As in so many areas where canine rabies is enzootic, a national system of diagnostic evaluation and reporting is required, together with surveillance

initiatives to measure the true impact of the disease (Dodet et al., 2008 and Ly et al., 2009). Many island nations have succeeded in eliminating learn more rabies, but some still struggle with the disease. This is most evident where deficiencies in the veterinary sector preclude coordinated control and prevention efforts. One such area is the Philippines, where rabies remains a threat to the human population (Estrada et al., 2001). A recent retrospective study in Manila highlighted the difficulty of assessing suspected rabies patients in a resource-limited setting, and concluded that the true disease burden may be 10-50% higher than reported (Dimaano et al., 2011). Together with Tanzania and Kwa-Zulu Natal in South Africa, the Philippines has been targeted for new initiatives by the Global Alliance for Rabies Control and the Bill and Melinda Gates Foundation, which Carfilzomib research buy aim to demonstrate the feasibility of eliminating canine rabies in a resource-limited setting (Anonymous, 2008, Alliance for Rabies Control, 2012, WHO, 2010 and WHO, 2013). Although networks of rabies experts exist in Asia, their resources are limited; input

from regional and national public health authorities will be required to increase their impact. The Asian Rabies Expert Bureau (AREB), founded in 2004, is an informal network of experts from 12 countries, which aims to eliminate human rabies deaths from Asia. Using the goals of the AREB as a framework, and with guidance from the WHO, several Asian countries have resolved to eliminate human rabies by 2020. Achieving this goal will require raising awareness, educating the public and new reporting and surveillance initiatives. To support country-based initiatives aimed at increased rabies awareness, the AREB recently surveyed some 4000 animal bite victims from eight countries, and found that the situation of such patients could be markedly improved through

education on appropriate wound care and timely consultation with a rabies prevention center (Dodet et al., 2008) However, the nearest primary health centre is often prohibitively distant, and its medical staff are unlikely to have Cobimetinib clinical trial access to a diagnostic laboratory or be able to provide PEP. Additional resources are clearly required (Estrada et al., 2001 and Matibag et al., 2009). A similar network, the Middle East and Eastern Europe Rabies Expert Bureau (MEEREB) network that was established in 2010, has improved regional collaboration (Aylan et al., 2011). Surveillance and reporting of rabies in the Middle East is variable, with many Middle East countries collating and reporting human rabies cases, but few reporting animal rabies (Aylan et al., 2011 and Seimenis, 2008).