Anda di halaman 1dari 26

Socio-economic modelling to support

zoonotic diseases control


The example of rabies in Flores, Indonesia
Ewaldus Wera
WHO AM I?

 Anak Desa (25 km arah barat kota Ruteng)


 Anak ke-3 dari 5 bersaudara
 SMUN I Ruteng (1997)
 IPB Bogor (Dokter Hewan; 2003)
 Utrecht University, Belanda (Master Epidemiology and
Economic Veteriner; 2010)
Riwayat Pendidikan & Pekerjaan

 Wageningen University, Belanda (Doktor Bidang


Epidemiology and Economic Veteriner; 2017)
 Staf Pengajar Prgram Studi Kesehatan Hewan, Politani
Kupang (2003-sekarang)

nanawaldi@yahoo.com; Facebook: Ewaldus Wera;


https://scholar.google.co.id/citations?user=uMW8rEIAAAAJ&hl=en
Zoonoses are important health problems
 Account for 70% of human infectious diseases
 Cause pandemics

 e pandemics.
Q-Fever
Vancomycin resistant vCJD
Staph. Aureus
West nile virus
Ecoli O157 SARS CoV Food borne HEV
MERS CoV H5N1 Influenza
Zika virus Ebola virus
Nipah virus
Rift Valley fever
Anthrax Brucellosis
Rabies Rabies
Pulmonary Hantavirus Hendra virus
Rabies in global perspective
 Rabies is a zoonotic viral disease
 60,000 deaths/year (40% children)
 99% caused by dog bites
 Economic impact: US$8.6 billion/year

Hampson et al., 2015; Plos NTD


Rabies di Indonesia

 Rabies/penyakit anjing gila: Penyakit infeksi akut


dari
susunan saraf pusat yang disebabkan oleh virus rabies
 Kasus pertama kali dilaporkan oleh Esser pada tahun
1884 pada seekor hewan kerbau (Jawa Barat)
 1889 : Rabies pada anjing (Jawa Barat)
 1894: Manusia (Jawa Barat)
 Dari jawa barat penyakit rabies menyebar ke provinsi
lain di Indonesia
Gejala Klinis

 Laporan Kasus (Koesharyono et al 2010):


● 150 ekor anjing jalanan diantar ke klinik oleh LSM;
5 diantaranya menunjukan gejala klinis 11-30 hari
setelah tiba diklinik, tanpa sejarah menggigit
orang.
● 2 ekor anjing diantar pemiliknya ke klinik untuk
divaksinasi: 1 ekor memiliki sejarah pernah
menggigit anak orang asing tanpa provokasi
Gejala klinis

 Ketujuh anjing tersebut diobservasi terhadap gejala


klinis rabies
 Dari 7 ekor anjiing tersebut ditemukan gejala
menyimpang /abnormal bervariasi dari:
 Hidrophobia (3 ekor)
 Photophobia (1 ekor)
 Aerophobia (1 ekor)
Gejala klinis (lanjutan...)

● Gerakan berputar (2 ekor)


● Sempoyongan (2 ekor)
● Tak mampu minum atau makan meski berupaya
menyentuh tempat makan karena paralisa rahang
bawah
● Hypersalivasi (2 ekor)
● Menggigit tanpa provokasi (3 ekor)
● Agresif (1 ekor)
Prevention is possible

..but low uptake


Socio-economic framework
Uptake of dog vaccination campaigns

 Survey 450 dog owners, 44 randomly selected villages:


● Socio-demographic factors,
● Knowledge of rabies,
● The uptake of dog vaccination campaign
Uptake of dog vaccination depends on:

 Accessibility of the village


 Dogs kept for breeding
 Economic value of dogs
 Income of dog owners

Wera et al., 2015; Plos Neglected Tropical Diseases


Intention to vaccinate dogs in the future
Theory of Planned Behaviour (Ajzen 1991)
Intention to vaccinate dogs in the future
Theory of Planned Behaviour (Ajzen 1991)
Intention to vaccinate dogs in the future

Wera et al., 2016; Preventive Veterinary Medicine


WHO recommendation 70%

● Targeted distribution of information:


● Importance of vaccination
● Vaccination schedules
● Training dog owners/vaccinators techniques to
catch and restrain dogs
Cost-effectiveness of annual vaccination
campaigns
I. Using short-acting vaccine with coverage of 50%
(current strategy)
II. Using short-acting vaccine with coverage of 70%
III. Using long-acting vaccine with coverage of 70%
Effectiveness 50 % vaccination uptake
Using short-acting vaccine
44
42
40
38
36
Number of infectious dogs

34
32
30
28
26
24
22
20
18
16
14
12
10
8
6
4
2
0
20
40
60
80
0

100
120
140
160
180
200
220
240
260
280
300
320
340
360
380
400
420
440
460
480
500
520
Time (Weeks)
Wera et al., 2016; Transboundary and Emerging Diseases
Effectiveness 70 % vaccination uptake
Using short-acting vaccine
44
42
40
38
36
Number of infectious dogs

34
32
30
28
26
24
22
20
18
16
14
12
10
8
6
4
2
0
40
20

60
80
0

100
120
140
160
180
200
220
240
260
280
300
320
340
360
380
400
420
440
460
480
500
520
Time (Weeks)
Effectiveness 70 % vaccination uptake
Using long-acting vaccine
44
42
40
38
36
Number of infectious dogs

34
32
30
28
26
24
22
20
18
16
14
12
10
8
6
4
2
0
20
40
60
80
0

100
120
140
160
180
200
220
240
260
280
300
320
340
360
380
400
420
440
460
480
500
520
Time (Weeks)
Cumulative costs of rabies control:
50 % vaccination uptake using short-acting vaccine

25,000
Cumulative costs

20,000 19,468
(US$/village)

15,000

10,000

5,000

0
1 2 3 4 5 6 7 8 9 10
Time (Years)
Cumulative costs of rabies control:
70 % vaccination uptake using short-acting vaccine

25,000
Cumulative costs
(US$/village)

20,000 19,468

15,000 15.000

10,000

5,000 4,225

0
1 2 3 4 5 6 7 8 9 10
Time (Years)
Wera et al.,; Under review by the Journal of Vaccine
Cumulative costs of rabies control:
70 % vaccination uptake using long-acting vaccine

25,000
Cumulative costs

20,000 19,468
(US$/village)

15,000
17.000
10,000

5,000 4,225
2,527
0
1 2 3 4 5 6 7 8 9 10
Time (Years)
Take home message

 Understanding the dog owners can improve control


 Increasing investment improves control ......
.... and pays itself back

 Socio-economic modelling needed for efficient control of


zoonotic diseases
THANK YOU
FOR THE ATTENTION
Acknowledgements
Directorate General of Human Resource

for Science, Technology and Higher

Education of Indonesia for funding this

research

26