Hello, I'm going to present a webinar on a topic that you might not be completely familiar. I hope at the end of this webinar, you understand better all these risks in the Amazon. So I want to present some new paradigms in prevention and control of sylvatic rabies or equilibrium paraba rabies and emerging risk in this part of the world in South America.
First of all, I need to mention about rabies. Rabies is a very well-known disease, actually one of the oldest known diseases. It's more than 5000 years we have reference of rabies.
They are all books that have description of bites from dogs and their relationship with rabies and deaths. So, rabies is caused by alisa virus like. Are a family of about 16 species of viruses.
Almost, almost all of them were found in bats, not all of them. So it's predominantly bat, reservoir, many of these lysairuses. All of these lysa viruses can produce disease like rabies.
So if you are in a part of the world that have rabies and you don't have the whole differentiation, maybe you can miss this disease. A different lysa virus. So this is a concern because not all the lisa viruses are covered by the modern rabies vaccines as we know.
The, rabies virus, which is considered, the rabies virus or Lisa one, is the most universal distribution in the. So dogs, bats, other wildlife could be reservoir of these lisa viruses and can transmit rabies when they bite people. So in the 21st century, this very old disease, it is still a problem all over the world, especially in Asia, Africa, we estimate 60,000 people die every year because the rabies.
We have vaccines, I have a picture here of pasture vaccinating, against rabies. It's a very well-known change game for rabies, so we can save people vaccinate. Well, not everybody has access to this vaccine.
That's why it's, it's still people dying from rabies. Well, this is the virus of, rabies virus, very well known virus is. Completely described, we know everything about this, this virus.
It's important to mention that in research and vaccine development is used as a vector, and some of the antigens can be put into this virus that could be used as transporter to the central nervous system, experimental models. So this is one of the very well-known viruses. This is a map that show you also in this violet or purple colour.
Where the rabies viruses in the Americas, and you can see only in the Americas, you have one of the lyses and all the lyses in other parts of the world. The good thing is that the vaccine will not cover very well, a rabies virus. Reminder how rabies infects people.
This is a virus that lives only in nervous tissue. So to produce the rabies disease, the virus needs to reach the central nervous system and how they do it through a bite, reach the neuromuscular, plate, and from there goes through the neurons to the central nervous system. And when it's there.
They start to replicate, replicate and came back through the cranial nerves to all the organs and to the skin and you actually have encephalitis and also the salivary glands produce a secretion of rabies virus. So this is the way the infection happens. It's important to remember there is something called incubation periods.
It means that after a bite or exposure, you don't get the disease the next day. It can take as short as 1 week, on average 45 days or even a few months before any manifestation of the rabies disease is onset. When this started, we have almost nothing to do other than give some care because it's 100% fatal.
So we need to prevent this disease. It's very important. It's still a problem, and now we need to think what's going on in the Amazon.
So I want to show some information from you, just to mention that a vampire but rabies is a rabies transmitted by the bites of a bat. That happen to feed on blood. This species of vampire bats only live in Latin America.
They do not live in US, Canada, or Europe, Asia or Africa. It's only a Latin American situation. Peru is one of the most affected countries for vampire bat rabies in humans.
Of course, there is circulation all the country will have some vampire bat population in the Amazon. well, just forgot to say that it's from Mexico to the north of Argentina where the virus and the bat is present. There are 3 species of vampire bats.
I have a picture of 3 of them here. The most important is the small rotundo. In this map, you can see the grey squares is the places where the small rotundos in Peru has been documented.
You see this red triangle, this is another species the Philaecho data, which is also linked to vamparava rabies, but mostly in cattle and another more, the Ademos yoni, the MH jogi, which is also implying rabies circulation, but it's told or believed that only feed on chicken, which recently demonstrated that also could feed on people. So, but the small rotundo is by far the most important because it's widely distributed in the whole country or the Amazon. You have a small map here with different colours.
It shows some geographical features of the territory in Peru. The yellow part is the coast, the brown is the Andean mountains, and the green is the Amazon part. So the Andean Mountains actually act as a wall, as a barrier for the circulation of the rabies virus because you see there is all .
The all the country is covered by population of the small rotundos, but so far it's not documented rabies in the vampire bats in the coast. While there are a lot in the Amazon area and part of the, which means this geographical barrier, it's very important to contain so far the circulation of the rabies virus among this vampire bat population. This is a Curve of human cases of rabies, but it's divided by rabies in dogs, rabies in humans, and Cases in humans transmitted by bats and cases transmitted by dogs in red.
