 2000 through i said before 439 were caused bydogs. but you can see that 149 werecaused by vampire bats, mainly
in the rain forests of thenorthern south america. other transmitters were bats,cats, livestock, and [ inaudible ]. so latin america is uniqueregarding rabies due to the presence of vampire bats and therisk of incidental transmissions of rabies by any species ofbats. for example through domesticcats and livestock. also, latin america and thecaribbean share with other regions of the world the threatof rabies spillover from -- to
humans or dogs from[ inaudible ] so the main elements of thestrategy for tracking the remaining challenges include afocus to avoid relaxation of controls when no human cases arereported. manage environments in relationto stray dogs. prevent circulation of rabiesamong dogs and white carnivore and tackling the challenge ofprophylaxis in remote areas with no access to health services. to achieve the dream of an areawithout human rabies, states are
reinforcing the leadership ofthe health sector with stronger partnerships, taking advantageof the environment set by the alliance for rabies control. new approaches are needed totackle the remaining challenges and the concept. oral vaccinations for allfree-roaming carnivore in addition to traditional dogvaccination when applicable, capacity to detect new varianceof the virus via surveillance based on cdc monitoring bodies,to monitor dog rabies variance
caused by other species, inevery country as a matter of international public healthinterest. promotion of animal welfare andprotection of people in remote areas with better prophylaxisschemes. all this should and can beapplied in all the countries with all levels of developmentas well as demonstrated by member states with the technicaltools developed by cdc and other scientific partners to reachsustainable achievements in public health.
and now, our next speaker,debbie briggs. >> good afternoon. i'm debra briggs, the directorof the global lines for rabies control, and i'm going to talkabout the role of advocacy and partnerships and how that can bevery effective at a community level. so you've heard from mycolleagues about the tools that we have and the fact that we canactually prevent human rabies. so therefore, one begins towonder, why do people still die
of rabies. and i can tell you from my tripsthat what i see is one of the main reasons is because of lackof awareness on all levels, including responsible petownership and the need to vaccinate pets, to where to getpost exposure pro-flags is -- phophylaxis and wound care. rabies immuneoimmunoglobulin isoften not available to poor countries. this is a pictures of a familywho had to travel a very long
way in tanzania to find vaccine. when they got there, they onlyhad enough money to vaccinate one of the five children thatwas exposed to a dog. so they have to make a decision. and this is realty. so i want to talk about howglobal partnerships and efforts can actually help to change thesituation. about five years ago, rabiesexperts from around the world got together to see what wecould actually do.
and in 2007, we launched thefirst world rabies day, which is a focal point for increasingawareness. the same year, the globalglobalalliance for rabies control, 501-3c was launched. then an informal group of publicand private partnerships, people, that come together inorder to solve problems and find solutions. and through these organizations,we have created a global e-communications network and abank of free educational
material. and we have actually in the lastthree years launched and successfully eliminated caninerabies in the philippines. i'm going to talk about that. so what have we done since thefirst world rabies day which, incidentally, is on september28. what we've seen is 135 countriesthat have actually reported holding events. we've had more than 150 schoolsof veterinary medicine and
colleges of medical educationthat have been involved and hosted events. we have had more than 300,000people coming to our web site to download educational material. and we have heard from over 200countries about what they're doing through efforts that we'veput on the web to help control rabies. and here is a picture ofactually the graph of what you can see how the awareness hasincreased over the years.
and the peaks are in september,the month of world rabies day, and you can see people coming toour site to download information. what we've seen regarding animpact is more than 1,200 reported events, and we knowthere are more than that when we travel around and speak tocolleagues. we know that almost five millionanimals have been vaccinated on world rabies day. and we know that we've senteducational messages to over 150
million people across the world. we also know that through worldrabies day, new animal vaccination programs have beenestablished in endemic countries. we've seen reinvigoratededucational programs. we've established globalnetworks, and we're also -- world rabies day is listed onthe u.n. globally observed day. prior to world rabies day, forexample, in a country like mozambique, dogs were notvaccinated because the people
thought that by vaccinating dogsthey were no longer good watchdogs. it was a lack of support fromthe government, and the basic educational materials were notavailable. after world rabies day, inmozambique we saw partnership between the veterinary clinicsand the veterinary university. we've seen multiple dogvaccination clinics being held throughout the country and thenational government is now funding vaccination programs onworld rabies day.
