Preventive Veterinary Medicine 65 (2004) 105–115

www.elsevier.com/locate/prevetmed

Vaccination coverage and epidemiological

parameters of the owned-dog population
in Thungsong District, Thailand
Wandee Kongkaewa,*, Paul Colemanb, Dirk U. Pfeifferc,
Chongmas Antarasenaa, Anyarat Thiptaraa
a
Southern Veterinary Research and Development Center, Thungsong, Nakhon si thammarat 80110, Thailand
b
Disease Control and Vector Biology Unit, Department of Infectious and Tropical Diseases,
London School of Hygiene and Tropical Medicine, Keppel Street,WC1E 7HT, UK
c
Epidemiology Division, The Royal Veterinary College, Hawkshead Lane, North Mymms,
Hertfordshire AL9 7TA, UK
Received 12 June 2003; received in revised form 22 March 2004; accepted 2 May 2004

Abstract

Canine rabies vaccination is delivered in Thungsong District, Thailand, as an annual campaign

between March 1 and 31, and also at other times through private veterinary clinics, para-veterinarians
and health-care staff residing in the villages. The current questionnaire-interview survey was
conducted between June 23 and July 18, 2002 to determine: rabies-vaccination coverage amongst
the owned-dog population; basic dog-population information; and community awareness about
rabies. The modified expand programme on immunization cluster-survey method was used to collect
information about dog demography and management characteristics. Household knowledge about
rabies and sources of rabies information were assessed. Vaccinated dogs were identified from vaccine
certificates or owner reports confirmed by vaccinators.
Seventy percent (95%CI 62–78) of 364 eligible owned dogs were vaccinated within the 6 months
prior to data collection. Of these 255 vaccinated dogs, 44, 21, 13, 17 and 5% were vaccinated through
the annual vaccination campaign, veterinary clinics, para-veterinarians, other vaccinators and
owners, respectively. Fifty-four percent of households owned dogs. The sex ratio in dogs was 2
males per female; the dog: human ratio was 1: 4.6 with an average of 0.9 dogs per household (1.7 dogs
per dog-owning household). Most dogs roamed freely and these were less likely to be vaccinated

* Corresponding author. Tel.: +66 75 538035 6; fax: +66 75 538035 6 ext 102.
E-mail address: [email protected] (W. Kongkaew).

0167-5877/$ – see front matter # 2004 Elsevier B.V. All rights reserved.
doi:10.1016/j.prevetmed.2004.05.009
106 W. Kongkaew et al. / Preventive Veterinary Medicine 65 (2004) 105–115

compared to dogs being kept on premises or on a leash. Almost all households were aware of rabies
and the need for dog rabies vaccination as a control method. Seventy-six percent believed that rabies
only occurred in summer. There was little awareness about cat rabies amongst households.
Vaccination coverage in the total dog population clearly has not yet reached the 80% target level
set by Thailand’s official rabies-control programme. Improved effectiveness of the owned-dog rabies-
vaccination campaigns in each community is needed–perhaps by more community education about
dog management or by better management of ownerless dogs.
# 2004 Elsevier B.V. All rights reserved.