You can see through the time since the 80s until now, rabies transmitted by dogs. It's in the decrease almost to control. But in the 70s, but here in the cubes in the 90s, documentation of vampire bat rabies transmitted to people, it's very frequent since that and increasing so far.
So this is a situation that it's a transition where the canine rabies in humans is more controlled rabies from wildlife, it's affecting more people. And the same curve here, but yes specific for Peru. The cure before was for the Americas and now this is for Peru, and you can see how Canon rabies in the red line is going down and until 2014 it's in this graphic.
The vampire but rabies reports are very frequent and not decreasing much. This is a bad bad. Feeding on cattle this, see the bull or this is a small wounds, and I will spend a few seconds to explain this is not an attack.
The vampire bats actually wait for the prey to sleep or to be quiet, completely sleeping in deep sleep, and then they start to leak the area that going to be beaten. And what the purpose of that is to desensitise the area. So when they bite, because this is a superficial bite, the individual doesn't feel it, and that's how it happens.
The animal or the person is bitten and start bleeding and they don't feel it and the vampire starts to leak. Whatever you heard also in the movies that these vampires actually suck blood, it's not true. They actually leak blood.
And they live for a few minutes that can be 15 to 20 minutes until they are full. When they are full, they cannot fly as great as they did before, so they look for places close by to rest until they can fly, OK, again. So just think about it.
This is the most important contact or intimate contact between people or animals to other predator animals. For 15 minutes. Imagine an open wound in an individual and you've been licked.
For bad for 1520 minutes. So this is something important that many people don't understand. This is not an open deep wound.
It's a superficial wound that's still bleeding and but you are in contact with the animal or whatever ectoparasites the, the vampire might have can actually be foreign to you. This is a map showing more or less because there is a lot more than this information, some kind of Occasional host. It, it means that the reservoir bites another.
Animal transmits rabies and this intermediate host country by people. When you are permanent host, I mean like here in the red circles, bats, dogs, and in Brazil, this monkeys a wing monkey, reservoirs, then, you can transmit directly to any mammal. So rabies is a disease that can affect any mammal, but not necessarily the animal ben became a reservoir.
You see there are a lot of reports from cats, even donkeys, monkeys, and cattle that might infect people, but they are not reservoir. They are just intermediate hosts bitten by some reservoir. So vampire bats are important.
They can bite any animal and through those animals can actually bite people. Some pictures about vampire advice in children. So you can fix in your mind what actually happened and remember this population is beating.
Almost every day, a vampire bat needs to feed every 1 or 2 days max. If they don't feed, they dehydrate and die. So survival instinct force them to look for prey to feed.
So something that you need to remember, it's documented that vampire bat bites go back to the same victim. Again and again and again until it's not available. For example, if this child gets rabies and die and goes back and don't find it, they look for somewhere else, somebody else, some other prey to get the blood.
If there is a cattle, cattle can actually feed a lot of vampire bats. The cattle die from rabies, those animals need to survive and they look for another source of blood. And usually they find the population, human population exposed skin from any individual can be open for them to feed.
And this is showing where is the most frequent bias is in the head, in the nose, and the fingers. And it's not here but in adults it's also in the elbow. And, and they remember this is rural areas.
Many people might notice the bits of children and many adults might think the bleeding they have might be due to any accident while working or being in the Amazon rainforest or something like that. So these bites are usually ignored. They don't seek attention.
Not always the vampire bat, is infected with rabies, so they don't see disease in, in years, and suddenly those vampire bat colonies are infected and start to transmit rabies and 12 months later, as I will explain in a minute. Rabies starts. So, Normally, these populations do not connect the risk of being bitten by a vampire bat with rabies or with any other.
So that's important. So they forget about it, they ignore it, they think it's something that happened and they don't seek any attention, any medical attention. Well, Peru has this kind of outbreak, and this is something important to say that when you see reports of dog rabies, it's usually one or a few cases.
When you hear about vampire bat rabies in humans, it's usually a cluster of cases of 10 to 20 cases, mostly children. Mostly females for any reason, it's not fully understood and most of the population here are indigenous populations that are the most affected of these clusters of deaths due to vampire but rabies. This is very important to remember in 1975, there are emergency here in the north of Peru in this province called Condorang.