we've seen increased educationalawareness of of the locals, and even a construction of an animalrecord data base. our communications outreachbegins by people getting on the web, logging on to our site,putting in the information that they need and then peter costa,our global communication ss expertwill send them, take what they need, send the material, andthey are the ones that use it to educate the people in theircommunity. we continually evaluate ourprograms and what we've seen as
a result of world rabies day, weconducted a survey this year. and of the 213 surveys that werereturned in four languages, we saw about 96% of the people thatsaid rabies education is actually saving lives. we saw 90% of the people thatsaid world rabies day is making a difference, and 95% of thepeople said that they would host another world rabies day event. what more can we do? when we put together thepartners for rabies prevention,
we wanted to really sit togetherand work as a group, and the partners februaryor rabiesprevention includes all the internationalhealth organizations. we come together to discusscommon strategies, look at needs, develop timetables anddeliverables, and actually make a difference. the global lines sits assecretariat. we developed a roadthat everybody agreed upon in 2008.
in 2009 and 2010, we developedthe first-ever blueprints for canine rabies elimination andprevention. the next step, what we're doingnow, is to re-evaluate the global burden of rabies. if we take just a minute to lookat the blueprint which you can see a picture of the web sitehere, it is the first time that all the information has been puttogether in one place. it's freely accessible, links toimportant documents, it has information on costs, planning,funding, et cetera.
it's actually a new concept. by putting everything togetherthat's accessible, people have less time to have to find whatthey need and don't have to pay for it. it's aimed at countries whereits present and countries where rabies is reintroduced. now, looking from the --actually writing the blueprint to implementation, what has itdone? well, it was launched about sixmonths ago, and we've already
seen workshops in istanbul andin india, and i can tell you that india's using the blueprintto actually, as a reference for human rabies prevention, andwest africa the blueprint is being used to improvecommunications and institute dog vaccination programs. and we are now working with thee.u. on four new languages for the blueprint, and we hope tohave that on line in the future. our program in the philippinesbegan actually with a publication that was authored bydr. dan fishbein from the cdc
and dr. betsy miranda from thephilippines. and they looked at what wouldhappen if you actually eliminate ed in the philippines. they reported that if dog rabieswas eliminated in the philippines, it would save $2.5million a year, and that money would be the -- the cost of theprogram would actually be recuperated in four to 11 years. therefore, we thought that wecould do a pilot project in the philippines, and we began withbohol.
and what has happened -- i cantell you that this problem has been amazing. we've gone from 140 people inthat particular province of which 1.4 million people live to15,000 people that are involved in rabies control. we vaccinated 70% of the dogs,we've increased the clinics and training, and of all of theschoolchildren that are enrolled in the education in thephilippines, we've educated all of them.
and that is 182,000 people. and last year, cdc actuallyconducted a training on the drit. the result is in the last twoyears, there have been no rabies deaths in bohol, philippines,and prior to that there were at least ten cases a year. and bohol is being evaluated bythe ministry of health to see if it can be declared rabies free. what have we learned from all ofthis?
well, we've learned that we canactually prevent rabies, but we need support from multiplesectors. we need public/privatepartnerships, we know now that communication networks are verypowerful, look at world rabies day. and last year we had our firstglobal webinar and had 34 countries participating, over2,000 participants were able to ask each other questions. we know that we have many toolsin place, including vaccines,
reduced regiments, the drit websites, et cetera but we still have lots of challenges. one of the most important thingswe need to do is to invest in tools for dog populationmanagement, and you heard that already from my colleagues. we need shorter preexposurevaccination regimens as the doctor said, in places like theamazon, the indigenous people cannot come and sit for a monthto have the vaccination regimen given to them.
we need improved global andnational surveillance, we need to reassess the global burden sothat we can actually look at tools and models and how thatcan save money in the long run. we need novel strategies andmethods, most importantly, to ensure sustainability whereprograms have actually been successful. with that, i thank you on behalfof all of the speakers. [ applause ]>> we'd like to open it to questions.
if there's anyone on n-vision. not seeing anybody. any questions from the audience? if you have a microphone, pleaseraise your hand. otherwise please approach themicrophone. >> hi, i'm from nationalstandards of infectious emerging diseases. it's large. this question is for the doctor,you mentioned in your talk that
rabies was historicallyintroduced into wildlife, particularly in southern u.s. from dogs into categories andsome other species. later you mentioned thatprincipally there's a current program in texas where the --it's seen in the dog population. my question is, what is the realrisk of the now adopt ed adopted role ofdog population and what about the dog population management toachieve the elimination? >> thank you.
yes, there have been cases ofgray fox spillover into dogs. fortunately through the orbeffort that have occurred there in west texas, there's not beenany continuation of that trend. there's been no cases since mayof -- i believe it's 2009. so, you know, they're both --obviously the cion genius is more distant than caus as acoyote. internationally, i'd hate tospeculate. i would turn it to dr. ruprickto speculate. >> it's a very interestingquestion.
