BELIZE

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Published on October 22, 2007

Author: Arley33

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Slide1:  Regional Program for the Elimination of Human and Canine Rabies Evaluation of the Goal for 2005 Elimination of Human Rabies Transmitted by Dogs in Latin America BELIZE CENTRAL AMERICA MAP OF BELIZE, CENTRAL AMERICA:  MAP OF BELIZE, CENTRAL AMERICA Belize:  Belize Land Size: 22,700 km2 Population: 265,200 Population Females: 131,340 Population Males: 133,860 Urban Population: 49,200 GNP (PPP): $US3,128.50 % Poverty: 33.4% % Literacy: 76.5 Child Mortality: 4.1 Population Growth Rate: 2.7% Fertility Rate: 3.4 Life Expectancy Male: 66.7 Life Expectancy Female: 73.5 Leading Cause of Mortality 2003:  Leading Cause of Mortality 2003 Hypertensive Diseases Acute Respiratory Infections Diseases of Pulmonary Circulation and other Forms of Health Diseases HIV/AIDS Transport Accidents Strategies:  Strategies Health Education & Community Participation (production & distribution of leaflet, posters, radio, TV & Print Media, lectures, community meetings) Vaccination of domestic animals (dogs & cats) livestock by Belize Agricultural Health Authority) Vaccination of human beings (pre & post) Extermination of stray/ownerless dogs Epidemiological surveillance Human Rabies Cases Belize 1990-2003:  Human Rabies Cases Belize 1990-2003 No human cases of rabies for the years 1990-2003 Canine Rabies, Belize 1990-2004:  Canine Rabies, Belize 1990-2004 Animal Rabies Cases Belize 2001-2003:  Animal Rabies Cases Belize 2001-2003 Anti-Rabies Treatment Belize 2001-2003:  Anti-Rabies Treatment Belize 2001-2003 Aggressing Animals Observed 2001-2003:  Aggressing Animals Observed 2001-2003 Canine Samples Sent to Laboratory Belize 2001-2003:  Canine Samples Sent to Laboratory Belize 2001-2003 Domestic Animals Vaccination (Dogs) Belize 2001-2003:  Domestic Animals Vaccination (Dogs) Belize 2001-2003 Extermination Stray/Ownerless Dogs Belize 2001-2003:  Extermination Stray/Ownerless Dogs Belize 2001-2003 Technical Cooperation with Countries of Guatemala, Mexico and Panama:  Technical Cooperation with Countries of Guatemala, Mexico and Panama Discussion :  Discussion There is no correlation between the incidence of rabies and demographic data. The incidence of rabies however is believed to be related to the predominance of caves in the districts, the presence of vampire bats and the existence of a large mammalian wildlife. The bovine rabies cases in Belize are highly suspected to be transmitted by wildlife, the vampire bat The Strengths of Belize’s Rabies Prevention and Control Program:  The Strengths of Belize’s Rabies Prevention and Control Program Yearly vaccination of domestic animals (dogs, cats, cattle) Public awareness and community participation Well informed population as it relates to rabies Technical cooperation among countries (Belize/Guatemala/Panama/Mexico) Administration of pre and post exposure anti-rabies treatment to those persons at risk and those exposed to or attacked by suspect or confirmed rabid animals Reduction of stray/ownerless dogs’ population Planning, monitoring, evaluation of the rabies program Human resource development/capacity building in rabies management, prevention and control Weakness of the Program:  Weakness of the Program Limited epidemiological surveillance No national laboratory for the diagnosis of rabies Absence of verification of the rabies variant (s) that exist in Belize Conclusion :  Conclusion Belize is free of human rabies. The case of canine rabies in 2001 in the Cayo district is a potential risk of human rabies in the district. The continued presence of bovine rabies in the Cayo, Corozal and Orange Walk districts remains a constant threat of canine rabies. The absence of verification of the rabies variant that exist in Belize and the absence of wildlife rabies prevention and control add to the ever present threat of wildlife rabies transmission to the domestic animal population and eventually to the human population. The availability of a functional laboratory for the testing of rabies specimen will enhance the epidemiological surveillance of rabies in Belize. The annual anti-rabies vaccination of domestic animals (dogs and cats) needs to be maintained especially in the high risk districts The administration of pre and post exposure rabies vaccination to those persons at risk and those exposed or attacked continues to be an integral part of the prevention of human rabies cases in Belize Key Points for The Control Actions:  Key Points for The Control Actions Plans for the maintenance of Belize