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Stop Tuberculosis
Reach. Treat. Cure. Everyone.
w
Contents
Message from IVSA, IFMSA and IPSF
Multidrug resistant tuberculosis
Collaboration w Event registration
More Resources
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Under the umbrella of the Stop TB Campaign’s call to "Reach, Treat, Cure Everyone" for Stop TB Day 2015, we are linking forces to raise awareness and advocate for better treatment.
The International Veterinary Students’
Association (IVSA) is the largest veterinary
student association in the world, representing
around 30,000 students in more than 40
countries. The International Federation of
Medical Students’ Associations (IFMSA)
represents more than a million medical
students in 116 countries. Finally, the
International Pharmaceutical Students’
Federation (IPSF) represents 350,000
pharmacy students and recent graduates in
70 countries worldwide.
IVSA, IFMSA, and IPSF have a short but
vibrant history of collaboration. There are
formal and informal partnership agreements
between each of the three organisations to
acknowledge and make plans for
multidisciplinary collaboration. While
attending the recent WHO Executive Board
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Meeting, representatives from all three
organizations met with the goal of developing
a stronger vision for future multidisciplinary
collaboration.
For Stop TB Day 2015, we are encouraging
YOU, our members, to join the fight to
“Reach, Treat, Cure Everyone” by focusing on
multidrug resistant TB (MDR-TB). Globally in
2013, an estimated 480,000 people
developed MDR-TB. About half died from the
disease. The primary cause of MDR-TB is
inappropriate treatment or the use of poor
quality drugs, as MDR bacteria do not
respond to at least isoniazid and rifampicin,
the two most powerful first line drugs.
Treatment for MDR-TB is not always available
and requires up to two years of treatment.
A complicating factor is the presence of
Mycobacterium bovis. M. bovis causes bovine
tuberculosis, which is one of the seven
neglected tropical diseases. As a zoonotic
disease, this bacteria causes disease in cattle
and humans. The contribution of M. bovis to
the human TB epidemic is on the rise,
reported in Tanzania to be the cause of 4-10%
of human TB cases. M. bovis and the more
common bacterial cause of human TB,
Mycobacterium tuberculosis, often present
very similar clinical pictures. However, they
can require different treatment. Few hospitals
have the diagnostic capacity to distinguish
between them.
Dear IVSA, IFMSA, and IPSF members,
We are encouraging YOU to join the fight to
“Reach, Treat, Cure Everyone.”
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Dear IVSA, IFMSA, and IPSF members,
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Patients with M. bovis often do not respond
to drugs that are commonly used to treat TB,
which can have fatal results. Just like with
MDR-TB, more expensive or less available
drugs are needed. In addition, inappropriate
use of drugs can accelerate the development
of MDR-TB.
Recent collaboration between veterinary and
medical professionals researching bovine and
human tuberculosis in Tanzania has resulted
in joint research on other zoonotic diseases,
the establishment of a
zoonoses group at the
livestock ministry, and a
series of meetings
between that group and
representatives from the
ministries of human
health and livestock
production (WHO,
2006). The breadth of this collaboration has
the potential to increase access to
appropriate diagnosis and treatment,
reducing the number of TB cases both locally
and worldwide. This is the kind of work we
can start doing right now, together!
Experience in this kind of multidisciplinary
collaboration should start at university training
level. When we achieve this, multidisciplinary
collaboration within the next generation of
healthcare workers will be even more
successful than it already is. On a global level,
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more attention is being given to the One
Health initiative, the concept that animal,
human, and environmental health are
inextricably linked. As three student
organization partners, IVSA, IFMSA, and IPSF
recognize that we are not working by
ourselves but are seeking and promoting
interprofessional collaboration to “Reach,
Treat, Cure Everyone.” To do this, we are
contacting you, members in countries with
cross-organizational reach, to develop
multidisciplinary teams and projects.
Together we will not
only educate, promote
appropriate diagnosis,
and raise awareness
about treatment
protocols that will heal
even more people,
prevent MDR-TB, and
help accelerate the decline of tuberculosis,
but build strong bonds between the
professions that will last into the future.