Keywords: Rabies; Dog; Survey

1. Introduction

The incidences that of canine and human rabies in Thailand has decreased over the last
two decades as a result of a national rabies-control campaign, including an annual mass
vaccination of dogs and cats, increased effectiveness and safety of human post-exposure
treatment and educational efforts (Mitmoonpitak et al., 1998). Official statistics report a
reduction of human rabies deaths from 0.78/100,000 in 1980 to 0.05/100,000 in 2001 (Wasi
et al., 1997, Hinjoy et al., 2002). Nevertheless, both human and canine rabies remain
endemic in all regions. Domestic dogs are considered to be the principal source of the
disease (contributing to 91–96% of reported animal rabies) (Panichabhongse, 2002) and
the major rabies vector in Thailand (Ito et al., 1999). Furthermore, during 1997–2001, rabid
dogs were responsible for 223 of 271 human rabies fatalities. Thirteen human deaths were
due to contact with rabid cats–now the second-most-important reservoir species (Hinjoy et
al., 2002).
The WHO recommends that 70% of the dog population in a community should be
immunised to eliminate or prevent outbreaks of this infection (Coleman and Dye, 1996).
Thailand has set 80% rabies-vaccination coverage in dogs as the programme target. WHO
(1984) emphasized that successful rabies control-and-elimination programmes depend
upon thorough knowledge of the characteristics of the dog population, its ecology and their
relationship with man. Given the present situation in Thailand, an assessment of rabies-
vaccination coverage and other factors that might influence the success of the on-going
programme was needed. As a result of economic and practical constraints, no reliable
information about the density and distribution of the dog population existed when we
began. This study uses WHO’s expand programme on immunization (EPI) cluster-survey
method (which first was developed to measure vaccine coverage among children in
developing countries). Its simplicity, low cost and satisfactory performance has resulted in
wide-spread adoption for other health-related surveys (Turner et al., 1996). In veterinary
public health, Robinson et al. (1996) applied this method to assess canine rabies
vaccination and other relevant characteristics of the owned-dog population in the
Philippines. We extended the scope of information obtained to include some aspects of
household characteristics, owner’s knowledge about rabies, information sources about
rabies and the vaccination campaign. The number of cats owned and their vaccination level
were also recorded for each household. Since the data collection was based on a household
 W. Kongkaew et al. / Preventive Veterinary Medicine 65 (2004) 105–115 107

survey, it is only possible to measure characteristics related to households (and not

individuals). In addition, this study only presents information about the owned dogs.

2. Materials and methods

2.1. Study area

Thungsong District is located in the central part of southern Thailand, which had a
human population of 147,298 in the year 2000. During 1997–2001, 47 to 70 animal-rabies-
suspect samples were tested annually in the district; 36–58% of them were rabies positive
by fluorescent antibody test (143 confirmed rabid animals). In addition, human-rabies cases
occurred occasionally. Therefore, in this area, rabies was considered to be an important
public-health problem.

2.2. Rabies vaccination

Rabies vaccination of owned dogs in Thailand is delivered through three principal paths:
(1) an annual free vaccination campaign between March 1 and 31 under the supervision of
and in co-operation between the departments of livestock development, of communicable
disease and of local administration; (2) private veterinary clinics (mostly urban); and (3)
trained para-veterinarians and health-care staff who reside in the villages. Since 1997, all
animal rabies vaccines available in Thailand are imported killed-virus vaccine; these are
delivered by subcutaneous or intramuscular administration, and confer 1–3 years
protection (DefensorTM3, Pfizer Animal Health, USA; Imrab11, Merial Inc., USA;
Rabigen Mono, Virbac Laboratories, France; Rabisin, Merial Leon, France; RabvacTM 3,
Fort Dodge Animal Health, USA).
Dogs aged  2 months are required by law to receive annual rabies vaccination. The
owner will receive a rabies vaccine certificate following vaccination. This includes a rabies
tag which indicates the year in which the dog has been vaccinated. In the current study,
dogs that had been vaccinated within 6 months prior to the survey were classified as
vaccinated dogs. This assumption was based on the following reasons: previous studies in
Thailand demonstrated protective antibody levels in only 64–72% of Thai dogs after 180
days of single vaccination; rabies vaccine is delivered at the village level between February
and April; and access to rabies vaccine is limited outside of this period. We confirmed the
vaccination status by checking the certificate.

2.3. Owned-dog definition

‘‘Owned dogs’’ are those having at least one referral household. The term includes
restricted, family and neighbourhood dogs following the WHO classification criteria
(WHO/WSPA, 1990). In accordance with these criteria, dogs were classified into four
groups based on the degree of supervision given to the dogs and the level of dependence of
a dog on human care, i.e. food, shelter and human companionship: A ‘restricted dog’ is
fully dependent and fully restricted or supervised; a ‘family dog’ is fully dependent but
108 W. Kongkaew et al. / Preventive Veterinary Medicine 65 (2004) 105–115

semi-restricted; a ‘neighbourhood dog’ is semi-dependent and semi- or unrestricted while a

‘feral dog’ is independent and unrestricted (and although it may need human waste for
sustenance, nobody will take responsibility for it).

