Rabies control and prevention in Georgia: current status and perspectives.

The incidence of rabies post-exposure prophylaxis (PEP) is very high in Georgia, at 876/100,000 persons in 2006. Data from the National Centre for Disease Control on rabies surveillance for 2004, 2005 and 2006 was analysed, with the objective of improving postexposure policy and practice, as well as identifying priorities for national surveillance and control. For the base period 1986-1995, a total of 40 rabies cases in humans were reported in Georgia. In 2004, 2005 and 2006 there were 12, 10 and 7 reported cases, respectively, representing a significant increase in overall incidence for this period. Ninety-three percent (93%) of cases were caused by dog bites. The large population of stray dogs and unvaccinated pets in Georgia is recognized as the main risk factor. In 2006, 38,569 patients received PEP following bites by an animal with suspected rabies, compared to 23,712 in 2004, and 30,254 in 2005 (representing a 1/3 increase annually). Of the total number of PEP treatments initiated in 2004, 16,568(69.9%) were discontinued due to the fact that the biting animal remained healthy during the observation period; 23,106 (76.4%) were discontinued in 2005; and 30,254 (78.4%) were discontinued in 2006. Concerns regarding the safety of available immunoglobulins, uncertainty regarding the use of vaccines and immunoglobulins from different manufacturers, and the inconsistency of national guidelines with international recommendations are cited as obstacles to an improved delivery of PEP. For the effective control of rabies, the national veterinary programmes need to be improved, stray dog population control measures need to be updated according to international standards, and clear national guidelines regarding the use of rabies vaccines and immunoglobulins for PEP should be developed and implemented.