Wa0020.

1
Table of Contents
Abbreviations and Acronyms..................................................................................................... ii
Forward.......................................................................................................................................... iii
Preface ........................................................................................................................................... iv
Acknowledgment .......................................................................................................................... v
Executive Summary .................................................................................................................... vi
Introduction ................................................................................................................................... 1
Epidemiology of rabies ............................................................................................................ 1
Global burden of rabies ........................................................................................................... 1
National situation of rabies ..................................................................................................... 2
Rationale of the strategy ............................................................................................................. 5
Vision .............................................................................................................................................. 6
Mission ........................................................................................................................................... 6
Goal ................................................................................................................................................. 7
Specific objectives ....................................................................................................................... 7
Guiding Principles ........................................................................................................................ 8
Strategies for rabies elimination................................................................................................ 9
1. Establish and enhance multi-sectoral approach for rabies elimination:............... 9
2. Elimination of rabies among animals:.......................................................................... 9
3. Prevention of rabies in humans: ................................................................................. 11
4. Strengthen surveillance systems: .............................................................................. 12
5. Advocacy, Communication, and Social support: .................................................... 13
6. Mobilize needed resources: ......................................................................................... 14
7. Promote Operational Research: .................................................................................. 14
Tips for implementation: ........................................................................................................... 16
Monitoring and evaluation ........................................................................................................ 21
Monitoring and evaluation ........................................................................................................ 22
Annex I: Monitoring and Evaluation Plan............................................................................... 23
Annex II: Proposed Budget....................................................................................................... 31
Annex III: References ................................................................................................................. 38
Annex IV: List of contributors .................................................................................................. 39
i
Strategic Framework
For Elimination of Dog-Mediated
Human Rabies in Egypt
Abbreviations and Acronyms
Animal Health Research Institute AHRI
Food and Agriculture Organization FAO
General organization of veterinary services GOVS
Ministry of agriculture and land reclamation MoALR
Ministry of Environment MoE
Ministry of Health and Population MoHP
Neglected Tropical Diseases NTDs
One Health OH
One Health – Technical Working Group OH-TWG
Post-exposure prophylaxis PEP
Rabies Post-Exposure Prophylaxis RPEP
Standard Operating Procedures SOPs
Veterinary Serum and Vaccine Research Institute VSVRI
World Health Organization WHO
September 2021
ii
Strategic Framework
Forward
This strategic plan was developed through a consultative process involving key
stakeholders sharing actively in prevention and control of rabies in Egypt. It is a result
of joint work with effective participation of representative from relevant organizations
and institutions who shared their valuable experience which was essential to get
proper vision of the problems and set priorities for actions.
September 2021
iii
Strategic Framework
Preface
September 2021
iv
Strategic Framework
Acknowledgment
A great effort was done by Ministry of Health and Population (MoHP) in leading this
process and driving it towards success, which comes in line with activities done for
strengthening and operationalization of the concept of one health (OH), which is a
collaborative, multisectoral, and transdisciplinary approach with the goal of achieving
optimal health outcomes through recognition of the interconnection between people,
animals, and their shared environment. All of which is a part of great work done by
MoHP in improving the quality of health services offered to Egyptian people.
We highly appreciate support offered by Dr Alaa Eid, Under Secretary of Preventive

Affairs, Dr Mohamed AbdelFattah, Head of the Central Administration of Preventive
Affairs and Dr Hanem AbdelRaoof, Director General of Communicable Disease
Control department. We also, highly evaluated the effort of the Zoonotic Disease
Control team at MoHP with special thanks to Dr Baher Eldesouki, Focal Point for
Zoonotic Diseases and One Health coordinator for his contribution and valuable
inputs.
We wish to acknowledge both Dr AbdelHakim Mahmoud Ali, Chairman of General

Organization for Veterinary Services, and Dr Ayman Mahrous, Head of Central
Administration of Public Health and Slaughterhouses at Ministry of Agriculture and
Land Reclamation, and also acknowledge Dr Luay Elsayed Zonkol, Director of
Biosafety Department at Ministry of Environment and all stakeholders from different
organizations and institutions for their outstanding contribution to the finalization of this
strategy.
Greetings extended to both country offices of the World Health Organization (WHO)
and the Food and Agriculture Organization (FAO) for their support thorough all the
steps of formulation of this strategic plan.
September 2021
v
Strategic Framework
Executive Summary
Rabies is a zoonotic disease, which can be transmitted to humans by animal bites or

scratches, mainly dogs. Globally the estimated number of deaths caused by human
rabies is 65,000 cases annually. The disease is still common in different countries with
rabid dogs responsible of 99% of human rabies.
Dog-mediated human rabies has been eliminated from Western Europe, Canada,
United States of America, Japan, and some Latin American countries. Despite many
success stories in Latin America and other countries, endemic rabies in Africa and
parts of Asia remains largely uncontrolled, resulting in about 95% of human deaths
from rabies worldwide. Rabies is considered one of the neglected tropical diseases
(NTDs) affecting mainly persons at low socioeconomic level living in remote areas.
Rabies is 100% preventable by vaccinating people. Annually, approximately 29 million