2.4. Cluster survey method

The WHO EPI cluster-survey technique was used to assess owned-dog vaccination
coverage, dog population characteristics and demography (including the household’s
knowledge about rabies and information relating to the rabies-vaccination campaign)
(Henderson et al., 1973). Thirty villages (i.e. clusters) were selected using simple random
sampling from a total of 116 villages and from the only municipal area in Thungsong
District, Thailand. All selected villages were listed alphabetically in Thai. The total
number of households for each village was based on the household census from June 2002,
provided by the registry and identity section, division of population registration. The
sampling interval was determined by dividing the total number of households of all villages
in the study area by 30. The first village was selected using a number selected from a
random-numbers table falling into the sampling interval. The other 29 villages were then
selected if a multiple of the sampling interval fell within its list’s cumulative household
sub-total. The first household in each village was selected by choosing the first house in the
direction selected after spinning a pen at the centre of the village. Then, the household next
to the index household along the roadside in the direction chosen was included until at least
13 households and 7 dog-owning households were selected per village. The sample size
required for households (384) was estimated assuming an expected prevalence of 50%,
ninety-five per cent confidence interval and desired accuracy of 5 (Canon and Roe,
1982). The requirement of at least 7 dog-owning households (210) per village followed
WHO EPI scheme and would also reduce the effect of clustering in case some households
owned  2 dogs.

2.5. Questionnaire interview

Questionnaire interviews were conducted between June 24–July 18, 2002, using two
separate questionnaires. The household questionnaire described the owned-dog and
owned-cat populations and their rabies-vaccination histories. It also included information
about household characteristics, knowledge of the households about rabies and sources of
information about the rabies vaccination campaign. In addition, a separate questionnaire
for each dog was used to determine vaccination coverage and collect descriptive data about
each dog and its management. All households selected were included in the study whether
or not they owned dogs. All dogs owned in those households were included in the dog-
questionnaire survey. In total, 403 households and 375 dogs were included in this study.
Any adult in the household was asked for information. Re-visits were conducted if no
household member could be interviewed at the first visit or if some information was
missing. Because most dogs do not hold pedigree or registration cards, their exact ages
could not be determined. Therefore, the owners were asked to estimate age to the nearest
month for dogs younger than 1 year and to the nearest year for older dogs. Dog owners were
asked to present vaccination certificates and vaccination tags to confirm that their dogs had
 W. Kongkaew et al. / Preventive Veterinary Medicine 65 (2004) 105–115 109

been vaccinated within the 6 months prior to the survey. Dogs reported as vaccinated by the
owners but without certificates or tags were followed up with the vaccinator for
confirmation; otherwise, the dog was classified as unvaccinated. Dogs which had been
vaccinated within the last 12 months but >6 months were noted. The owners were asked
whether their dogs had been vaccinated during the campaign, by a veterinary clinic or by
other sources.

2.6. Data analysis

Data were compiled and coded on a standardised form before entry into a computerised
database. The Epi Info 2002 software (CDC, Atlanta, USA) was used to calculate the
vaccination coverage among owned-dogs  2-months-old and neutering proportions
among owned-dogs  9-month-old (including confidence limits) because it provides the
required statistical procedures that take account of the sampling design used in the current
study. The design effect calculated by the procedure reflects the estimated variance of the
survey data relative to that of a simple random sample. Generally, cluster sampling tends to
increase the design effect. Percentages and odds ratios (and 95% confidence intervals) for
dog-management characteristics were calculated using Stata 7.0 software (Stata Corp,
College Station, Texas, USA). Data collected in this survey was compared to household
size and human sex-ratio estimates obtained from the 2000 human-population census
(National Statistical Office, 2000).

3. Results

3.1. Household characteristics

The 403 households selected included 1742 persons (1324 adults and 418 children), and
household size ranged from 1 to 13 members (median = 4). Information about dog
population and management characteristics was obtained for 375 dogs from 218
households. On average, households had 0.9 dogs and 1.7 dogs per dog-owning household
(median = 2). The dog:human ratio was 1:4.6. The sex ratio in dogs was 2 males per female
(248:125). Of the households that did not own dogs at the time of the survey, 70% (74/106)
previously had owned dogs and 17 households intended to get a dog. Amongst households
that had never owned dogs, most mentioned reasons such as: dislike (70/99); lack of space
and time to take care of a dog (19/99); or concern about disturbing neighbours or that in
their professional career (shopkeepers, food sellers), they could not have a dog (18/99).