It was the epicentre of vampire rabies for many years. Some factors that influence when part about rabies as you can expect low education, languages, many ethnicities living in those areas have different languages and it's complicated for the healthcare personnel to communicate sometimes without translators. A geographical access.
To vaccines, no healthcare services anywhere in miles or days navigating around these towns are made so difficult for them to look for any medical attention or vaccine. Housing, the style of housing is open. It's a very humid and heat.
A heated areas. So you see mostly open houses with open walls of with rural materials that allow the entry of bats and these houses are mostly platforms over the, the land. Why?
Because most of the rainforest in the Amazon is flooded half of the year. That's probably not many population knows about this. But they need to have some of this plat platform in some elevation when the floods came so they can actually preserve the, the activity they have in the area.
This is a picture of a real patient. This patient tried to use some protection for bite. I mean, this was a 15 year old boy that died from babies in, in the Peruvian Amazon.
And I got these pictures just to show in this elevated house, the opening in the floor a low entry of bits and more of that. They tried to prevent the bite with Malaria nets. I mean these mosquito nets used for malaria, but these are broken, not replaced for years.
These are poor populations. They have difficult access. It's difficult for them to replace this and it's difficult for healthcare person to go often to try to advise or to fix this situation.
So this person has access for from everywhere you see even. The wall and the ceiling have some spaces so vampire bats can very efficiently use any space to get into those spaces. This is a diagram of what happened with the vampire bat rabies outbreak.
It's in Spanish, so we'll try to translate. Number one says this vampire colony is susceptible, so it's, it's biting people, biting animals, but it's not infected with rabies. In another step, it gets infected with rabies in the step number 3.
This infection produced disease in the bats, in the colony of bats. Some of them became infectious, some of them died, and very small part of the population don't get infected or survive the infection and became in the number 4, you see less population, but these survivors are immune to rapes. So what happened when this vampire bat rabies happening in the colony of bats, they start to bite and they cannot actually transmit disease to any wildlife and any cattle, you see the the letter A, it can produce a rabies outbreak among cattle in the area and also humans.
And the bee means can produce human outbreak. The usual response from the existing either the Ministry of Agriculture or Ministry of Health is just to arrive when something called vampiricide. This vampiricide is applied to the in the back of a vampire because these vampires going in living colonies, they groom each other.
They can actually disseminate. The component of this ointment which is anticoagulant and produce haemorrhage and supposedly they led the population of this colony of bats and prevent rabies, but it is not true. It just arrived too late.
Reember were in step number 3 or 4 when you have seen the drama, diagram below 1 month at least passed from the rabies infection in bats. To start a cattle outbreak of rabies and probably 1 or 2 months already happened or passed. When this vampire bat rabies was active in the colony already died and when the government response arrived, they tried to eliminate the animals, but the animals that eliminated the bats.
Are already survivors are immune. They are not a problem for rabies anymore, but they delete it. They, they kill it and unfortunately that means that some natural barrier that those vampires will never rabies in the future, but when they kill it, you open the page for new susceptible vampires because there is some biological rules to occupy that open niche when they.
They're dead. Well, in humans, as I said, when a human outbreak of a bat babies happen, already 1 or 2 months passed after the bats were infected. So, to make things more horrible.
This is the only outbreak that somebody has to die for the healthcare system to recognise there is an outbreak. Before they are dead, we can also use the, the cutters of a sentinel, information and surveillance to go and intervene and protect this population, but it's actually not happening and Somalias do not have enough cattle to act as a sentinel. So usually the response of the government in any country right 5 days, 1 week, 10 days after the outbreak starts, and that's why we have reports of 10 to 20 people dead in each cluster of these outbreaks.
This is some pictures and some explanation where this vampirs came from. It was invented in the 70s. The logic was to eliminate vampires 50 years later.
Rabies is still there, vampires are still there. It was not intact to reduce vampire, but rabies, there is even a hypothesis published already. That this elimination of the vampire that rabies, this bad survivors eliminating the natural barrier may actually facilitate the perpetuation of and dissemination of vampire, the rabies among the vampire population.
So, this is an intervention that unfortunately has no significant impact in stopping human outbreaks in the. Another song, a very important thing to comment is this paparaba rabies can be also driven by changes, changes in the environment, in the habitat. In 2011 was this outbreak and you can see here in the yellow circle.