persons receive rabies post-exposure prophylaxis (RPEP) worldwide. Rabies PEP
costs 40-50 US$ per person which is too much for families living at the average of 1-
2 US$ per person/day. Vaccines are not only available for humans, but also for animals
consisting an essential element for prevention of rabies.
In Egypt, rabies and animal bite incidents are both an important public health issue.
The Ministry of Health and Population (MoHP) offers PEP free of charge at more than
300 centers all over the country. Animal bites is increasing annually with enormous
economic burden due to costs of PEP beside other losses related to lost working days,
consumed resources, and sometimes related human disabilities or even deaths.
The strategy of rabies elimination in Egypt aims at zero human cases of rabies by
2030 as targeted by World Health Organization (WHO). The first priority of the strategy
is to establish and enhance multi-sectoral approach of rabies elimination at national
and governorate levels, which is a key point to help prevention or control of all zoonotic
diseases, including rabies. The second priority is elimination of rabies among animals
through dog population management, mass dog vaccination and promotion of
responsible pets’ ownership. The third priority is to prevent human rabies by providing
proper management of PEP and raise awareness about proper rabies and animal bites
monument by health care workers. The fourth priority is concerned with strengthen of
September 2021
vi
Strategic Framework
surveillance systems in both humans and animals and establishing a link for
information sharing between both systems. The fifth priority area addresses the
importance of advocacy, communication, and social support to raise community
awareness and education on dealing with animals and prevention of animals’ bites. It
will also help to enhance community participation in rabies prevention activities
especially by non-governmental organizations. The sixth priority is mobilizing needed
resources which should be available and sustainable all through the duration of the
strategy implementation. The seventh priority area addresses the importance of
strategic information through encouraging operational research.
Also, this strategy highlights the importance of establishment of a strong and effective
monitoring and evaluation system to provide the information needed to assess the
strategy implementation, ensure effective operations, follow up, and guide future
planning.
We expect high cost/benefit ratio of implementation, as the extra needed funds will be
much less than the losses induced by management of increased number of animal
attacks to humans annually.
September 2021
vii
Introduction
Epidemiology of rabies
Rabies is a zoonotic disease that can be transmitted to human causing acute infection
with progressive encephalitis. Infection is usually transmitted by animal saliva
contaminating animal bites or scratches. Manifestation started by apprehension,
headache, fever, malaise, and sensory changes at the site of bite or scratch.
Excitability then follows with swallowing muscles spasm, aerophobia, and
hydrophobia. These manifestations usually followed by delirium and occasional
convulsions. Once manifestations started the disease is almost 100% fatal.
Rabies is caused by rabies virus of the Lyssavirus group. Reservoirs of infection are
wild and domestic canidae including dogs, foxes, wolves and others. Cats, cattle,
horses, and camels usually get infected by rabid dogs, foxes, or wolves. Transmission
is usually caused by the virus laden saliva from rabid animal contaminating wounds
caused by bites or scratches. The incubation period is usually 3-8 weeks. Incubation
period depends on the severity of wound and its location near by nerve supply, head,
and neck where the incubation period tends to be relatively shorter.
Although being 100% fatal, it is 100% preventable if rabies post-exposure prophylaxis

measures were taken timely and appropriately. Rabies PEP includes primarily
thorough wash of wounds with running water and soap, vaccination doses and
sometimes immunoglobulin in high-risk circumstances or severe wounds caused by
animal bites.
Global burden of rabies
Inadequacy of rabies surveillance and sometimes its absence in areas of endemicity

of the disease makes it difficult to have an accurate estimate of the problem. Globally
the numbers of deaths caused by human rabies are 65,000 deaths annually. The
disease is still common in different countries while rabid dogs are responsible of 99%
of human rabies deaths. Being a disease that primarily affect animals, then
subsequently humans are accidently exposed, the real burden and expenses should
be estimated based on the burden among animals.
1 1
Strategic Framework
Rabies is reported in all continents except Antarctica. Dog mediated rabies has been
eliminated from Western Europe, Canada, the United States of America, Japan, and
some Latin American countries. The majority of cases of human rabies are reported
in African and Asian countries, with 95% of human deaths from rabies worldwide.
Rabies is considered among the neglected diseases of the tropics affecting mainly
person at low socioeconomic level living in remote areas. The age most at risk was
found to be children 5-14 years representing most deaths due to human rabies.
Fortunately, rabies is 100% preventable by vaccinating people; however, an annual

number of approximately 29 million persons receive rabies post exposure prophylaxis
(RPEP) worldwide, resulting in a huge economic burden on health systems and
communities. Rabies PEP costs 40-50 US$ per person which is too much for families
living at the average of 1-2 US$ per person/day. Vaccines are not only available for
humans, but also for animals consisting an essential element for prevention of rabies.
National situation of rabies
Human rabies and animal bites are both included in the national surveillance system
of Ministry of Health and Population (MoHP) in Egypt. The average number of clinically
reported cases of human rabies is around 50 cases annually. However only 32 and 37
cases were reported in 2018 and 2019, respectively compared to 59 and 65 cases in
2016 and 2017 (Figure 1).
Most of human rabies cases were among children 5-14 years and mostly in rural areas.
Among reported cases 70% did not receive PEP for rabies.
Regarding animal bite incidents, a total number of cases of reported animal bites were
482,040 in 2018, compared to 431,917 in 2017 and 355,373 in 2016 (Figure 2). It
seems that this trend of increased number of reported incidents of animal bites is
continuing, as 574149 cases were reported during 2019 with a rate of 20% increase.
It was also observed that more than 70% of cases of animal bites were by stray dogs.
On the veterinary side, there are reports of cases of animal rabies among domestic
animals caused from wildlife animals in New Valley Governorate.
September 2021
2
Strategic Framework
The significant reduction of human rabies cases in 2018 and 2019 is believed to be as
a result of implementation of the updated national post-exposure prophylaxis
guidelines that covers all cases of animal bites or scratches with 1st aid measures,
vaccination, and prioritization of cases regarding their need to receive immunoglobulin.
This was achieved despite the increased number of reported cases of animal bites
which adds to the burden of the disease annually.
70 65
59
60 55
50
40 37
32
30
20
10
0
2015 2016 2017 2018 2019
Figure (1): Reported clinical cases of human rabies in Egypt (2015-2019)
700000
600000 574149
500000
482040
431917
400000 355373
328046
300000
200000
100000
0
2015 2016 2017 2018 2019
Figure (2): Reported cases of animal bites in Egypt (2015-2019)
MoHP is offering preventive and curative services for human rabies. Nationwide, there
is more than 300 centers providing PEP free of charge for persons suffering from
September 2021
3
Strategic Framework
animal bites -including dog ones- in different general, central and fever hospitals in all
governorates. Human rabies vaccines are available at these centers and offered for
free. The guidelines of PEP were updated to offer rapid high-quality level of services.
Health education materials were developed to increase awareness of the public about
hazards of exposure to attacks from animals especially dogs. MoHP is also working
with other ministries including Ministry of Agriculture and Land Reclamation (MoALR),
Ministry of Environment (MoE), Ministry of Local Development and Ministry of
Education to concert efforts of prevention of animal and human rabies in Egypt.
The cost of anti-rabies vaccines required for PEP is estimated at almost 300 Egyptian
pound per case, not including immunoglobulins and other medical services cost. The
estimated total cost for vaccines only in a year is almost 150 million Egyptian pounds.
This estimation does not include loss of working days by injured victims and human
losses due to human rabies deaths. Availability of human vaccines and
immunoglobulins is a challenging issue with the intermittent shortage in production by
international companies.
On the other hand, animal rabies vaccines are available in both injection and oral
doses. More than one brand of the injectable vaccine is available in Egypt. One of
these brands is manufactured locally and the others are imported. The national
vaccine cost only 25 Egyptian pound per dose while the imported brands cost between
75-150 pounds. The oral type of animal rabies vaccine is not available in Egypt. The
cost for one dose of oral vaccine costs 0.63 US Dollars.
The challenging current situation of rabies in Egypt and the international interest in
elimination of human rabies by 2030 mandates the adoption of a national strategy for
elimination of the disease in Egypt. This strategy should be adopted by all players
having a role in the elimination of the disease in both humans and animals. The cost
benefit of implementation of this strategy will be high considering the enormous cost
of PEP and other medical care needed. In addition to the burden of lost working days
or even deaths caused by rabies.
September 2021
4
Strategic Framework
Rationale of the strategy
In Egypt, Rabies is one of the priority zoonotic diseases. MoHP categorized priority
zoonotic diseases according to different factors to align with global priority zoonosis
in terms of human mortality and morbidity, impact on livestock, amenability to
agriculture/veterinary-based interventions. One of the major challenges is the steady
increase in the number of human cases of animal bites, with approximately 500,000
per year, and 50 rabies cases.
Nowadays, Egypt is heading to achieve the Global Initiative to Eliminate Rabies by