as a country free of human rabies and urban canine rabies include Administration of pre and post exposure anti-rabies treatment to those persons at risk and those exposed to or attacked by suspect or confirmed rabid animals Vaccination of domestic animals (dogs, cats, cattle) Reduction of stray/pwnerless dogs’ population Public education and community participation Activation of BAHA’s rabies diagnostic laboratory Epidemiological surveillance Technical cooperation with countries of Guatemala, Mexico and Panama Verification of rabies variant that exists in Belize Planning, monitoring, evaluation of the rabies program Human resource development/capacity building in rabies management, prevention and control Technical support from Pan American Health Organization (PAHO) General Context:  General Context Belize has a land area of 22,700 km2 and is the only English-speaking country in Central America, although Spanish is widely spoken. It is more similar to Caribbean countries in culture, politics, and economy. Belize is governed by a parliamentary democracy based on the British system. The Prime Minister and Cabinet constitute the executive branch, and a 29 – member elected House of Representative and an 8 – member Senate form the bicameral legislature. The Cabinet members are appointed by the Governor General on the advice of the Prime Minister. The country is divided into six administrative districts: Corozal, Orange Walk, Belize, Cayo, Stann Creek, and Toledo. Belmopan, the new capital was established in 1981. Belize City, however, remains the commercial center with almost a quarter of the population. General Context cont’d:  General Context cont’d Belize’s population at mid year estimate 2002, stood at 265,200 (133,860 males and 131,340 females) with 49.2 % of the country’s population living in the urban areas while 50.8% resided in the rural areas. Belize’s Gross National Product per capita stood at ($US) 3,128.50 (2001). Belize’s population living below poverty line stood at 33.4%, with the Toledo District with the worse at 79.0% (2001). Belize’s adult literacy rate was 76.6% (Census 2000) and the child mortality rate stood at 4.1 per 1,000 live births (Table 1). Belize’s population is diverse with Mestizo (48.7%), Creole (24.9%), Mayas (10.6%), Garifuna (6.1%), Mennonites (3.6%), East Indians (3%) and other smaller groups (3.3%). The population is young with 41% below age of 15 years and 61% under 25 years of age. General Context cont’d:  General Context cont’d Belize’s crude birth rate was 27.7 per 1,000 (2002), maternal mortality rate of 95.2 per 100,000 live births (2002), crude death rate of 4.8 (2002), under-five mortality rate of 23.8 per 1,000 live births and a general mortality rate of 4.8 per 1,000 (males 5.6, females 4.0). Belize’s population grew at the rate of 2.7% (2002) and its total fertility rate was 3.4 (2002). Belize had a life expectancy at birth of 69.9 ( males 66.7, females 73.5) (2002). Belize’s economic growth rate stood at 4.6, and since 1976, the exchange rate has been at US $ 1.00 to Belize $2.00. Belize’s economy is primarily based on agriculture, tourism and services. It is dominated by agriculture exports including sugar citrus concentrate, bananas, and marine products. General Context cont’d:  General Context cont’d The five leading causes of mortality in Belize for the year 2003 are Hypertensive Diseases, Acute Respiratory Infections, Diseases of Pulmonary Circulation and other forms of Heart Diseases, HIV/AIDS and Transport Accidents. All these causes are related to lifestyle and are therefore preventable. Epidemiological situation of the country:  Epidemiological situation of the country Belize’s last cases of human rabies were in a 5 years old male and a 6 years old male in 1989 from the Town of Benque Viejo del Carmen in the Cayo District of western Belize, border with Melchor de Mencos, Peten, Guatemala. These human cases were exposed through the bite of a less-than-three-months old unvaccinated pup. A case of human rabies in a 12- year old female reported from a rural community in the Stann Creek District in southern Belize in 1988 was exposed through the bite of a cat. The cat was believed to have been infected through exposure to wildlife, vampire bat. There is no record of human rabies being transmitted by other species in Belize. For period 1990 to 2003 no case of human rabies was diagnosed nor reported in Belize (Table 2). Similarly no case of human rabies was reported in Belize for period 2001 to 2003. Epidemiological situation of the country:  Epidemiological situation of the country After reporting seven cases of canine