09/27/18 04:23

Strategic Plan for Elimination of Dog Mediated Human Rabies by 2023 and Rabies Freedom by 2030

Bhutan

Background

Rabies has been declared a notifiable disease in Bhutan and rabies control activities are coordinated at the national level. Livestock Act of Bhutan 2001 and Livestock Rules and Regulation 2017 covers an aspect of zoonotic disease (including rabies) management. However, some form of control has been initiated in early 1990s when dog rabies became endemic even in the capital city, Thimphu. Only in mid 2000s some form of planned activities were initiated however implemented sectorally (Public Health and Veterinary sectors) . By late 2000s joint activities with the Department of Pubic Health were initiated and the national rabies prevention and control plan 2017 specified the roles and responsibilities of various stakeholders for the prevention and control of rabies in Bhutan. Human rabies management guideline 2014 also covers aspects of dog bite and rabies case management as well as reporting for surveillance and standard recommendations for rabies PEP in human.

Bhutan One Health Strategic Plan (2017-2021) has been approved by the government and a MoU signed between the two key Ministries and countersigned by other relevant stakeholders. To implement the strategy, Bhutan One Health Secretariat (BOHS) has been formally agreed to be established at the Royal Centre for Disease Control (RCDC), Department of Public Health, Ministry of Health. Activities under the secretariat are to be coordinated by two secondees from the two sectors whose appointment is to be realised soon.

However, activities on zoonoses including rabies continues to be implemented jointly between the two key sectors since the late 2000s. Ever since the start of the joint activities in 2008-2009 following One Health Approach (multi-sectoral collaboration) Bhutan did not experience any human rabies case between 2011 till date, except one case each in 2013 and 2016 at the southern border districts. Strategic Plan for Elimination of Dog Mediated Human Rabies by 2023 and Rabies Freedom by 2030In 2018 a team of experts from the Ministry of Health  and Ministry of Agriculture and Livestock  jointly developed truly One Health Approach Plan for Rabies aimed at eliminating dog-mediated human rabies by 2023.The guiding principles for the development of the plan were:

  1. Dog bites are the primary source of human rabies. Human rabies prevention is possible through mass dog vaccination, promotion of responsible pet ownership and dog population control programmes with a partnership approach (One Health approach).  
  2. Dog bites are a medical urgency and thorough cleaning of a bite wound is an important step which needs to be promoted at the community level through advocacy, awareness and education. 
  3. Post-exposure rabies prophylaxis including rabies immunoglobulin where indicated should be made readily accessible and affordable for those that require it.
  4. Enhanced surveillance is the key for monitoring the progress of the control program
  5. Elimination of rabies is a model for One Health collaboration between the key sectors.


The joint plan, which was developed in line with the Bhutan One Health Strategic Plan has been submitted to the two Ministries for official recognition/endorsement. It is expected to be realised soon after the parliamentary election in October 2018.

Goal:
To eliminate dog-mediated human rabies by 2023 and maintain freedom through 2030 in Bhutan

Main Objectives:

  • To enhance rabies prevention and control in dogs through mass dog vaccination, dog population management and promoting responsible pet ownership;
  • To provide timely access to post exposure prophylaxis including rabies immunoglobulins where indicated to all humans exposed to rabid animal bites;
  • To enhance community engagement on rabies prevention and control through community awareness and education, and
  • To institute coordination and collaboration mechanism through One Health approach at all levels


Strategies for Rabies elimination
The following are the key strategies that will be implemented to achieve rabies elimination plan in Bhutan. 

  1. Organizational setup of rabies control - A National Committee for Rabies Control (NCRC), with representation from the relevant agencies and dzongkhag level task force shall oversee the implementation of rabies control. This multi-sectoral task force will provide stewardship and be responsible for the implementation of the different components of the national rabies elimination strategy. 
  2. Prevention and control of rabies in dogs
  3. Prevention of rabies in humans
  4. Strengthen and enhance surveillance
  5. Strengthen disease outbreak response
  6. Promote and conduct operational research 
  7. Advocacy, communication and community/social mobilization 
  8. Enhance partnerships, collaboration and coordination
  9. Cross-border control 
  10. Resource mobilization


Key stakeholders and partners identified to implement the rabies control program:

  • Government agencies:
    • Ministry of  Agriculture and Forests (MoAF) – Department of Livestock (DoL), Bhutan Agriculture and Regulatory Authority (BAFRA), Department of Forest and Park Services (DoFPS);
    • Ministry of  Health (MoH) – Department of Public Health (DoPH), Department of Medical Services (DMS);
    • Royal Bhutan Police (RBP);
    • Ministry of Finance (MoF);
  • Local government: Thromdeys (Municipal Corporations), Dzongkhags (Districts) and Geog (Block) administrations;
  • Others: Bhutan Chamber of Commerce and Industries (BCCI) and private individuals. 
  • Regional and international organizations: SAARC, WHO; OIE, FAO 
  • NGOs: HSI, VBB and relevant local NGO’s and animal welfare organizations

Photo Gallery

 
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