2030. The MoHP and General organization of veterinary services (GOVS) at MoALR
are committed to jointly formulate a strategic plan for achievement of this goal. The
strategic plan will involve all sectors related to rabies among humans and animals.
Considering that animal bites in humans in Egypt is a serious public health problem
with increasing numbers each year, in which dogs are responsible for the majority of
incidents and hence human rabies infections. Thus, Support should be directed for
dog population control activities, mass dog vaccination and educational outreach,
along with other activities to mitigate human risk.
September 2021
5
Strategic Framework
Vision
Egypt free from human rabies.
Mission
Gradually reducing human rabies till complete elimination by 2030 through measures
applied to control the disease in dogs and appropriate measures for prevention of
human rabies through timely and proper PEP.
September 2021
6
Strategic Framework
Goal
Eliminate dog mediated human rabies in Egypt by 2030.
Specific objectives
1. Reduce incidence of the disease in Human
2. Mitigating the risk of transmission of the disease from animal to Human
3. Control of dog rabies by all available means in accordance with principles of

animal welfare.
4. Strengthen surveillance systems for both animal and human rabies and set a
mechanism of integration between the two systems.
5. Mobilize resources needed for implementation of human rabies strategy in

Egypt by 2030.
September 2021
7
Strategic Framework
Guiding Principles
1. Animal bites and rabies infections are major public health problems in Egypt
due to human loss of 100% fatal infections and the enormous costs of PEP for
persons exposed to animal bites, medical care needed, and loss of working
days.
2. The international interest of elimination of the disease by 2030 guarantee

international support for any national efforts in this respect.
3. The success of many Latin American and Asian countries with nearly similar
economic circumstances of Egypt indicates possibility to replicate the process
and achieve the objective of disease elimination.
4. Collaborative multi-sectoral approach, which is essential for elimination of

rabies, is possible as it was already achieved in Egypt in many other successful
programs.
5. Availability of highly effective vaccines for both humans and animals makes it
possible to achieve its elimination.
September 2021
8
Strategic Framework
Strategies for rabies elimination
This national strategic framework consists of seven pillars in which it is expected to

get use of maximum efforts of representatives from different technical areas that
should be involved in a multi-sectoral partnership to speed the progress towards
reducing the mortalities due to rabies, including:
1. Establish and enhance multi-sectoral approach for rabies elimination:
Many players should be included in the elimination activities of rabies. These players
include -but not restricted to- MoHP, GOVS at MoALR, MoE, Ministry of Local
Development, Ministry of Education, Academia, and others. Partnership should be
ensured at all levels.
Activities in this domain will include:
1.1- Support ongoing efforts to finalize the update of the influenza ministerial
committee to a One Health (OH) ministerial supreme committee including all
relevant ministers and other stakeholders in charge to address zoonotic
diseases, antimicrobial resistance and other issues needing multisectorial
approaches.
1.2- Institutionalization and operationalization of the One Health Technical Advisory

Group (OH-TAG) as technical advisor for zoonotic disease policy control
including rabies.
1.3- Organize and activate sub-national committee for elimination of zoonotic

diseases including rabies.
1.4- Enhance coordination and collaboration for implementation of elimination

activities at different administrative levels in each governorate.
2. Elimination of rabies among animals:
Increasing numbers of stray dog population is a challenging problem for any control
program for rabies elimination. Vaccination programs of roaming dogs necessitate
prior management of dog population numbers.
September 2021
9
Strategic Framework
Presence of heaps of garbage provide plenty of food and attract dogs to inhabited
areas in close contact with humans exposing them to high risk of animal attacks.
Regular removal of heaps of solid wastes was believed in reducing and controlling of
dog population and pushed away from centers of cities and villages.
Dog ownership is common as a hobby and are used to help in guarding by farmers,
ranch workers, storehouse owners and guards of under construction buildings. There
are available laws regulating ownership of pets in Egypt. These laws need to be
revised, updated, and activated to guarantee prevention of rabies among animals and
humans.
Recognition of dog-mediated rabies as a public health problem allowed establishment