It is a place that have cattle and usually a lot of vampire but but it's to cattle, but the development arrived and government was installing electricity. So from not having electricity from one day to the next, they did have electricity and electric light in the externals. One part but but needs time to adapt.
And sudden changes forced them to change feeding habits. So having electricity and life from 6 p.m.
To midnight, they were not allowed to buy and feed as usual because they need complete darkness to start their their activities. So they look for an alternative place and then attack or by a lot of people or especially kids in this place called Yuppiusa that happened to be 5 kilometres away a straight line. You try to reach one town to the next, this, this town, it takes about 1.5 to 2 hours.
I went to there by, by foot, by car, and then by boat, and then you have to go buy food again and the whole journey made you think it's quite far, far away, but In a straight fly, these bats can reach it very fast, 5 kilometres away. They can actually fly up to 10 kilometres every night to look for food. So what's happening is you should have 1 kid dead and you have 19 kids die due to this outbreak.
This is interesting situation because when these changes of habitat due to development in rural areas are going to happen, intersectorial communication will help to Ministry of Health to prevent any risk for people. And normally this doesn't happen and the energy ministry have their own activities, transportation ministers have their own activities, and so on. What?
So this vampire bat rabies outbreak in human affecting most indigenous people, mostly kids and being a social injustice that somebody has to die, so the system has to react and react like forced to, . Try to crystallise an idea is the, the idea to prevent rabies before, I mean, giving vaccines to people before. This is something that has not been recommended, it has been suggested that would be an idea to protect people, but no country actually Install a programme like that to vaccinate everybody in our population so they even they get beaten, don't get raped.
So to support this idea, we went to Peru and did this study and try to document bites and we picked a place 50 kilometres away. From the epicentre of this outbreaks, as I said, Korani, that I mentioned was important to remember. Now we went to a place where no vampire but rabies reported in human or cattle.
We are 50 kilometres away. It was in the deep of the Amazon area, the rainforests, all this isolation that already explained, and we went to survey people and find out. What are the realities of bits and rabies, risks and what they know about.
And we found something really very important. Before this study, were some reports of population beating 50% of the population beaten by vampires, but we found the highest ever reported, which is 88% of the whole population of the towns we visit were beaten. And all the homes, all the houses had somebody beaten in recent months.
From that, we have a very astonishing discovery is that some people, I mean, 11% of the people we got a cell sample. Had antibodies against rabies. How could that be possible if these people have been, have been never vaccinated or had the disease?
This was a reason of a lot of attention or media attention because nobody ever documented in the population, antibodies against rabies without vaccinate. So the conclusion of this was these people was so exposed along the the life many times with a small inocul of, of rabies virus, so they developed some antibodies. When we tested those antibodies were non-neutralizing antibodies which, which means they were not really protective against rabies but they documented they were the evidence.
That nobody could doubt anymore that these people are exposed at a high risk to having some vampire, vampire bad rabies outbreak. So with all this evidence and other interesting circumstances, the government of Peru decided to start a massive for of Prophylaxis, a pre-exposed prophylaxis, which means administering the vaccine to everybody living in what we call the high-risk areas. This was possible also because the government stopped using the vaccine development nervous tissue so you can see here a big X of not doing it, which is the former use of vaccines.
Around the neighbour with subcutaneous tissue with some vaccines preparing nervous tissue. WHO, the World Health organisation does not recommend those vaccines repairing nervous tissue because they produce severe adverse reactions, neurological reaction. So it's not possible having large massive campaigns with these vaccines.
But with the other vaccines, the modern vaccine which cultural cell vaccine or embryonated vaccine which chicken is egg embryo cells or the barro cell vaccine, it is possible to have this massive, massive vaccination campaign. So Peru start to change from the old vaccine to the modern circles of vaccines. It was able to prepare.
Massive vaccination or massive pre-exposed prophylaxis for the people living in the high risk areas for the Amazon. You can see in this small map the areas where they started the 1st 3 years and some of the numbers showing what happened with the vaccinations. A couple of pictures, the vaccine use and some ideas and this may deserve a mention.