Love, Sarah (IVSA Chair of the Standing
Committee on One Health)
Skander (IFMSA Chair of the Standing
Committee on Public Health)
Barbara (IPSF Chair of Public Health)
Together we will not only educate, but build strong bonds between
the professions.
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Multidrug resistant tuberculosis has
become a major public health issue,
causing a huge threat for the progress
made in the global tuberculosis care,
control and treatment success.
Resistance can occur through improper
use of antimicrobials and is often a result
of inadequate treatment regimens as
well as a lack of patients' compliance to
finish their antimicrobial course. Drug
resistant tuberculosis can be transmitted
from one patient to other individuals
and is mainly emerging in areas with
weak tuberculosis surveillance.
multidrug-resistant Tuberculosis
● Multidrug-resistant tuberculosis
(MDR-TB ) is caused by bacteria that
do not respond to at least isoniazid
and rifampicin, the two most
powerful, first-line anti-TB drugs.
● Extensive drug resistant tuberculosis (XDR-TB ) is a form of
multidrug-resistant tuberculosis that
does not respond to the most
effective second-line anti-TB drugs
such amikacin, kanamycin and
fluoroquinolones, which are even less
available.
WHO Definitions
Resistance
Current and Future
WHO Poster
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Development of Resistance
Resistance to effective first-
line drugs requires a
combination with second line
drugs, thus the treatment
might take longer, cost more
and there are possibly more
severe side effects. There is a
significant correlation
between the development of
drug resistance and global
antimicrobial overuse. Some
tuberculosis strains are
already resistant to second
line drugs. In 2013 multidrug
resistant tuberculosis was
approximately responsible
for the death of 210 000
people worldwide.
Consequences of multidrug-resistance
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An estimated 480 000 people developed
MDR-TB in 2013. Extensively drug-resistant
tuberculosis (XDR-TB) has been reported in 100
countries, while an estimated 9.0% of people
with MDR-TB have also XDR-TB.
Analysis comparing data of former years
show that the proportion of new cases with
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MDR-TB remains unchanged, but there is a
severe risk of MDR-TB epidemics in quite some
countries. Furthermore there is still a major
diagnostic gap, thus an estimate of 55% of
reported tuberculosis patients who have MDR-
TB were not detected.
Situation Current
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1. Set prevention of multidrug
resistance as a first priority by
ensuring high quality and
evidence based treatment of
drug-susceptible tuberculosis;
2. Scale up rapid testing and
detection of all MDR-TB;
3. Provide prompt access to
effective treatment and proper
care, including adequate supplies
of quality drugs and a scaled up
country capacity to deliver
services;
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4. Prevent transmission through
infection control by implementing
appropriate infection control
measures and quickly enroll
diagnosed patients in effective
treatment plans to minimize the
risk of disease transmission; and
5. Underpin and sustain the MDR-
TB response through high level
political commitment, strong
leadership across multiple
governmental sectors and ensure
adequate financing for care and
research.
In order to control drug-resistant tuberculosis, the implementation of a global
surveillance system is needed, which requires a strong contribution of every
country. The WHO further set a list of five priorities in order to combat the
crisis:
Future Perspectives
Recently two new drugs, bedaquiline and delamanid, were presented for the use in
the treatment of MDR-TB and an interim guidance on their use was developed by
the WHO. However in order to tackle this severe threat for public health, people of
the world whether they are health professionals, politicians or patients need to work
hand in hand - to ensure antimicrobials will stay powerful weapons against diseases
and further provide access to this lifesaving treatment to everyone in need.