of effective control programs using dog vaccination which should be coupled with
population management strategies for rabies control. The choice of vaccination
method and strategy is critical to ensure enough dogs will be vaccinated to break the
cycle of rabies transmission.
Maintaining adequate herd immunity in the dog population is critical to prevent the
return of dog-derived rabies variants. With limited resources, vaccination programs
should be tailored to risk-based vaccination approach, suit the area characteristics –
including human-dog interaction and dog population ecology– to efficiently and cost-
effectively reduce rabies spread.
Characterizing the dog population can guide the decision regarding which vaccination
methods and targeted area that will led to the most successful vaccination campaign
outcome. Unfortunately, the actual density of dogs inside cities and villages is not
accurately known. Thus, support should be given in the beginning to understand and
identify the risk area of dog population which will be the pillar to formulate the rabies
vaccination strategy and related SOPs.
Dog Rabies vaccines are available and proved highly effective in prevention of animal
rabies. Support should be given for locally produced dog vaccine produced by
Veterinary Serum and Vaccine Research Institute (VSVRI) or any other governmental
institute to ensure availability of efficient and enough quality vaccine.
Standard Operating Procedures (SOPs) for dog vaccination program should be

developed prior to implementation, with an objective for vaccination coverage to be at
September 2021
10
Strategic Framework
least 70% of dog population and maintained for successive three years to be effective.
Several countries had experienced a reduction in rabies transmission and human
cases by reaching a 70% vaccination coverage in the dog population.
a. Management of dog population
2.1- Control of stray dog population taking into consideration animal welfare
acceptable methods e.g. spaying and increase number of animal shelters
2.2- Regular removal of solid garbage to push animals away from inhabited areas.
2.3- Update and activate pet ownership laws
2.4- Promotion of responsible pet ownership
b. Mass vaccination of dogs
2.5- Apply mass vaccination programs in dogs using rabies vaccines especially in
targeted high-risk areas.
3. Prevention of rabies in humans:
PEP services for human suffering from animal bite are provided by MoHP at more than
300 centers affiliated to general, central, fever hospitals and others all over the
country. These centers provide the five doses of anti-rabies vaccine for free for more
than 500,000 cases annually. In 2018, an updated guideline was prepared by MoHP
for Rabies PEP. These guidelines are in line with recent World Health Organization
recommendations and approved by different technical partners and stakeholders.
Also, MoHP has shared actively in the process of raising awareness regarding rabies
prevention and control including raising public awareness about how to avoid
exposure to animal bites. Recently, two health education materials were developed to
increase awareness of Health care providers and as well public about the burden of
rabies and how to prevent it and avoid animal attacks.
September 2021
11
Strategic Framework
3.1- Ensure access to high quality and timely services of PEP for rabies prevention
among humans.
3.2- Availability of human rabies vaccines and immunoglobulins.
3.3- Capacity building with knowledge, and skill improvement of health care workers
on proper implementation of PEP.
3.4- Supporting educational programs particularly for at risk population regarding

safe dealing with animals, pre- and post-exposure prophylaxis.
3.5- Offering rabies pre-exposure prophylaxis upon request for at risk population.
4. Strengthen surveillance systems:
Surveillance is a fundamental part of preventive programs. It provides strategic

information for policy makers regarding the burden of the problem. It also provides
data for monitoring and evaluation of effectiveness of interventions. The preventive
sector of MoHP already updated guidelines of surveillance of animal bites in the
centers offering PEP medical services. The system still uses paper sheets for data
reporting which makes it difficult to organize and analysis data and to report on current
situation to policy makers.
GOVS/MoALR has an administrative structure for zoonotic diseases control in the

country through the Department of Zoonoses and Public Health represented at all
levels. The whole system depends mainly on event-based surveillance for rabies in
animals. Diagnosis of rabies in animals is performed through the Animal Health
Research Institute (AHRI) by an accredited laboratory inducing experienced capable
researchers. The system allows performing of rabies testing in dogs or other domestic
and wild animals when requested.
It is highly essential to establish a system of integrated surveillance system of rabies

among humans and animals. This integrated system will ensure data sharing, joint
actions to control foci of high risk of rabies infection and joint study to provide strategic
information for planning, implementation, and monitoring of control measures.
September 2021
12
Strategic Framework
4.1- Strengthen surveillance of human rabies and animal bites with regular
evaluation of key indicators. The system should be transformed to digital
system to help facilitate data analysis and calculation of key performance
indicators.
4.2- Strengthen methods for surveillance of rabies among animals including routine
surveillance, event-based methods, and updating mechanisms of initiating joint
actions upon notifications from MoHP and other stakeholders.
4.3- Establish a mechanism of integration and information sharing between human

and animal surveillance systems. An online channel can be created for timely
sharing of data and facilitation of proper interventions.
4.4- Strengthen capacity of specimen collection from the field and laboratory
diagnosis of rabies in both humans and animals.
5. Advocacy, Communication, and Social support:
It is essential to guarantee high level of public awareness about the burden of rabies,
rabies prevention and proper and timely PEP for dog wound management. Increased
awareness will encourage adoption of responsible pets’ ownership and preventive
activities of the disease by the community, governmental and nongovernmental
organizations.
Develop a joint risk communication plan targeting various audiences at all levels to be
implemented through a large mass communication campaign and using various tools
of communications (media, social media, direct communications, etc….)
5.1- Develop Rabies national risk communication plan.
5.2- Implement community awareness and education campaigns on dealing with

animals and prevention of animals’ bites and human rabies. These campaigns
should focus on school children as being the major sector of those suffering
from dog bites and attacks according to surveillance data.
September 2021
13
Strategic Framework
5.3- Enhance community participation in rabies prevention especially non-

governmental national and international organizations.
6. Mobilize needed resources:
The implementation of activities of elimination will need to mobilize resources. These

resources should be sustainable during the period of implementation of strategic
activities. Resources should be shared by different stakeholders including
governmental and nongovernmental sectors. International donors interested in
elimination of rabies should also be included as possible.
The cost benefits of funds for elimination will be high as by saving lives and
expenditure for PEP to the increasing number of animal bites. Saving of other medical
expenditure and lost working days also count. The strategy could be a fund-raising
document to get resources from donors either national or international
6.1- Mobilize resources to support rabies elimination activities by different

governmental partners.
6.2- Engage interested international and national non-governmental organizations

to participate and support the implementation of the rabies national elimination
strategy.
7. Promote Operational Research:
It is essential that disease prevention and control measures are evidence-based.

