Am. J. Trop. Med. Hyg., 89(6), 2013, pp. 1040–1042 doi:10.4269/ajtmh.13-0229 Copyright © 2013 by The American Society of Tropical Medicine and Hygiene Perspective Piece Gains and Future Road Map for the Elimination of Dog-Transmitted Rabies in the Americas Alfonso Clavijo,* Victor Javier Del Rio Vilas, Friederike Luise Mayen, Zaida Estela Yadon, Albino Jose Beloto, Marco Antonio Natal Vigilato, Maria Cristina Schneider, and Ottorino Cosivi Pan American Health Organization, Veterinary Public Health Unit, Health Surveillance and Disease Prevention and Control, Rio de Janeiro, Brazil; Pan American Health Organization, Communicable Diseases, Health Surveillance and Disease Prevention and Control, Washington, DC; Veterinary Public Health Consultant, Rio de Janeiro, Brazil; Pan American Health Organization, Peru Country Office, Lima, Peru; Pan American Health Organization, International Health Regulations-Alert and Response and Epidemic Diseases, Health Surveillance and Disease Prevention and Control, Washington, DC In 1983 the countries of the Americas, with the technical cooperation of the Pan American Health Organization (PAHO), pledged to eliminate human rabies transmitted by dogs. 1 Since then, countries have made great efforts to elimi- nate this disease, with notable success, within the framework of the Regional Program of Elimination of Human Rabies. The success achieved during the last 30 years and the historical solidarity between countries in the region support the goal of elimination of dog-transmitted rabies in the American conti- nent by 2015. As this date approaches, there is a need to reflect and reassess the current plan of rabies elimination. This work briefly describes the achievements of the Regional Program and the proposed new Regional Action Plan for the elimination of dog-transmitted rabies. The technical support for the Regional Program for Elimina- tion of Human Rabies is founded on the resolutions of the Meet- ing of Directors of the National Rabies Control Program in the Americas (Reunio ´ n de Directores de los Programas Nacionales de Control de Rabia en Ame ´ rica Latina-REDIPRA). Approxi- mately every 2 years, PAHO convenes the REDIPRA, during which the countries present and discuss the epidemiological situ- ation with regard to rabies and strategies for prevention. The conclusions and recommendations of the REDIPRA are submit- ted for consideration and approval by the Ministers of Health and Agriculture of PAHO member states during the Inter- American Meeting at the Ministerial Level of Health and Agri- culture (Reunio ´ n Interamericana a Nivel Ministerial en Salud y Agricultura-RIMSA). Inter-sectorial policies relating to the rabies elimination program are discussed within the RIMSA to be submitted later to the PAHO Directive Council. There have been strong political mandates and international commitments for the elimination of human rabies transmitted by dogs in the Americas since 1983. 2 In 2009, the PAHO Directive Council, by resolution CD 49.R19, 3 called the coun- tries of the Americas to commit to the elimination or reduction of neglected diseases and other poverty-related diseases includ- ing the elimination of dog-transmitted rabies by 2015. 4 Since the implementation of the Regional Program, the number of human cases has decreased by ~95% (from 355 cases in 1982 to 10 cases in 2012). 5 In dogs, the reduction has been of 98% (from 25,000 cases in 1980 to fewer than 400 in 2010). 5 Much of this success has been a result of the application of dog vaccine and the strong cooperation between health and agri- culture sectors of member countries, and the collaboration of regional agencies, international, public, private, and non- governmental organizations. 6 The Regional Rabies Program has been considered since its inception as an intersectoral ini- tiative within the framework of One Health, where epidemio- logical surveillance includes cases in humans, domestic animals, animals of economic interest, and wildlife. Today, most parts of the Americas have already eliminated the circulation of rabies virus in canine populations. 7,8 Cases of human rabies transmitted by dogs in the region are circumscribed to a small number of well-defined areas 9 (Figure 1). Of the 570 first administrative level sub-units (province, state, or depart- ment) in Latin America, only 11 units (2%) reported cases of human rabies transmitted by dogs in the last 4 years. These cases are concentrated in areas of the periphery of big cities, neglected communities, or international border areas where the popula- tion has little information about the risks of the disease, limited access to quality health services and poor living standards or working conditions. These areas are also characterized by having a high proportion of unvaccinated dogs 10 and of limited availability or accessibility to immunobiological products for pre- or post-exposure prophylaxis. 11,12 The elimination of these pockets of disease depends on the local implementation of proven control plans, widespread participation of the population, and the technical cooperation between countries. As commonly seen in control efforts for other diseases, the reduction of the number of cases of human rabies transmitted by dogs has led to a parallel decline in the attention given to the disease by institutions and health departments. Even for endemic areas within countries, the competitive allocation of scarce funds to other priorities at the national level can result in the allocation of fewer resources for the fight against rabies at lower administrative levels. As a result, institutional memory and awareness among the population might be lost. PAHO has prioritized technical cooperation for the imple- mentation of the Regional Program on four pillars of action: attention to populations at risk, canine rabies vaccination, sur- veillance, and training and communication. Care for people at risk of infection is based on ensuring universal access to pre- and post-exposure prophylaxis and decentralization of health care to secure access. The effective distribution of post-exposure pro- phylaxis to all people exposed to rabies is a logistical challenge, especially given the marginalization of populations currently affected. Canine rabies vaccination has been used successfully as a cost effective approach with over 40 million dogs vaccinated every year in the Americas. However, enzootic areas fail to * Address correspondence to Alfonso Clavijo, Pan American Health Organization. Av. Governador Leonel de Moura Brizola, 7778, CEP: 25040-004- Duque de Caxias, RJ, Brazil. E-mail: aclavijo@paho.org 1040