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Weekly epidemiological record Relevé épidémiologique hebdomadaire 17 FEBRUARY 2

Weekly epidemiological record Relevé épidémiologique hebdomadaire 17 FEBRUARY 2017, 92th YEAR / 17 FÉVRIER 2017, 92e ANNÉE No 7, 2017, 92, 77–88 http://www.who.int/wer 2017, 92, 77–88 No 7 Annual subscription / Abonnement annuel Sw. fr. / Fr. s. 346.– 02.2017 ISSN 0049-8114 Printed in Switzerland WORLD HEALTH ORGANIZATION Geneva ORGANISATION MONDIALE DE LA SANTÉ Genève Contents 77 Human rabies: 2016 updates and call for data 87 Regional Technical Advisory Group on Immunization: Request for nominations Sommaire 77 Rage humaine: mise à jour de 2016 et appel à la communication de données 87 Groupe consultatif technique régional sur la vaccination de l’OMS: Appel à candidatures 77 Human rabies: 2016 updates and call for data Introduction Rabies is an infectious viral disease that is almost always fatal following the onset of clinical signs. The virus claims an esti mated 59 000 (95% confidence intervals (CI):25–159 000) human lives annually, mostly among underserved populations in Africa and Asia.1 Over 95% of rabies deaths in humans result from virus trans mission through the bites of infected dogs.2 Rabies is 100% preventable through timely administration of post-exposure prophylaxis (PEP) to bite victims, however fatalities still occur in many endemic countries3 (Map 1). The substantial human suffering and cost of providing PEP treat ment could be avoided through elimina tion of the virus at source. Elimination is feasible through mass vaccination of domestic dog populations;2 this not only reduces the number of deaths attributable to rabies, but also the need for PEP as part of dog-bite patient care in the longer term. In this report, rabies refers specifically to human rabies transmitted by dogs, where not indicated otherwise. In 2015, WHO Member States and key partners4 set a global goal to achieve zero human deaths from dog transmitted 1 Hampson, K, et al. «Estimating the global burden of endemic canine rabies.» PLoS Negl Trop Dis 9.4 (2015): e0003709. 2 WHO Expert Consultation on Rabies: second report. Geneva, World Health Organization, 2013 (WHO Technical Report Series, No. 982. Available at: http://apps.who.int/iris/bitstre am/10665/85346/1/9789240690943_eng.pdf; accessed January 2017. 3 See No. 2, 2016, pp. 13–20. 4 FAO, OIE and GARC and wider stakeholders. Rage humaine: mise à jour de 2016 et appel à la communication de données Introduction La rage est une maladie virale infectieuse qui est presque toujours mortelle après l’appari tion des signes cliniques. On estime que le virus tue environ 59 000 personnes chaque année (intervalle de confiance (IC) à 95%: 25-159 000), principalement parmi les popula tions mal desservies d’Afrique et d’Asie.1 Plus de 95% des cas mortels de rage chez l’homme résultent de la transmission du virus par la morsure d’un chien infecté.2 Bien que la rage puisse être entièrement prévenue par l’admi nistration en temps utile d’une prophylaxie postexposition aux victimes de morsures, elle continue d’entraîner des décès dans de nombreux pays d’endémie3 (Carte 1). Les souf frances humaines considérables que provoque la maladie et les coûts substantiels associés à la prophylaxie postexposition pourraient être évités en éliminant le virus à la source. Cet objectif peut être atteint grâce à la vaccination de masse des populations de chiens domes tiques,2 une stratégie qui permet de réduire non seulement le nombre de décès dus à la rage, mais aussi, à plus long terme, le besoin de recourir à la prophylaxie postexposition dans la prise en charge des patients victimes de morsures canines. Dans le présent rapport, le terme de rage se rapporte spécifiquement à la rage humaine transmise par les chiens, sauf indication contraire. En 2015, les États Membres de l’OMS et leurs principaux partenaires4 ont établi un objectif mondial consistant à porter à zéro le nombre 1 Hampson, K, et al. «Estimating the global burden of endemic canine rabies.» PLoS Negl Trop Dis 9.4 (2015): e0003709. 2 WHO Expert Consultation on Rabies: second report. Genève, Organisation mondiale de la Santé, 2013 (WHO Technical Report Series, No. 982). Disponible à l’adresse: http://apps.who.int/iris/ bitstream/10665/85346/1/9789240690943_eng.pdf; consulté en janvier 2017. 3 Voir No 2, 2016, pp. 13-20. 4 FAO, OIE, GARC et autres parties prenantes. 