Therefore, applied research is required to provide this evidence. Research
collaboration between relevant sectors may take different forms and take place at
different levels, ranging from identification of research topics, joint implementation and
securing funding. Another form of collaboration is to call for joint public health and
animal health proposals for research.
September 2021
14
Strategic Framework
7.1- Encourage implementation of operational research by different academic

institutes to provide strategic information.
7.2- Support translation of research results into actions related to planning,

monitoring, and evaluation of elimination program activities.
September 2021
15
Strategic Framework
Tips for implementation:
1- Establish and enhance multi-sectoral approach for rabies elimination:
Egypt has a successful experience of multi-sectoral approach for management of

the avian influenza. The committees organized for this purpose are still working
and can be utilized by expansion of their activities to cover other zoonotic diseases
including rabies. This will need legislative modification of its responsibilities. Such
committees that directly related to Prime Minister have high authority and more
effective in ensuring commitment of governmental and nongovernmental sectors
with elimination activities of rabies.
2- Elimination of rabies among animals:
International experiences indicated mass vaccination as the most effective method

for elimination of rabies. In Egypt, the total number of stray dogs is expected to be
high and information about dog population is not available. Mass vaccination under
these circumstances may be difficult and of high cost. However, targeted risk-
based strategy for vaccination could regulate the cost problem.
A national campaign for controlling stray dog numbers in the first years of
implementation of the strategy is recommended. Stray dog control campaign will
use all available methods that conform to standards of the International
Organization of Animal Health and rules of animal welfare to reach the goal of
reducing stray dog number in the country. This activity should be in parallel with
communication activity for pets’ owners about keeping dogs and not abandoning
them on the streets and encourage NGOs for the establishment of holders for these
types of abandoned dogs.
This is followed by a need to perform studies about estimation of the size of stray
dogs’ population in different areas of Egypt with focus on high risk areas. These
studies will help accurately the estimation of needed doses of vaccines for mass
vaccination campaigns.
The implementation policy for mass vaccination should be subject to phases until
we cover all the country. Implementation of vaccination in risk areas for three
September 2021
16
Strategic Framework
successive year reaching 70% coverage then enforce regulation of pets owners
and movement control of dogs in these areas in addition to other activities of stray
dog control, will results in free area from the disease. Then we can move to other
areas using the same strategy.
It is recommended during implementation of mass vaccination to get use of all

types of available rabies vaccines with proved efficacy.
The vaccination process should be in collaboration with the Ministry of Environment

for availability of logistics.
Mass vaccination of animals requires well trained personnel to be effectively

implemented. Snow balling training may be effective where a group of personnel
are trained, and a small group of persons are attached with each trained person
who is responsible to train and supervise them. The attached groups once trained
are asked to train other small attached groups by each trained person. The circle
will be repeated and within short time, we can have large number of trained
persons. The option of including newly graduated veterinary students, NGO
members, volunteers in this training cycles to support activities related to
vaccination of stray dogs is to be considered.
Activities of rabies elimination among animals need high level of collaboration and
support among all ministries involved such as General Organization for Veterinary
Services (GOVS) at Ministry of Agriculture and Land Reclamation (MoALR),
Ministry of Environment, and Ministry of Local Development. This support and
collaboration is highly crucial for success of these activities.
3- Prevention of rabies in humans:
A study about the increasing number of animal bites is necessary. A risk map can
be done by epidemiological analysis of available data exported from both human
and animal surveillance data to identify risk factors and most suffering areas and
plan for reducing the number of accidents.
In-service training of health care worker regarding proper management of animal

bites and PEP is essential to update their knowledge and compensate the high
September 2021
17
Strategic Framework
turnover of trained personnel. Thus, keeping high quality standard of provided

service and avoid unnecessary use of medical supplies.
The cost of PEP is high especially for immunoglobulins. Ministry of health should
perform a study to estimate the unnecessary use of the costly immunoglobulins to
avoid it.
4- Strengthen surveillance systems:
MoHP has a national center for health informatics that could support technical
officers in creation of a digital system for animal bites surveillance. This will enable
timely analysis of reported data, which is essential to produce indicators of
performance for activities of rabies elimination. This system should have a link with
a similar system for rabies among animals. Timely sharing of information between
the two systems will help identify areas where rabid animals could be found to
direct the veterinary department to take necessary actions soonest possible.
MoHP is working on introducing lab testing for confirmation of clinical cases of

human rabies. On the other side, the AHRI is well equipped and internationally
recognized to perform such confirmatory test, and a similar quality assured
laboratory is available at Sadat University.
The surveillance system of incidents of rabies among animals conducted by GOVS

should be updated to use all needed methods beside event-based method. There
should be a mechanism of integration between GOVS surveillance among animals
and MoHP surveillance among humans. This will help the creation of SOPs for joint
actions of control of rabies, highly effective to accelerate rabies control and finally
elimination of human rabies.
5- Advocacy, communication, and social support:
Health education campaigns are necessary to ensure community participation in

the activities of rabies elimination. Health education department in MoHP and
Veterinary guidance and education department in GOVS/MoALR both have the
capacity to conduct such campaigns. They need to cooperate to design suitable
health education messages and information communication materials directed to
September 2021
18
Strategic Framework
different at risk population specially children and rural residents and disseminate it
by all available suitable methods.
Health education campaigns should have especial consideration of raising

awareness of school children on both rural and urban regions using direct
educations, extra-curricular activities, and science lessons. Educational material
about avoidance of animal bites and rabies can be added to students’ tablets
distributed by Ministry of Education to students used for educational purposes.
Social media have wide access to many clients and may be effective in
dissemination of health education messages. Efforts should be done to create
channels of communication of rabies educational materials through social media.
NGOs interest in animal welfare should be used in raising their awareness to

understand burden of problem of rabies among human and get their support to
elimination activities. They can also share in community education and elimination
of rabies among animals by vaccination and spreading the concept of responsible
pets’ ownership.
6- Mobilize needed resources:
Available and sustained resources is crucial for success of activities of hu man