3.2. Dog management

Dogs were kept primarily as guard animals (83%). Most of them were allowed to roam
freely during the day (74%), and they were fed with household-prepared food (56%).
Sixty-one percent of dogs had been given to the households, and 11% had been found. We
compared dog-management characteristics (source, function, restraint during day, food)
between vaccinated and unvaccinated dogs (Table 1). Only restraint was associated with an
110 W. Kongkaew et al. / Preventive Veterinary Medicine 65 (2004) 105–115

Table 1
Description of dog management characteristics comparing vaccinated and unvaccinated owned dogs in Thung-
song District Thailand (2002)
Variables Vaccination history Crude OR P
Vaccinated Unvaccinated OR (95% CI)
Number (%) Number (%)
Source n = 364
1. Born in household 46 63 27 37 0.7 0.3–1.4
2. Given by neighbors 152 72 59 28 1
3. Found 22 56 17 44 0.5 0.2–1.5 0.22
4. Bought 23 82 5 18 1.8 0.5–6.0
5. Given from other villages 12 92 18 4.7 0.5–47.2
Function n = 360
1. Guard 143 67 71 33 1
2. Pet 44 73 16 27 1.4 0.6–3.1 0.29
3. Guard & pet 68 79 18 21 1.9 0.8–4.4
Restraint n = 351
1. Free-roaming 167 64 93 36 1
2. On premise 40 89 5 11 4.5 2.2–9.1 <0.05
3. Leashed 38 83 8 17 2.7 1.2–5.8
Food n = 358
1. Household leftovers only 95 64 53 36 0.7 0.3–1.3
2. Household prepared only 115 73 42 27 1
3. Household leftovers & household prepared 12 71 5 29 0.9 0.2–3.2 0.76
4. Household leftovers & pet food 5 83 1 17 1.8 0.1–25.0
5. Household prepared & pet food 22 73 8 27 1.0 0.4–2.4
Note: Differences in numbers of dog among variables was caused by dropping out of some strata containing no
dogs.

increased chance that a dog had been vaccinated. Free-roaming dogs were less likely to be
vaccinated compared to dogs being kept on premise (OR = 4.5; 95% CI 2.2–9.1) and
leashed dogs (OR = 2.7; 95% CI 1.2–5.8). Thirty-three percent of female and 4% of male
dogs aged  9 months were subjected to reproductive control (surgical or hormone
injection) (OR = 11; 95% CI 7.6–14.2).

3.3. Rabies vaccination in dogs

Of the 364 dogs aged  2 months, 255 (70.1%; 95% CI 62.1–78; design effect 2.9) had
been vaccinated during the previous 6 months. More than half of the vaccinated dogs had
been vaccinated in March (36%) and April (26%) (Fig. 1), and 44% were vaccinated during
the free vaccination campaign conducted by the district livestock office, municipal office,
sub-district administrative office, district public health office or local college. Veterinary
clinics (21%) and door-to-door vaccinators (17%) also played a significant role in rabies
vaccine delivery to owned dogs in Thungsong District (Fig. 2). Reasons for not vaccinating
their dogs were obtained from 87 of 94 households. Ten dogs aged between 3 and 8-
months-old were believed to be too young to be vaccinated, 6 dogs could not be restrained,
8 dogs were not vaccinated because the owners were not at home during the free
 W. Kongkaew et al. / Preventive Veterinary Medicine 65 (2004) 105–115 111

Fig. 1. Month of vaccination among vaccinated owned dogs in Thungsong District, Thailand between December
2001 and June 2002. (95%CI).

vaccination campaign, and 15 dogs were not at home during the vaccination campaign.
Five dogs were not vaccinated because the owner could not afford it. Twenty-two dog
owners were waiting for door-to-door vaccination delivery. Ten dogs had been vaccinated
within the previous 12 months (although not within the previous 6). Two dogs were
pregnant and one dog had been acquired about 30 days ago. Eleven dogs were kept without
expectation of dog ownership and the owners did not intend to vaccinate those dogs.

3.4. Rabies vaccination in cats

Cats were owned by 29% of households. Thirty-six percent of cat-owning households

reported that their cats had been vaccinated against rabies. Amongst 70 respondents from
the 71 households owning unvaccinated cats, 16 owners had never heard of the need of
rabies vaccination in cats.