i think the bigger take-homepicture is that not only has red fox rabies through orv beencontrolled and eliminated some places, and we've brokentransmission of that particular variant most importantly here inthe united states, we've prevented the progression ofraccoon rabies from east to west. this orv demonstration,particularly in texas, demonstrates, again, that we'redriving these variance to extripation.
as you're aware, some of theseviruses no longer exist except in our freezers. another demonstration ofintersectorial cooperation, based upon the ecology of thedisease and using useful, humane, and innovateivetechniques to drive these viruses to extinction. the ability to bring it backwill be driven to zero. that variant no longer exists innature. yes, it is microphone.
>> oads. thank you all for thepresentations. one of the speakers alluded tothe need for simplified preor post exposure regimens forhumans. are there any sort oftechnological breakthroughs like that on the horizon? i know recently we've gone to areduced dosage, reduced number of dosages. but are there -- are there anymuch larger breakthroughs to get
it down to where we are withmost vaccines where it's a -- a single dose or a smaller --smaller number? >> thanks, that's an excellentquestion. quick answer -- yes, from someof the fbrr-funded research initiatives. for example at cdc. we're looking toward needlistdelivery of biologics which in theory could be as if not moreeffective than intradermal delivery, which is a verycost-effective measure.
and in addition, manyresearchers are looking at the possibility of replicationdeficient rabies virus vaccines. for example, in areas that thedr. mentioned such as in amazonia, this would provide theopportunity to give in theory perhaps even a single dose of afuture biologic if in fact this is proven out through limitedclinical trials. perhaps dr. briggs and leanishave other comments about breakthroughs? >> i think it's a really goodquestion.
one of the problems is the costof doing clinical trials. but what we have seen incountries where it's very expensive, the vaccine is veryexpensive, for example in one country i know of in asia, theaverage number of doses that a patient would receive is three. and we don't see deaths. so we know that we can actuallyreduce the numbers. it's just doing the clinicaltrials. >> yes, ma'am?
>> hi, dr. tax, eis officer atthe rabies branch. i have a question about the roleof cats and rabies. viral cats populations ingeneral tend to be a big problem in most states. i don't believe even requirevaccination necessarily of cats in general or necessarily allcats. so what's the risk in maybe someother alternative controls? because just like with gettingsome of the roaming dog populations, trying to catch aferile cat and vaccinate it is
quite a safety hazard. that's an excellent point. and in fact, cats have replaceddogs as the major domestic species of concern in the unitedstates. there's been a lot of activityas you're probably aware about the management of ferile catpopulations through abc, such as vaccination, release,sterilitycontrol, et cetera similarly, cats are one of those animalsthat for whatever reason we ignore.
we think that a happy catnecessarily has to be an outdoor cat. which brings up issues ofresponsible pet ownership. obviously there's similaritiesbetween responsible parenting and responsible pet ownership,as well. we don't let our -- well, we'renot supposed to let our children go unsupervised. a similar situation in regardsto our pets. i think one of the major thingsthat we can do and hopefully
agree on is improve educationthrough responsible pet ownership, and i know dr. slatemight have something to say in terms of the contraceptivepossibilities for gnrh-like vaccines for cats. >> i heard you mention bobcats. let me spoke to that first. there was in south texas wherewe were conducting on, rabb vaccination in clab -- rabiesevacuationation in collaboration with the steps of healthservices.
there's suspicion given thenumber of bobcats in the area that bobcats might serve as areservoir. they are the next species mostfrequently reported, if i'm not correct -- right? well, possibilities -- i mean,there may be possibilities as it works in both males and females. i would put you in touch withdr. lowell miller at our national research center to looksfwror into the possibility.