rabies elimination. The cost benefit of these activities will be high.
Ministerial approval of the strategy should be obtained from all ministries sharing
in activities. Each ministry should identify the needed resources for implementation
of activities and ensure availability of needed resources in the ministry’s budget.
Lobbying assisted by members of Parliament should be used to get approval for

the needed resources of implementation and ensure sustained financial support.
This lobbying is also needed to revise and update laws related to responsible
animal ownership including responsibility of owners to vaccinate their animals and
protect the community form their attacks.
7- Promote operational research:
September 2021
19
Strategic Framework
Strategic information is needed for situation analysis, proper planning, monitoring

and evaluation of activities. The following studies are needed to provide such
information:
- Analysis of surveillance data of human rabies and animal bites to determine

disease burden and magnitude of the problem.
- Basic information about dog population and their ecology including also
number of domestic owned dogs, and awareness of dog owners about
responsible pets ownership.
- Knowledge attitude and practice studies for awareness about proper PEP
and awareness of sites providing the services
- Awareness and practices of health care workers at centers dealing with
management of animal bites on the guidelines of PEP for rabies.
- Post vaccination surveys among stray dogs and domestic owned dogs to
determine vaccination coverage.
- Assessment of the outcome and impact of rabies reduction activities. This
should include reduction in rabies incidence, use of PEP reduction and cost
effectiveness.
- Evaluation of animal and human rabies surveillance systems.
September 2021
20
Strategic Framework
Monitoring and evaluation
A monitoring and evaluation plan will assist in determining the organizational and
operational strengths and weaknesses. It will help in defining priorities and approaches
for improvement. Furthermore, a routine monitoring and follow up mechanisms should
be in place to regularly assess the overall level of performance, recognize
improvements and support future planning.
September 2021
21
Strategic Framework
Monitoring and evaluation
A monitoring and evaluation plan will assist in determining the organizational and
operational strengths and weaknesses. It will help in defining priorities and approaches
for improvement. Furthermore, a routine monitoring and follow up mechanisms should
be in place to regularly assess the overall level of performance, recognize
improvements and support future planning.
September 2021
22
Strategic Framework
Annex I: Monitoring and Evaluation Plan
1- Establish and enhance multi-sectoral approach of rabies elimination:
Activity Indicator Source of information
1.1- Finalize the formulation of One Health • Establishment of the committee with wide
(OH) ministerial supreme committee to MoHP
representation of all stakeholders
address zoonotic diseases, antimicrobial MoALR
• Number of meetings of the committee per year
resistance and other issues needing MoE
multisectorial approaches.
1.2- Institutionalization and operationalization • Establishment of the OH-TAG with wide

of the One Health Technical Advisory MoHP
representation of all stakeholders
Group (OH-TAG) as technical advisor for MoALR
• Number of meetings of the OH-TAG per year
zoonotic disease policy control including MoE
rabies.
1.3- Organize and activate sub-national • Establishment of the committee with wide
committee for elimination of zoonotic representation of all stakeholders MoHP and MoALR
• Number of meetings of the committee per year
1.4- Enhance coordination and collaboration • Number of occasions of discussion of rabies

for implementation of elimination elimination activities and health committee of the
activities at different administrative levels governorate MoHP and MoALR
in each governorate.
• Number of activities shared by different players
23 September 2021
Strategic Framework
2- Elimination of rabies in animals:
2.1- Control of dog population. • Total number of sterilized animals annually

MoALR
• Number of governorates/communities having
Local municipalities
estimation results of stray dog population
MoE
• Number of dogs related complaints by the
Academia
community
2.2- Apply mass vaccination programs using • Number of available vaccine doses annually
available effective animal vaccines.
• Coverage by vaccination for stray dogs MoALR
• Number of diagnosed rabid animals annually
2.3- Regular removal of solid garbage to • Reports by inspection indicating a decrease of Local municipalities
push dogs away from inhabited areas. number of areas used to suffer of solid waste
MoHP
accumulation.
MoALR
• Number of complaints by the community
related to uncontrolled garbage management. MoE
24 September 2021
Strategic Framework
2.4- Promotion of responsible pets’ • Number/Percentage of licensed animals per

ownership year MoALR
• Number/Percentage of domestic animals Local municipalities

vaccinated
2.5- Update and activate pet’s ownership • Number of occasions of discussion of laws in
National OH-TAG for
regulation laws national committee for prevention of zoonotic
control and prevention of
diseases and other authorities
zoonotic disease
• Incidents of update of laws
2.6- Providing shelters for stray dogs • Number of shelters MoALR
• Number of dogs/shelter Local municipalities
25 September 2021
Strategic Framework
3- Elimination of rabies in humans:
3.1- Ensure access to high quality and timely • Number of timely served patients with PEP
MoHP
services of PEP for rabies
• Number of cases of rabies
3.2- Availability of human rabies vaccines • Number of available doses of rabies vaccines /bitten
MoHP
and immunoglobulins. patients.
3.3- Capacity building with knowledge, and • Number of trained health care workers on PEP
MoHP
skill improvement of health care workers
• Level of knowledge, attitude, and practice about
on proper implementation of PEP. (KAP studies among
proper management of animal bites by health care
health care workers)
workers.
3.4- Supporting educational programs • Number of trained at risk workers of pre- and post-
MoHP
particularly for at risk population exposure prophylaxis.
regarding safe dealing with animals, pre- (KAP studies among
• Level of knowledge, attitude and practice of at risk
and post-exposure prophylaxis. at risk workers)
workers of pre- and post-exposure prophylaxis.
3.5- Offering rabies pre-exposure • Number of people from risk group receiving pre-
MoHP
prophylaxis for at risk population. exposure prophylaxis.
26 September 2021
Strategic Framework
4.1- Strengthen surveillance of human rabies • Transformation of the system to digital one
with regular evaluation of key indicators. MoHP
• Number of regular reports issued by the
system including key indicators
4.2- Strengthen surveillance of rabies in • Establishment of a system for routine

animals particularly dogs. surveillance of rabies in animals.
• Establishment of a mechanism for initiating
joint actions upon notifications from MoALR
stakeholders.
• Number of regular reports issued by the
system including key indicators
4.3- Establish a mechanism of integration • Existence of mechanism of information sharing