Many countries in these remote areas, and the more rural areas, they live undocumented, which means they are citizens, but they don't feel the use to have the proper registration in the civil registration citizen system because there is nothing that might get from that because they live far, far away. Some changes happening in Peru and other countries. Peru start to have some kind of Special some money for extremely poor people and the condition is that you need to show your identity and actually change and give the opportunity to have the correct identity.
Just stop for a second and think how did they register people vaccinated before, as the name sounded as they wrote in the registration, who was vaccinated. All, all our indigenous people with ethnic languages there that might sound one way to one healthcare worker and different to the next healthcare worker. So a kid vaccinated started to be registered with several different names that looked like they were different people.
Right now, this is not possible anymore. Everybody have a a personal ID even children have that everywhere in the country. So it was possible for this product to be successful to identify who actually was vaccinated and who wasn't.
And this is quite important for the next explanation what happened. They vaccinated the first area. Of course, they have to start with the epicentre in Condor County.
The three districts that compound that province were targeted and you see in 2010, they did have cases. In 2011, they, they have the vaccination, but in 2010, in the red circle, you see two people dead. What happened if they were vaccinated?
What happened is these two people dead were Two adults, remember, mostly a fat kid. I will explain that now. But these two adults declined to be vaccinated and they signed, this declining in front of some authorities, and this is so unfortunate that next year they were actually with rabies and died.
What means that? This is a powerful evidence of the impact of this massive pre-exposure prophylaxis, it means that people vaccinated were likely bitten by bats, and those bats were obviously still transmitting rabies or rabies was circulating in those vampire bat populations. So these two unfortunate individuals.
Were beaten by bats with rabies. While other people beaten, vaccinated, didn't get the disease. These 2 individuals did it and died.
And this is terrible. However, became another evidence of how. Was the impact of this, campaign and government continue this campaign and you can see how the scheduling and the coverage were obtained in 2018 and how they expanded the areas of vaccination to more and more.
It's so difficult to work in those areas. Remember, it's quite, quite far. The new paradigm of vaccinate everybody for assisting was ex is prepared for vaccinate only people be.
That's the paradigm that changed. In the past, only people be and report to the healthcare assistants and get the vaccine. So if they don't report, they don't get the vaccine, of course, here in this new paradigm, it's not only people beating.
Everybody gets the vaccine because we assume they will be beating at some point and the healthcare system will not be any clause to help them with vaccine at any moment after that might happen. So what's better to do it before and the impact was also documented in this graphic. You can see in the straight line, a solid line, the Amazonas where condo condo is, the area vaccinated, how the rabies cases in humans stop in 2012 is 0, 2012, there were two people already mentioned and you see the peak before.
What we see with the dotted line, you see the cases in other parts of the country that were still not vaccinated, still producing human cases of rabies due to vampire backpack. So this is another evidence that this campaign should continue until they call the whole populations living in the Amazon. WHO took this experience and have a publication in 2017 explaining and documenting how this campaign happened and in 2018, the most recent rabies expert consultation by WHO already The recommendation of massive pre-exposure prophylaxis for populations living in high-risk areas that will have very difficult access to prophylaxis if they are beaten.
So the next question is who is at risk? And you can see in this map an attempt to answer that. So in the area surrounded by the red line in the map is the biogeography territory of the Amazon, the Amazon basin.
And then in how many people live there, it's about 25 million, 26 million people. And if we actually consider who is actually living close or have some access to healthcare, which means they live in big urban centres or they are a few minutes of very close by navigation, food or car to healthcare system, you can still get 8 million people that have no healthcare access easily and they're far away and they could be beaten by bats at any moment right now. So this 8 million people in the nine countries seems a small number, but we need to remember this is a vulnerable population, indigenous population.
Many Amazon populations are disappearing. Also, there is a lot of new developments that will explain in a few slides ahead about how more people could be exposed that do not live there, but they will go to participate in economical development there. Well, how to organise a pre-exposure prophylaxis, massive campaign.
You need to select the area and make a prioritisation that . Including high risk of being beaten, exposure, access, decide if you wanna use intramuscular vaccination as WHO recommends or the intradermal vaccination. In the past for the Peru campaign where 3 visits, 3 doses of vaccine that will now updated only need 2 doses.
Why it's so important? Because you need to go. 3 times to a really, really far place, so difficult to get there in day 0, day 7, and then day 28, it's a big challenge.