this worked in several speciesit's been tested in so far with one-shot multiple-year efficacy. so i would put you in touch withdr. miller. we'll be happy to do that. but the bobcat question was oneof could it be a reservoir. perhaps. i mean, it's certainly -- aninteresting question. it might be a reservoir undercertain high density situations and certain geography with --with, say, gray fox variant
present. nobody knows the answer to that,but we have done some ecological studies on habitat partitioningand contact radio telemetry that will be interesting to see thefinal results on there. >> so there could be benefitsfrom focus of research on bobcats, as well as domesticcats for the issue of the feladay as a whole. luckily, barring this lastpotential example, luckily no cats domestic or wild anywherein the world are recognized as
reservoirs. and so one of the primary waysat least from the rabies standpoint is to focus on thereservoirs and rabies cases in cats would then be driven tostichkz. of course, vaccination becausethe issues related to bats and bat catching cats. >> from the oral vaccinationstandpoint, it would be difficult to beat cats becausethey are truly chase predators. would be hard to bait them withthe type of bait that's we're
using now at least. >> dr. monroe? >> thanks. stephen monroe, division of highconsequence pathogens and pathology. i'm not sure who best couldanswer this. my question has to do with thesustainability issue. certainly we've seen with thepolio eradication efforts that as the program goes on andtrying to achieve the last few
percent that in countries whereresources are limited, there's -- the tendency todivert resources from a program that seems to be not importantanymore to other things that are so are there approaches from theeducation side, whatever, to maintain the political will tokeep the program going and sustained over time? even when you do achieveelimination of human cases? >> i'd like to answer that. and just looking inging ulholphilippines project, we looked
at sustainability and how wecould many that. what they did in the philippineswas actually to charge a small amount to register dogs, andthat small fee goes back into the program. and so it is sustainable whenthe funding that we have been able to acquire with a swissfoundation disappears. then it's going to besustainable through the money that they raise. and also, educationwise, whatwas done in the philippines was
actually to take education andput it into the curriculum so rabies was put into math andscience and reading and just integrated into it that way. and it appears that it'sextremely successful. >> jan nicholson, oid. i noticed that, chuck, youtalked about the confirmatory test is a dfa. i'm wondering if there are anyplans to look at a molecular test.
>> thank you very much. yes, there are a variety ofmolecular tests. the limitation is that thingslike antigen based, be they the direct fluorescent antibody testor the drit, by and large we can get a rapid answer in about anhour. very cost effectively. and similarly, unless one isthinking about some of the advanced diagnostic that areused for certain other agents, the utility of even light-basedmicroscopy is it's an anatomiic
biologic diagnosis as opposed toa light or band. when we looked at some of themore recent point of care devices, they've not had thesensitivity and specfit that we'd like -- specfisity thatwe'd like to see. it could be useful for grosssurveillance, but in terms of the quality, the standards thatwe've recently risen to, there doesn't seem to be anything incurrent development that's going to replace either thesensitivity or the specfisity, the gold standard, be it thedirect test or the drit test
that you can use in the fieldand don't even need electricity for now. so it's a much needed goal, butone that we haven't been able to realize as of yet. yes, ma'am? >> abigail humphry. question for dr. slate. i've heard you present half adozen times over the last several years.
i'm completely fascinated thatwe drop vaccines out of airplanes. i think pasteur would be soproud. my question is in regards to --to doing some of the orb campaigns that you've done, whatsort of communications do you do in advance to semi residentialareas before vaccine drop occurs? >> yes, we work with the localentity and use our legislative and public affairs.
and we've even worked with cdcto get the message out to let folks know that batesits aregoing to be falling from the air andto not be handling them. if the dog has one try ton takeit out of its mouth. that's the most common way thata hume san exposed to the vaccine -- human is exposed tothe vaccine. we have a communications plan toget the message out. we even have media days when thebait drops begin. bring the media and gettelevision coverage and things
of that nature. so it's kind of a diverse, youknow, communications plan to get the message out. >> maybe a sign of success thatin fact people are losing interest in the media attentionof it because it's becoming almost as happenstance asvaccinating your dog or your child. so perhaps that's ademonstration of success that it's no longer consideredunusual or bizarre for a concept
that was born at cdc 40 yearsago. >> hi, jennifer mckristen andmcezid. i think the current name. very nice presentation. and i was really interested inthe information you presented on both injectable and potentialoral contraception for dogs. and given that dog populationcontrol can have numerous public health impacts and rightlydriven by rabies but also field diseases looig ss by ticks andthings
affected by population control. i'm curious if you have anopinion about how far we are from having a licensed oral orinjectable contraceptive for dogs in the united states. >> well, i think that'sobviously ideal and vision airary. i think we're a ways away fromthat. as i mentioned, the work goingon in mexico i think is a very important piece of work todetermine if in fact the new
formulation of gonacon would beacceptable to use in mass injectable campaigns. and dr. rue here at cdc has doneearly work at oral development -- development oforal delivery. and dr. miller at the nationalresearch center had considerations. i think we're a ways downing theroad before -- down the roads before oral delivery. and we'd be talking about oraldelivery in dogs.
for wildlife, use of gonaconwould be injectable if at all because of the -- it's difficultto integrate that kind of thing into wildlife populations from apolitical perspective. >> thank you all very much forattending, participating, and thanks to our speakers. may i ask you to give them onemore round of applause. [ applause ]and we'll see you same time, same place in five weeks.