and information sharing between human MoHP
• Number of reports shared by two systems
and animal surveillance systems.
• Number of joint interventions based on MoALR
information sharing
4.4- Strengthen capacity of specimen • Number of reports issued/collected specimens

collection from the field and laboratory MoHP
• Number of annual specimens collected and
diagnosis of rabies in both humans and MoALR
tested compared to previous year
animals.
27 September 2021
Strategic Framework
5.1- Develop Rabies national risk • Development of an integrated plan with MoHP
communication plan. involvement of all stakeholders MoALR
• Endorsement and dissemination of the plan MoE
5.2- Implement community awareness and • Number of communication materials available MoHP
education campaigns on dealing with • Number of awareness sessions implemented MoALR
animals and prevention of animals’ bites MoE
• Level of community KAP about rabies
and human rabies.
Others
5.3- Enhance community participation in • Number of governmental parties sharing in the

rabies prevention especially non- activities of rabies elimination compared to
previous year National OH-TAG for
governmental national and international control and prevention of
organizations. • Number of national NGOs sharing in rabies zoonotic disease
elimination activities compared to previous
year
28 September 2021
Strategic Framework
6.1- Mobilize resources to support rabies • Number of different committed sectors to

elimination activities by different allocate specific fund for rabies elimination Council of Ministries
governmental partners. Information Center
• Sum of fund allocated for rabies elimination
activities by each sector
6.2- Encourage interested international and • Number of NGOs and international agencies
national non-governmental sharing in rabies elimination compared to
organizations to participate in previous year Council of Ministries
implementation of elimination activities. Information Center
• Fund spent by NGOs and international
agencies for rabies elimination activities
compared to previous year
29 September 2021
Strategic Framework
7.1- Encourage implementation of • Number of protocols submitted Council of Ministries

operational research by different Information Center
• Sum of fund spend for research
academic institutes to provide strategic
• Availability of reported research results
information.
Published or
communicated reports
7.2- Support translation of research results • Number of implemented projects

into actions related to planning,
Relevant Ministries
monitoring, and evaluation of elimination
program activities.
30 September 2021
Strategic Framework
Annex II: Proposed Budget
This proposed budget is an estimation for needed extra budget in Egyptian pounds, taking into consideration that currently working
activities are not included in this budget:
1- Establish and enhance multi-sectoral approach of rabies elimination:
Budget in million Egyptian pounds

Activity
2021 2022 2023 2024 2025 2026-2030
1.1-Organize and activate national

committee for elimination of zoonotic 0.5 0.5 0.5 0.5 0.5 2.5
1.2-Organize and activate sub-national

committees for elimination of zoonotic 0.1 0.1 0.1 0.1 0.1 0.5
1.3-Enhance coordination of
implementation of elimination activities at 0.5 0.5 0.5 0.5 0.5 2.5
administrative levels in each governorate.
Total extra needed fund = 11 million
31 September 2021
Strategic Framework
2- Elimination of rabies in animals:

Activity
2021 2022 2023 2024 2025 2026-2030
2.1-Control of dog population. 130 6 3 3 3 15
2.2-Apply mass vaccination programs 5 200 100 100 50 50
2.3-Regular removal of solid garbage to

CA CA CA CA CA CA
push dogs away from inhabited areas.
2.4-Promotion of responsible pets

-------- -------- ------- -------- ------- --------
ownership
2.5-Updae and activate pets ownership

-------- -------- ------- ------- -------- --------
regulation laws
2.6-Providing shelters for stray dogs 10 10 5 5 5 25
CA=currently available resources.
32 September 2021
Strategic Framework
3- Elimination of rabies in humans

Activity
2021 2022 2023 2024 2025 2026-2030
3.1-Ensure access to high quality and

timely services of PEP for rabies and
Establishment of Rabies Model Referral 9 9 9 3 3 15
Center at the main fever hospital in each
governorate
3.2-Availability of human rabies vaccines

CA CA CA CA CA CA
and immunoglobulins*.
2.3-Capacity building with knowledge, and

skill improvement of health care workers on 1.0 1.0 1.0 1.0 1.0 5
proper implementation of PEP.
3.4-Improve knowledge of pre and post

exposure prophylaxis skills of at risk 0.5 0.5 0.5 0.5 0.5 2.5
workers dealing with animals.
* This fund is expected to decrease gradually with implementation of strategy activities
CA=currently available fund.
33 September 2021
Strategic Framework

Activity
2021 2022 2023 2024 2025 2026-2030
4.1-Strengthen surveillance of human

rabies and animal bite incidents with
regular evaluation of key indicators. 3 3 0.5 0.5 0.5 2.5
Establishment of an electronic platform
for reporting of animal bite incidents.
4.2-Establishment of a system for

surveillance and response for animal 5 5 1 1 1 5
rabies.
4.3-Establish a mechanism of
cooperation and information sharing
1 0.5 0.5 0.5 0.5 2.5
between human and animal
surveillance systems.
4.4-Strengthen capacity of specimen

collection from the field and laboratory
1 0.5 0.5 0.5 0.5 0.5
diagnosis of rabies in humans and
animals.
34 September 2021
Strategic Framework

Activity
2021 2022 2023 2024 2025 2026-2030
5.1-Raise community awareness and

education on dealing with animals and
prevention of animals’ bites and rabies. 1.5 1.5 1.5 1.5 1.5 5
Development of health awareness
materials; posters, recorded
5.2-Enhance community engagement in

rabies prevention including all
1.5 1.5 1.5 1.5 1.5 5
stakeholders especially non-governmental
national and international organizations.
35 September 2021
Strategic Framework

Activity
2021 2022 2023 2024 2025 2026-2030
6.1-Mobilize resources to support rabies

elimination activities by different governmental -------- -------- -------- -------- -------- --------
partners.
6.2-Encourage interested international and

national non-governmental organizations to
-------- -------- -------- -------- -------- --------
participate in implementation of elimination
activities.
Total extra needed fund = 0.0 million
36 September 2021
Strategic Framework