It's a very expensive operation, and complicated. So you only need to go twice, makes things far easier and you can vaccinate more people in faster time. Another important thing mentioning this is that is the ID and the picture ID is there.
So you can just go and vaccinate and having a number total how many people were vaccinated. You need to identify who was vaccinated. Surveillance, it's Imposing this need to explain if anybody have rabies being vaccinated could be a big, big situation.
What happened with the cold chain or something like that. So for surveillance and other reasons, individuals need to be properly identified when they receive this vaccine. For core chain, it's quite important which is mentioned at the end of this slide.
So we need to assume. This is another key issue. If we're saying that everybody's beating all the time and the paradigm says that if you are beaten, you need to get full post-exposure prophylaxis, but now we have people beaten, but I'm not gonna give full post prophylaxis.
I will give only pre-exposure prophylaxis which only to those. So we need to decide which scenario are we? So It's a time where there are, there is an epidemic, there, there are outbreaks going on right now, so I can be sure there is rabies circulation of the opposite.
There are no cases in cattle, no cases in people. So then assume there is an epidemic silence, which means at least 3 months there is no rabies cases, then I will assume there is no recent circulation. I have full confidence.
To vaccinate only. Pre-exposive prophylaxis, 2 doses and know the paradigm that says that you are beating 4 doses of the vaccine. So you need to assume that there is no rabies virus circulation at the moment of the campaign.
Also, you need to to understand that. If somebody is exposed, no, no matter the age or whatever, everybody has to be vaccinated if they are present in the eye. So then what happened with the babies and newborns.
So it's probably advisable to come back and complete them later or regularly include in the . Childhood vaccination schedule. And another important thing is there is a lot of controversy or question about that.
Do I need a booster? Every, how many years I need a booster and the best answer is that booster is not needed unless you are beaten, but you are beaten all the time. So it becomes an ongoing question all the time.
So I think the most important thing to remember is that you need to cover a risk. For the population who's who is exposed, so is the, the priority is to governing with at least one course of this pre-exposed vaccination. After that, then you start to think if they need a booster or not.
According with the new regulations, you do not need a booster, but every country needs to examine what is the situation if any front exposure is documented, there is an outbreak. Some criteria need to be examined for each area. Not every area is the same, every country has the same consideration.
So there is a proposed here, . For proposal of criteria that's gonna be published in a book coming next month and the title is there and you can look for the chapter on the pre-exposure vaccination and the table will be there. Very important it considered the frequency of exposure, frequency of bites, access to care, is the rabies circulation documentary note.
There are some, other tools you can use. There is a tourist place. What are the cultural issues there, ethnicities, languages, beliefs, all the stuff might play a role when you want to decide who's going to be intervened first or who's going to be intervened and who, I mean, which population will not need an intervention.
So it's very important to have a criteria, analysis before deciding who's gonna get. So this is more or less the result now. In red the cases by dog rabies as, as explained we're in control.
The cases in blue are the vampire but rabies. This is from the Ministry of Health, and there are no cases in 2017. So, there's quite success to prevent human cases.
Circulation of rabies is still ongoing in vampire, but But in the Amazon, yes. This programme prevented some deaths, as you can see here, dramatically, yes. Already explained this, you have to remember, I is not intervene.
I still, having some cases occasionally, but they stopped at 17. A reflection here. If we're in a big campaign for canal babies.
0 by 30, which means no more human cases by 2030, and it's taking so long time the logistics of canine rabies globally are really very intense and complicated, of course. But for one part of rabies, which is a smaller region, a model of predation from animals to people very unique, probably transmitting all the diseases which explain in a minute. Why to wait?
We can intervene now. We can have 0 by next year. So this is a reflection, this intervention works.
It's probably cost effective and there are many other cultural situations that actually be benefited by it. So this is not all. Bites are still ongoing, rabies is still circulating and those bites, remember, have some intimate contact with a human and a bat for 1520 minutes.
So it's nothing, nothing that we could forget. So we keep researching and there are in the last decade, was part of this studies documenting all the pathogens found in vampire bats, vampire bats. And you can see here N Bartonelas in Peru.
Alsoomas. Virus responsible for hepatitis in this case C. These are all contributions from other countries, so they might be in bats.
The most recent one of the group documented leptospira in some vampire bat bites, bats. Very interesting influence I. Influence I called so much attention and yes, there is a movie poster here too.