Fig. 2. Source of rabies vaccination of vaccinated owned dogs in Thungsong District, Thailand between
December 2001 and June 2002. (95%CI).
112 W. Kongkaew et al. / Preventive Veterinary Medicine 65 (2004) 105–115

3.5. Household’s experience with rabies exposure

Members of 69 of the 402 households had been bitten by dogs or cats, and 78% (53/68)
of these had received post-exposure treatment. The victims were bitten by their own
animals (6%), animals owned by someone else (78%) or feral dogs (16%). Of 165
households, 50 and 94 reported that they had seen suspected rabid dogs in the village within
the previous year and about 2–4 years ago, respectively. (Twenty-one of 165 households
could not remember when they had last seen rabies cases.)

3.6. Household knowledge about rabies

Most of the households had some knowledge of rabies (93%). The most-common
sources of information were television (37%), verbal propaganda (36%), newspapers
(25%), and schools (25%). Thirteen percent of households could remember having seen
animal (44/374) or human (9/374) rabies cases. Ninety percent (363/403) and 66% knew
that rabies can infect dogs and cats, respectively. (Only 16% knew that rabies can infect all
mammals and 6% could not give an answer.) Furthermore, 76% (288/398) of households
that knew about rabies believed that rabies occurred only in summer.

3.7. Household knowledge about rabies post-exposure prophylaxis

Most households consulted doctors or health-care staff if they had been bitten by dogs
(354/383, 92.4%). Two-hundred and sixty-nine (70.2%) would clean the wound. Ninety-
two (24.0%) would use a disinfectant to clean the wound. Seventy-seven (20.1%) would
restrain biting dogs for rabies observation. Only sixty-four (16.7%) would kill the animal
immediately and submit it for rabies diagnosis, and 64 (64.7%) would kill the animal
immediately without submitting it for laboratory diagnosis.

3.8. Household knowledge about vaccination campaign

Little information was obtained about the rabies vaccination campaign because of the
time-lag between campaign and survey (and also because this question had not been clearly
formulated in the questionnaire). The most-common sources of information about the
rabies vaccination campaign were local administrative offices (52/196), para-veterinarians
(47/196), house-to-house loud-speaker vehicles (42/196), district veterinarians (34/196)
and local health care staff (32/196).

4. Discussion

Vaccination is the most-effective control method for dog rabies. Field experience and
epidemiological models have shown that a large proportion of the dog population needs to
be immunised in order to interrupt the transmission cycle within the population. It is
therefore necessary to assess the vaccination coverage in the population to monitor the
effectiveness of a campaign. This includes collection of information about the size and
 W. Kongkaew et al. / Preventive Veterinary Medicine 65 (2004) 105–115 113

structure of the different dog-population segments (Matter et al., 2000). In developed

