Improving the rabies national control plan in Tunisia

He then outlined the main priorities for the future animal-mediated rabies strategy – in order to eliminate human rabies – namely:

• improve vaccination, including of at-risk dogs, during annual campaigns;
• better management of outbreaks and better overall surveillance of the disease;
• adapt regulations;
• provide effective training and communication for all stakeholders.

The aim of this workshop was to bring together all field staff involved in the fight against rabies in Tunisia to review, based on the feedback from field vaccinator teams, the current strategy and consider ways of improvement towards implementation in the coming years,

Overall, the workshop was attended by approximately 70 participants, mainly from the Decentralized Tunisian Veterinary Services (CRDA) and from the central level (DGSV), as well as officers from various agencies under the Ministry of Agriculture: CNVZ, IRVT, Veterinary Council, etc., as well as veterinary practitioners and veterinary students.

The workshop was facilitated by Dr. Kaouther Oukaili, Rabies Programme Officer in the Tunisian Ministry of Agriculture, assisted by several DGSV officers, along with rabies experts, such as Dr. Florence Cliquet (Head of the Lyssa-virus Unit of the ANSES Rabies and wildlife Laboratory in Nancy) and communication experts, such as Dr. Catherine Bertrand-Ferrandis (Head of the OIE Communication Unit) and Ms Valerie Vouligny (Director of the Life AH communication agency).

By way of introduction, Dr. Kaouther Oukaili presented an overview of the situation in Tunisia in respect of the epidemiological situation of animal rabies and the control options in the fight against the disease.

Dr. Florence Cliquet outlined how to implement a rabies control strategy. She illustrated her presentation of successful examples implemented in several countries. She stressed the importance of starting in a pilot area before scaling up to the whole country. Finally, she stressed the importance of post-vaccination monitoring, which should be set up, according to a sampling plan, 4 to 5 weeks after the vaccination campaign. This crucial step makes it possible to collect information on the quality of the vaccination (the importance of the vaccination skills, the storage of vaccines, the maintenance of the cold chain, …), the vaccination coverage (and coherence with the geographical coverage), the dog census data (number, types of dogs, …). She also stressed the importance of training field workers in capturing difficult dogs, i.e. “dogs at risk” when it comes to the rabies transmission cycle – for inclusion in the vaccination programme.

Dr. Catherine Bertrand-Ferrandis, introduced the “One Health” concept, developed following the avian flu crisis in order to avoid the possibility of human contamination from sick animals, a crisis during which several hundreds of human casualties were reported worldwide. She pointed out that rabies kills nearly 70,000 people every year in the world, mostly in Asia and Africa and went on to present the global rabies strategy that was first presented at the Global Conference in Geneva in December 2015, the objective of which is the eradication of human rabies by focusing on the transmission from the dog. Mass vaccination of dogs in general – facilitated by the use of regional OIE vaccine banks – is expected to achieve the target set by this global strategy: zero human deaths by 2030.
In addition, Ms Valérie Vouligny stressed the importance of rabies communication, which targets many, diversified, actors. In particular, she stressed the importance of defining the message according to the target audience.

In summary, the 7 major points (the 7 “Cs”) to have in mind when contemplating communication are:

• Capture the attention;
• Clarify the message;
• Communicate the benefits;
• ;Consider coherence;
• Consider the heart and mind;
• Create trust;
• Channel this into action

In order to illustrate that the strategy validated at the global level is indeed effective, Dr. Jocelyn Merot presented several campaigns conducted in different countries or cities which led to a significant reduction in the number of cases of rabies, or even to the elimination of the disease. Several “success stories” were cited: the example of Zanzibar, Namibia, Kenya, Mexico City, Lima, in Peru, Indonesia, the Philippines … He stressed the need for collaboration of all actors concerned and the teams work on the ground to achieve success, as well as the importance of integrating “dogs at risk” into the mass vaccination programmes (i.e. the difficult dogs that are usually overlooked by the teams implementing the annual vaccination programmes). Hence, the interest of training such field teams in the capture of such dogs. The collaboration between the veterinary services and the municipal services in Tunis is an example to follow in order to improve the management of difficult dogs (stray dogs, semi-stray dogs, owned dogs which are too aggressive to be approached,… ) and to better control the stray dog ??population by combining a sterilisation and euthanasia programme with a vaccination programme. In conclusion, Dr. Jocelyn Merot hopes that the example of Tunisia will soon be included in aforementioned “success stories”.

Dr. Soumaya Ben Chehida presented the action of the Urban Environment Protection Directorate of the Tunis Municipality in the management of stray dogs and in particular highlighted the progress made since the participation of their operatives in the Training workshop on the handling of stray dogs or aggressive dogs, organised by the OIE Sub-Regional Representation for North Africa in collaboration with the Tunis Municipality and the Tunisian Veterinary Services (DGSV) in Tunis, Tunisia in May 2017. She also welcomed the participation, since early September, of veterinary interns as part of an agreement with the Sidi Thabet National School of Veterinary Medicine (ENMV).

From day one onwards, participants, through practical group exercises, worked on the aforementioned 4 selected priority areas to improve the rabies strategy, namely:

• improve vaccination, including of at-risk dogs, during annual campaigns;
• better management of outbreaks and better overall surveillance of the disease;
• adapt regulations;
• provide effective training and communication for all stakeholders.

Discussions were very constructive throughout the two days of the workshop and covered many topics such as, for example :

• the options for marking vaccinated dogs,
• the distinction of dogs, according to the risk of rabies transmission,
• the best time to vaccinate dogs,
• the procedures for monitoring the cold chain for the storage of vaccines,
• the upgrading of laboratories,
• the modalities of regulatory review,
• the safety of vaccinators, of staff harvesting the heads of rabies-suspected dogs, of samples dispatched to the laboratory, and
• the improvement of the transmission of test results …

During the second day of the workshop, the participants also worked in groups on situational exercises to familiarise themselves with some of the communication tools presented the previous day.

• What would you want to see changed ?
• What message would you want to convey to a particular target audience?
• How would you address a political decision-maker asking him or her to support actions to control rabies?

The workshop was wrapped-up by Dr. Kaouther Oukaili who presented draft recommendations and areas for improvement of the future rabies control strategy.

In the short term, a working group will prepare a final document, a summary of which will be presented to the Minister of Agriculture in order to release the budget necessary for the implementation of an effective rabies control action plan and to keep the number of human cases at zero…