It was kind of connected. And you saw this movie, you see at the end there is some bats that were imply in the transmission of this epidemic show here. Well, was the time actually discovered this that influenza A could be a, a danger and what happened in these bats are in contact with my face for 1520 minutes.
This is a valid question for you. Think about it. We need to demonstrate there is some potential for transmission either by divide by ectoparasite what inf influences respiratory virus.
We need to think if this patterns could be transmitted to people. More documentation of influenza A in bats from Peru. Most outstanding situation recently we documented that Tripanosoa cruise already found antibodies of Tanusoal cruisei invapar but bodies in different countries, but we documented.
The parasite in the salivary glands of a vampire bat and antibodies of many other species including, including the small roton. So the question is valid. Vampire bats could transmit Chagas disease.panosomal rosi is the agent of Chagas disease.
Chagas disease is believed to be in restricted areas in Peru in the south, but now the question, what is the surveillance? Do we know they do have Chagaz not reported. What's going on.
So there is a first line now, now of, of research that we need to look for. Is there a new risk that These people could be exposed because they buy. This is a map just to show, with this red lines that show where the human objects happen and another map to show with all these .
Orange territories are the territories recognised to indigenous ethnic groups in the Amazon. Seems a lot, right? And in the former map, you see how many of these territories have coincidence with the human rabies outbreaks due to vampire bad bites.
So these maps are very important. Make us think what's going on, who is exposed, and where we need to do some more research. Something or something else to think about is that.
As you see in this map, Amazon is very attractive for exploration of oil, and oil exploration companies are very intense as you see in this map in Ecuador and also in Peru, all these blue areas are areas where there is exploration or exploitation right now. Who is doing that? The locals, no, there are companies, engineers, workers coming from outside that go into an endemic area or high risk area for vampire.
But by a vampire bat rape is transmitted to people, then you have Illegal mining, gold mining in Peru from centuries to now is still a big attraction and the Amazon seems to be easier to explore because less it's remote, there are less police or less surveillance for illegal activities, but important to mention. Illegal mining in Peru already surpassed the laundry money that narco traffic used to to be in the past. So this is not a small thing.
There is a lot of activity with undocumented people. We don't know how many people are doing this exploitation and in this trade that might be exposed to vampire bad bits. And deforestation, another very well publicised situation in the Amazon.
All these black points are deforestation. Very, very few of those are legal. There's a lot of illegal activity with deforestation in the Amazon area, which implies the same what it says.
So then you have almost all the Amazon area in Peru exposed to visitors. People with no immunity and people who might not be very stimulated to go to the legal healthcare points to get identified to ask for vaccines. So there is not a small situation.
It's not only about ethnicities living there or local populations. Right now it's becoming a new risk for emerging diseases. And not only as I explained, rabies also potentially all the diseases we see how coronavirus and the sonotic link to that.
It's important and the Amazon, it's quite interesting, important, and we are not paying enough attention because this of 15 minutes, skin to skin with these animals. And people do not happen massively as it happened in the Amazon anywhere in the world. But in summary, I part about rabies.
It's a forgotten disease. I would say it's very neglected. I would say double neglected.
Check for the neglected disease list in WHO. You can find rabies, can I, but what do rabies do to one part of wildlife. Didn't make the list, so it's double neglected.
It's important, situation, emerging diseases might come from here. It's a need for more attention. We cannot control this vapa but rabies with traditional strategies already presented a new strategies, massive vaccination.
It would be probably nicer if we have ways to intervene the bats and other the people, but we don't have that now. And a lot more research and technologies, innovation is needed to get to that point, but that, at this point we need to vaccinate people exposed to those rights. .
International agenda is, it's is concentrated in canine rabies as explained. We need to see how this is gonna be an issue for the future for the Amazon. I need to pay attention, probably, the regional agenda, it's for the governments, but I would say the scientific agenda to pay more attention as this unique interaction that might actually lead.
Could be a model for potential sonotic transmissions in the future. And that might happen in the future. Well, there is limited access, and this is something that cannot be changed in a long time.
The poverty levels and other cultural situations that belong to this part of the world will be always a challenge, but we still can have this pre-exposed vaccination, predisposed prophylaxis massive available to them. And some investment and support from the national or governments should happen for that. So I will be very happy to answer any questions or consultation through those emails in the future and thank you very very much for your attention to this webinar.