countries, random-sampling surveys can be applied easily, such as a telephone-
administered household survey (Egenvall et al., 1999; Goodwin et al., 2002). However,
such methods cannot be applied in developing countries due to the high cost and inadequate
telephone coverage. The current study used a modified EPI scheme by choosing at least 13
households and at least 7 dog-owning households per village to obtain information beyond
vaccine coverage. The results obtained for vaccination coverage had a design effect >1
(2.9). This suggested that there was a strong clustering effect in the data probably because
some households contributed more than one dog to the sample. Amendment of the scheme
to make it more representative was done by a modified EPI (taking every fifth house,
dividing each community into quarters and selecting a separate EPI sample from each one,
or taking part of the sample from the centre of the community and part from the periphery),
as has been suggested by El Bindari-Hammas and Smith (1989, cited by Bennett et al.,
1994).
The estimated household size from our EPI was slightly higher than what was found in
the population census, and the human sex-ratio was more biased towards females. A cluster
study conducted in the Philippines by Robinson et al. (1996) showed substantially higher
dog-population estimates from EPI when compared to studies conducted in different
settings in that country. This present study also gave a high dog-population estimate with a
dog: human ratio of 1:4.6 when compared to the dog: human ratio of 1:6.7 obtained from an
estimate of the total dog population in Thailand that was carried out on the basis of random
sampling in 1990 (Meesomboon and Sagarasaeranee, 1993). Thus, this method might not
be suitable to estimate the dog-population size. However, the same study by Robinson et al.
(1996) reported that similar results were obtained on rabies-vaccine coverage when
comparing the EPI survey and capture-mark-release method (Childs et al., 1998). For the
situation in Thailand, we recommend that further studies should be conducted to develop
an amended EPI cluster-survey method so that more-accurate information about owned-
dog population size, vaccination coverage as well as other related factors can be obtained.
We found that 70% of the owned dog-population in Thungsong District had been
vaccinated in the past 6 months. This estimated vaccine coverage level is considered to be
sufficiently high to prevent rabies outbreaks in a setting where ownerless dogs are very rare.
Unfortunately, Thailand has many unvaccinated stray dogs. Owned dogs and stray dogs
live in close contacts about 25% of rabies-positive dogs were owned dogs
(Panichabhongse, 2002). Mean age of owned dogs obtained from our study was relatively
low (mean = 2.6 years; Q2S = 0.8; median = 2; Q7S = 4, data not shown) compared with 4.5
years for owned dogs in the U.S. (unknown source cited by Wandeler et al., 1988) or 3.1
years for dogs in Kenya (Perry et al., 1995)–possibly indicating a shorter life span of Thai
dogs. Tepsumethanon et al. (1991), Sage et al. (1993) and Delgado and Carmenes (1997)
demonstrated that not all dogs vaccinated once maintain protective antibody level. Besides,
Sagarasaeranee et al. (1993) showed that persistence of antibodies over 0.5 IU/ml was
found at day 180 and 360 in 64–72% and 55–60% of Thai dogs after a single rabies
vaccination. Considering these observations and the fact that rabies incidence is still high,
rabies vaccine should be made available at the village level throughout the year or a twice-
annual rabies vaccination campaign should be set up so that vaccine coverage among the
owned-dog population will be increased.
114 W. Kongkaew et al. / Preventive Veterinary Medicine 65 (2004) 105–115

Most households had some knowledge about rabies and paid for rabies vaccination of
their dogs due to insufficient availability of free vaccine. This suggests that there is
motivation within communities to participate in rabies-vaccine campaigns. This should be
supported through increased public-awareness campaigns combined with provision of
sufficient free rabies vaccine for dogs and cats that could be delivered by visits to
households organized by local administrative authorities.
Dog management in Thailand appears to be similar to other countries where rabies is
endemic and that have large proportions of stray dogs. Some management methods such as
restraint related to the odds that dogs were vaccinated–in agreement by Matter et al. (2000).
It was also notable that the households which kept dogs without expectation of dog
ownership did not tend to use appropriate management. They fed their dogs with household
left-overs, provided inadequate shelter and allowed their dogs to roam freely. This problem
group of households should be targeted specifically by education and regulation through
local administrative authorities. The sex ratio in dogs was 2 males per female. It was
consistent with some other surveys in other parts of the world (Brooks, 1990). This finding
perhaps suggested an idea to limit the number of dog in household by keeping male dogs
and abandoning female dogs.
Cats are the second-most-common domestic animal in Thai households; however, the
awareness of rabies amongst cats is low. Although all dog owners knew that dogs have to be
vaccinated against rabies, some cat owners did not know. Some believed that cats are not
likely to get infected with rabies. Hinjoy et al. (2002) reported an increase in the number of
human rabies deaths from cats, and Panichabhongse (2002) reported a steadily increasing
trend in rabid cats and a decrease in rabid dog numbers in Thailand.
In conclusion, even though this modified EPI cluster-survey had some limitations for
estimating owned-dog population size, the estimated vaccine coverage appeared realistic
given the observed rabies prevalence. To improve vaccination coverage in the total dog
population in Thailand, we infer that effective vaccination of owned dogs has to be
maintained–but also, that large numbers of stray dogs have to be vaccinated. In addition,
we suggest that appropriate dog-management procedures (such as restraint and neutering)
be promoted. More education about cat rabies has to be provided to the public.

Acknowledgements

This project was supported by Southern Veterinary Research and Development Center
(SVRDC), Department of Livestock Development. We thank Prof. Dr. Henry Wilde, Dr.
Nimit Trivanatham for support, comment and advice. We are also grateful to all staff at
SVRDC for their contribution during questionnaire preparation, interviewing and other
parts of the project.

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