Activity
2021 2022 2023 2024 2025 2026-2030
7.1-Encourage implementation of
operational research by different
5 3 3 2 2 5
academic institutes to provide
strategic information.
7.2-Support translation of research

results into actions related to planning,
-------- -------- -------- 2 2 10
monitoring, and evaluation of
elimination program activities.
37 September 2021
Strategic Framework
Annex III: References
1. Hemachuda T., Meslin F., Rupprecht C., Wiles H. “Rabies” In: Control of
Communicable Diseases Manual. Heymann DL editor. American Public Health
Association and World Health Organization, 19th edition, 2008.
2. Center for Disease Prevention and Control (CDC) “Rabies around the world”
available at: https://www.cdc.gov/rabies/location/world/index.html accessed on
14/10/2019
3. Taylor H., and Nel L “Global epidemiology of canine rabies: past, present and
future prospectives” Veterinary Medicine: Research and Reports 2015:6
361–371
4. Carrara P, Parola P, Brouqui P, Gautret P. Imported human rabies cases

worldwide, 1990–2012. PLoS Negl Trop Dis. 2013; 7(5):e2209.
5. World Health Organization “Rabies” available at: https://www.who.int/news-

room/fact-sheets/detail/rabies accessed on 14/10/2019
6. Ministry of Health & Population, Disease Prevention Sector “Statistics of

animal bite surveillance”
7. Coleman, P. G. and C. Dye (1996). “Immunization coverage required to prevent

outbreaks of dog rabies.” Vaccine 14(3): 185-186.
8. Fitzpatrick, M. C., K. Hampson, et al. (2012). “Potential for rabies control

through dog vaccination in wildlife-abundant communities of Tanzania.” PLoS
Negl Trop Dis 6(8): 21
9. Touihri L, Zaouial L, Elhili K, Dellagi K, Bahloul C. Evaluation of mass

vaccination campaign against rabies in dogs in Tunisia. Zoonosis and Public
Health 58:110-118, 2011
September 2021
38 38
Strategic Framework
Annex IV: List of contributors
Governmental Organizations or Institutions:

1. Ministry of Health and Population:
a. Central Administration of Preventive Affairs
§ Communicable Disease Control
§ Epidemiology and Surveillance
§ Infection Control department
b. Central Public Health Laboratory
c. Central Administration of Curative medicine
§ Hospital management department
§ Fever hospital management department
d. Central Administration of Community engagement and Health education
2. Ministry of Agriculture and Land Reclamation (MoALR):
a. General Organization of Veterinary Services (GOVS)
§ General Directorate for Public Health and Zoonotic Diseases
§ Department of Veterinary Extension
b. Animal Health Research Institute (AHRI).
3. Ministry of Environment (MoE)
4. Ministry of Education
5. Ministry of Local Development
6. Academia
International Organizations or Institutions:

1. World Health Organization (WHO) – Egypt country office
2. Food and Agriculture Organization (FAO) – Egypt country office
September 2021
39 39
39
Strategic Framework
40

Wa0020.

Uploaded by

Copyright:

Available Formats

Wa0020.

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Wa0020.

Uploaded by

Copyright:

Available Formats

1

Abbreviations and Acronyms

Animal Health Research Institute AHRI

Food and Agriculture Organization FAO

General organization of veterinary services GOVS

Ministry of agriculture and land reclamation MoALR

Ministry of Environment MoE

Ministry of Health and Population MoHP

Neglected Tropical Diseases NTDs

One Health – Technical Working Group OH-TWG

Post-exposure prophylaxis PEP

Rabies Post-Exposure Prophylaxis RPEP

Standard Operating Procedures SOPs

Veterinary Serum and Vaccine Research Institute VSVRI

World Health Organization WHO

We highly appreciate support offered by Dr Alaa Eid, Under Secretary of Preventive

We wish to acknowledge both Dr AbdelHakim Mahmoud Ali, Chairman of General

Rabies is a zoonotic disease, which can be transmitted to humans by animal bites or

Rabies is 100% preventable by vaccinating people. Annually, approximately 29 million

Although being 100% fatal, it is 100% preventable if rabies post-exposure prophylaxis

Global burden of rabies

Inadequacy of rabies surveillance and sometimes its absence in areas of endemicity

Fortunately, rabies is 100% preventable by vaccinating people; however, an annual

National situation of rabies

Figure (1): Reported clinical cases of human rabies in Egypt (2015-2019)

Figure (2): Reported cases of animal bites in Egypt (2015-2019)

Rationale of the strategy

Nowadays, Egypt is heading to achieve the Global Initiative to Eliminate Rabies by

Egypt free from human rabies.

Eliminate dog mediated human rabies in Egypt by 2030.

1. Reduce incidence of the disease in Human

2. Mitigating the risk of transmission of the disease from animal to Human

3. Control of dog rabies by all available means in accordance with principles of

5. Mobilize resources needed for implementation of human rabies strategy in

2. The international interest of elimination of the disease by 2030 guarantee

4. Collaborative multi-sectoral approach, which is essential for elimination of

Strategies for rabies elimination

This national strategic framework consists of seven pillars in which it is expected to

1. Establish and enhance multi-sectoral approach for rabies elimination:

Activities in this domain will include:

1.2- Institutionalization and operationalization of the One Health Technical Advisory

1.3- Organize and activate sub-national committee for elimination of zoonotic

1.4- Enhance coordination and collaboration for implementation of elimination

2. Elimination of rabies among animals:

Recognition of dog-mediated rabies as a public health problem allowed establishment

Standard Operating Procedures (SOPs) for dog vaccination program should be

Activities in this domain will include:

a. Management of dog population

2.3- Update and activate pet ownership laws

2.4- Promotion of responsible pet ownership

b. Mass vaccination of dogs

3. Prevention of rabies in humans:

Activities in this domain will include:

3.2- Availability of human rabies vaccines and immunoglobulins.

3.4- Supporting educational programs particularly for at risk population regarding

4. Strengthen surveillance systems:

Surveillance is a fundamental part of preventive programs. It provides strategic

GOVS/MoALR has an administrative structure for zoonotic diseases control in the