rabies in 1990, Belize was free of canine for a period of four years. An outbreak with four canine rabies cases in 1995 continued with seven cases of canine rabies in 1996 and twenty-two cases of canine rabies in 1997. For the next three years there was no case of canine rabies in Belize until 2001. This case of canine rabies was reported from the rural community of San Antonio in the Cayo District of western Belize, border with Melchor de Mencos, Peten, Guatemala. (Table 4). San Antonio is within ten miles from the municipality of Sn Ignacio/ Santa Elena, the second largest municipality in Belize. While no case of animal rabies has occurred in the urban communities for many years in Belize, the cases of bovine rabies in the last two years and the last case of canine rabies in 2001 occurred within 10 miles of urban communities. Epidemiological situation of the country:  Epidemiological situation of the country Belize continues to have cases of rabies in other species. During the year 2002, a case of wildlife rabies, in a fox was reported from a village within two miles from San Ignacio/Santa Elena Town. A case of bovine rabies was also reported the same year from rural Cayo District within five miles from San Ignacio/ Santa Elena Town. While no case of canine rabies was reported from the Cayo District after 2001 and no case of bovine rabies was reported in 2003, a case of bovine rabies has already been reported for this year 2004. The only cases of rabies in Belize for the year 2003 were two bovine from northern rural Belize in the Orange Walk District, border with Mexico. Control actions carried out :  Control actions carried out Rabies prevention and control As in the previous years, during the last three years rabies prevention and control in Belize include the following: 1. Administration of pre and post exposure anti-rabies treatment to those persons at risk and those exposed to or attacked by suspect or confirmed rabid animals. Of the 209 persons seen during the period 2001 - 2003 at the public health facilities due to exposure to or attack by suspect or confirmed rabid animals, 93 (44.5%) were administered anti-rabies treatment. Of the 93 persons who initiated treatment, 82 (88%) completed their treatment. The Cayo, Orange Walk and Corozal Districts report seeing more persons. The Cayo District report treating more individuals and also more individuals completing their treatment. Control actions carried out :  Control actions carried out In addition to private sector health facilities, the public sector currently has 8 hospitals, a national referral hospital, a psychiatric hospital, 40 health centers and 35 health posts. Forty-three of the health facilities are equipped and supplied to offer pre and post-exposure treatment to people attacked by an animal that could potentially transmit rabies Rabies incriminated animals are either observed for 10 days following exposure or attack under the supervision of the BAHA or Public Health personnel or are euthanized by BAHA personnel and brain tissue sent to the laboratory in Panama During the period 2001-2003, a total of 160 attacking animals were placed under observation, an average of 53 per year, with the most been in the Cayo District It must be noted that on the report of a case of rabies in whatever species, the preventive and control measures are implemented in accordance with the rabies prevention and control measures for Belize Slide29:  Epidemiological Surveillance Belize does not have a functional rabies diagnostic laboratory. Of the estimated dog population of 26,520, a total of 28 canine samples were sent to the Ministry of Agriculture Laboratory in Panama for rabies diagnosis for the period 2001 to 2003. Of this number only one was confirmed positive (Table 4A). The viral variant associated with this case was not characterized. Vaccination of Domestic Animals During the three year period 2001to 2003, a total of 41,030 dogs were vaccinated against rabies in all six districts of the country. The Cayo District has an average vaccination coverage of 95%, Stann Creek 74.4% and the Orange Walk District with 73.4 %. Reduction of stray/ownerless dogs’ population The control of stray dog population in Belize falls under the responsibility of the Municipal Technical cooperation with countries of Guatemala, Mexico and Panama:  Technical cooperation with countries of Guatemala, Mexico and Panama Belize – Guatemala Exchange of materials & supplies Exchange of information Exchange of manpower Regular meetings (planning & evaluation) Joint trainings (vampire bat control) Belize– Panama Laboratory Diagnosis of rabies Belize – Mexico Human resource development/capacity building Training of lab tech in rabies diagnosis Stabilization of canine population Exchange of information Exchange of materials & supplies Meetings (planning) Control actions carried out cont::  Control actions carried out cont: While the Belize Agricultural Health Authority (BAHA) has a Central Investigation Laboratory and satellite laboratories throughout the country, no rabies diagnoses is carried out in these laboratories because of the absence of reagents and mice. Specimens are therefore sent to The Ministry of Agriculture Laboratory in Panama. However the Laboratory in Panama does not conduct characterization analyses which have resulted in the lack of variant verification for positive samples. Although several requests have been made for the characterization of samples in a sub-regional reference laboratory via PAHO, the absence of protocols and problems related to logistical arrangements for shipping and handling of samples has not allowed this materialized. This is recognized as important constraint for which PAHO’s assistance is required. It is strongly suspected that the variants present in Belize are those of the vampire bat and fox. Investigations conducted for the most recent canine rabies case (March 2001) indicated that it was the result of exposure to wildlife rabid animal. Discussion: :  Discussion: There is no correlation between the incidence of rabies and demographic data. The incidence of rabies however is believed to be related to the predominance of caves in the districts, the presence of vampire bats and the existence of a large mammalian wildlife. The bovine rabies cases in Belize are highly suspected to be transmitted by wildlife, the vampire bat. The strengths of Belize’s Rabies prevention and control program are the following: Yearly vaccination of domestic animals (dogs, cats, cattle) Public Awareness and community participation Well informed population as it relates to rabies Technical cooperation among countries (Belize/Guatemala/ Panama/Mexico Administration of pre and post exposure anti-rabies treatment to those persons at risk and those exposed to or attacked by suspect or confirmed rabid animals. Reduction of stray/ownerless dogs’ population Planning, monitoring, evaluation of the rabies programme Human resource development/Capacity building in rabies management, prevention and control Weakness of the program include:  Weakness of the program include Limited epidemiological surveillance No national laboratory for the diagnosis if rabies Absence of verification of the rabies variant(s) that exist in Belize Conclusion :  Conclusion Belize is free of human rabies. The case of canine rabies in 2001 in the Cayo District is a potential risk of human rabies in the district. The continued presence of bovine rabies in the Cayo, Corozal and Orange Walk Districts remains a constant threat of canine rabies. The absence of verification of the rabies variant that exist in Belize and the absence of wildlife rabies prevention and control add to the ever present threat of wildlife rabies transmission to the domestic animal population and eventually to the human population. The availability of a functional laboratory for the testing of rabies specimen will enhance the epidemiological surveillance of rabies in Belize. The annual anti-rabies vaccination of domestic animals (dogs and cats) needs to be maintained especially in the high risk districts. The administration of pre and post exposure rabies vaccination to those persons at risk and those exposed or attacked continues to be an integral part of the prevention of human rabies cases in Belize. Key points for the control actions: :  Key points for the control actions: Plan for the maintenance of Belize as a country free of human rabies and urban canine rabies include: 1. Administration of pre and post exposure anti-rabies treatment to those persons at risk and those exposed to or attacked by suspect or confirmed rabid animals. 2. Vaccination of domestic animals (dogs, cats, cattle) 3. Reduction of stray/ownerless dogs’ population 4. Public education and community participation 5. Activation of BAHA’s rabies diagnostic laboratory 6. Epidemiological surveillance 7. Technical cooperation with countries of Guatemala, Mexico and Panama 8. Verification of rabies variant that exists in Belize 9. Planning, monitoring, evaluation of the rabies programme 10 Human resource development/Capacity building in rabies management, prevention and control 11. Technical support from PAHO Slide36:  Thanks for your attention

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