78 WEEKLY EPIDEMIOLOGICAL RECORD, NO 7, 17 FEBRUARY 2017 Map 1 Endemicity of dog rabies and dog-transmitted human rabies, 2016 Carte 1 Endémicité de la rage canine et de la rage humaine à transmission canine, 2016 Endemic dog-transmitted human rabies: dog rabies and dog-transmitted human rabies present in the country – Endémie de la rage humaine transmise par les chiens: la rage canine et la rage humaine à transmission canine sont présentes dans le pays Endemic dog rabies: dog rabies in the majority of the country, but no dog-transmitted human rabies cases – Endémie de la rage canine: rage canine présente dans la majeure partie du pays, mais aucun cas de rage humaine transmise par les chiens Sporadic dog-transmitted rabies: dog rabies in few areas of the country with sporadic human cases – Cas sporadiques de rage transmise par les chiens: rage canine présente dans quelques zones du pays, accompagnée de cas humains sporadiques Controlled dog rabies: few cases of dog rabies in limited areas of the country but no dog-transmitted human rabies cases – Maîtrise de la rage canine: quelques cas de rage canine dans des zones limitées du pays, mais aucun cas de rage humaine transmise par les chiens No dog rabies: zero dog rabies and zero dog-transmitted human rabies cases (except from imported) – Absence de rage canine: aucun cas de rage canine et aucun cas de rage humaine transmise par les chiens (sauf cas importés) No information – Aucune information Not applicable – Sans objet The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. – Les limites et appellations figurant sur cette carte ou les désigna tions employées n’impliquent de la part de l’Organisation mondiale de la Santé aucune prise de position quant au statut juridique des pays, territoires, villes ou zones, ou de leurs autorités, ni quant au tracé de leurs frontières ou limites. Les lignes en pointillé sur les cartes représentent des frontières approximatives dont le tracé peut ne pas avoir fait l’objet d’un accord définitif. © WHO 2017. All rights reserved – © OMS 2017. Tous droits réservés RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 7, 17 FÉVRIER 2017 79 rabies by 2030.5 This surpassed the goals of the WHO roadmap on neglected tropical diseases (NTDs),6 which set regional elimination targets only. A comprehensive business plan that encompasses both human and animal perspectives for achieving this target by the year 2030 is in preparation. Although rabies is notifiable in many countries, surveil lance is often weak and official reporting of disease incidence in humans and animals remains inadequate and incomplete.7 It is increasingly accepted that the available data underestimate the true incidence8 and that in many cases the true quantitative burden of rabies is best displayed using estimates. As control programmes and systems improve, effective surveil lance results in more robust data and the incidence of dog-transmitted human rabies has been shown to decline. This is the situation in many countries in the Region of the Americas where disease incidence has decreased by 98%. This report updates the epidemiological information on dog-transmitted rabies, discusses the changing needs from surveillance when approaching elimination and data sources for rabies in animals; it outlines new sources and recent developments towards more complete rabies data and calls for active participation of countries in these processes. Global map showing endemicity of dog rabies and dog-transmitted human rabies The updated map (Map 1) shows endemicity of rabies at a national level. Categories of endemicity take into consideration occurrence of cases of dog rabies and dog-transmitted human rabies. The limitation of the map is that classification is at country level and not at sub-national administrative levels, such as by district. The categories were designed to differentiate at a coun try level, thus the map does not portray subnational details. For the map, countries were attributed categories based on: i) existing data3, 9, 10, 11 (Table 1), and ii) expert knowl edge. The map will be updated regularly based on new data input (see “Call for data” at the end of this report). 5 Global Elimination of rabies. The time is now. (2015). Available at: http://apps.who. int/iris/bitstream/10665/204621/1/WHO_HTM_NTD_NZD_2016.02_eng. pdf?ua=1; accessed January 2017. 6 Accelerating work to overcome the global impact of Neglected Tropical Diseases. A roadmap for implementation. (2012). Available at: http://www.who.int/neglec ted_diseases/NTD_RoadMap_2012_Fullversion.pdf; accessed January 2017. 7 Taylor L, Knopf L, Surveillance of Human Rabies by National Authorities--A Global Survey. Zoonoses Public Health. 2015 Nov;62(7):543–552. 8 Taylor Louise H, et al. Difficulties in estimating the human burden of canine rabies. Acta tropica (2015). 9 Rabies bulletin Europe. Rabies Information System of the WHO Collaboration Centre for Rabies Surveillance and Research. Available at : http://www.who-rabies- bulletin.org/Default.aspx; accessed January uploads/Geographie/human-rabies-2016-updates.pdf