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Reemergence of Rabies, Bhutan, 2008 | CDC EID
EID Journal Home > Volume 16, Number 12–December 2010
Volume 16, Number 12–December 2010
Reemergence of Rabies in Chhukha District, Bhutan, 2008
Tenzin, Basant Sharma, Navneet K. Dhand, Nilkanta Timsina, and Michael P. Ward1 Comments to Author
Author affiliations: The University of Sydney, Camden, New South Wales, Australia (Tenzin, N.K. Dhand, M.P. Ward); Regional Livestock Development Centre, Gelephu, Bhutan (Tenzin); and Regional Livestock Development Centre, Tshimasham, Bhutan (B. Sharma, N. Timsina)
Suggested citation for this article
From January through July 2008, rabies reemerged in the Chhukha district of southwestern Bhutan. To clarify the distribution and direction of spread of this outbreak, we mapped reported cases and conducted directional tests (mean center and standard deviational ellipse). The outbreak resulted in the death of 97 animals (42 cattle, 52 dogs, and 3 horses). Antirabies vaccine was given free of charge to ≈674 persons suspected to have been exposed. The outbreak spread south to north and appeared to follow road networks, towns, and areas of high human density associated with a large, free-roaming, dog population. The outbreak was controlled by culling free-roaming dogs. To prevent spread into the interior of Bhutan, a well-coordinated national rabies control program should be implemented in disease-endemic areas.
Rabies is a fatal zoonosis caused by rabies virus or rabies-related viruses (genus Lyssavirus) and transmitted by the bite of a rabid animal (1). Domestic dogs are the main (>95%) source of human rabies infection. An estimated 55,000 persons die of rabies in Asia and Africa each year (2), >20,000 in India alone (3).
In Bhutan, rabies is endemic to the southern districts that border India (4,5). Domestic dogs are the main reservoir and are responsible for spillover infection of other domestic animals, especially cattle. Sporadic human deaths have also been reported in south-central and southwestern rabies-endemic areas of Bhutan (6,7).
On January 23, 2008, a clinical case of rabies in a cow in Dala, a subdistrict of the Chhukha district, was reported and later confirmed by fluorescent antibody test (8,9). The cow had reportedly been bitten ≈3 weeks earlier by a stray dog with suspected rabies. On the same day, another case was reported (and later confirmed by fluorescent antibody test) in a stray dog in the town of Tshimalakha, Bjachho subdistrict. A retrospective epidemiologic field investigation found that an unreported rabies outbreak in dogs had occurred in the southern villages of Dala subdistrict during November and December 2007.
We report a rabies outbreak in the 3 subdistricts of Chhukha district, Bhutan: Dala, Bongo, and Bjachho (Figure 1). To help develop future control programs, our objectives were to 1) describe the spatio–temporal patterns of the outbreak, 2) generate hypotheses about rabies introduction and spread, 3) assess the relationship between animal rabies and public health, and 4) estimate the cost of the outbreak.
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