There is hope
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© World He a lt h Org aniza t ion 2 0 1 4
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Collaboration
Groups of veterinary, pharmacy, and medical students are joining forces all over the world to tackle Tuberculosis! The World Health Organization outlines basic steps of inter-organizational collaboration: Check out the Framework for Action at:
w https://www.uea.ac.uk/documents/4006821/4007300/FMH+-+CIPP+-+Framework+for+Action.pdf/6e15515c-0744-45cd-97b4-15fcc344113d
Register your campaign HERE: w https://docs.google.com/forms/d/1vzQoxUNcQS1LPi-
iXPYplpKW8JwRSu4eCS5NYCEed-4/viewform?c=0&w=1
Links: w Drug-Resistant TB - Surveillance and Response, WHO, 2014.
http://www.who.int/tb/challenges/mdr/MDR_TB_2014.pdf?ua=1
w Seven Neglected Endemic Zoonoses, WHO, 2015.
http://www.who.int/zoonoses/neglected_zoonotic_diseases/en/
w The Control of Neglected Zoonotic Diseases, WHO, 2006.
http://www.who.int/zoonoses/Report_Sept06.pdf?ua=1
w Tuberculosis, WHO, 2015.
http://www.who.int/mediacentre/factsheets/fs104/en/
w What is multidrug-resistant tuberculosis and how do we control it?
WHO, 2014.
http://www.who.int/features/qa/79/en/
w cdc.gov
w ecdc.europa.org
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IVSA 2015 Stop Tuberculosis Informative Leaflet
Guidance Manual World Rabies Day 2014 – How to Plan an Event
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Other Resources
Veterinary Significance: Excerpt from IVSA 2015 Stop Tuberculosis Informative Leaflet
Bovine tuberculosis (TB) is a chronic and serious disease of animals caused by bacteria
called Mycobacterium bovis which is closely related to the bacteria that cause human
and avian tuberculosis. This disease can affect practically all mammals, causing a
general state of illness, coughing and eventual death.
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Importance Today TB remains an important disease of
cattle, wild animals, and is a significant
zoonosis (a disease of animals which can
also infect humans). Tuberculosis today
remains an epidemic in much of the world,
causing the deaths of nearly one-and-a-
half million people each year, mostly in
developing countries.
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Where is it found? TB is found throughout the world. The
disease is more prevalent in most of Africa,
some parts of Asia and America.
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Veterinary Significance: Excerpt from IVSA 2015 Stop Tuberculosis Informative Leaflet
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Transmission The disease is contagious
and spread by contact with
infected domestic and wild
animals. The usual route of
infection is by inhaling
infected droplets which are
expelled from the lungs by
coughing. Calves and
humans can also become
infected by ingesting raw
milk from infected cows.
Transmission of M.bovis can
occur between animals,
from animals to humans and
more rarely, from humans to
animals and between
Clinical Signs in Cattle TB usually has a prolonged
course, and symptoms take
months or years to appear. The
usual clinical signs include:
w Weakness,
w Loss of appetite
w Weight-loss
w Fluctuating fever
w Intermittent hacking
cough
w Diarrhea
w Large prominent lymph
nodes
However, the bacteria can also
lie dormant in the host without
causing disease
Symptoms in Humans Symptoms of respiratory TB
include weight loss, night
sweats, fever and a persistent
cough which may contain blood
or pus. Infection acquired
through consuming dairy or
other food products containing
M.bovis may affect any part of
the body.
Diagnosis The standard method for detection of TB is the tuberculin test,
where a small amount of antigen is injected into the skin, and
the immune reaction is measured. Definitive diagnosis is made
by growing the bacteria in the laboratory, a process that takes
at least eight weeks.
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humans. Transmission to
people can occur through
consumption of unpasteurized
milk and unpasteurized milk
products from infected
animals.
It is also possible to contract
M.bovis infection by inhaling
the bacteria shed by infectious
animals in respiratory and
other secretions, or through
contamination of unprotected
cuts or abrasions in the skin
while handling infected
animals or their carcasses,
although this is rare.
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Veterinary Significance: Excerpt from IVSA 2015 Stop Tuberculosis Informative Leaflet
A Veterinarian’s Role
What should you do as a VET to prevent and control bovine tuberculosis?
The standard control measure applied to TB
is test and slaughter:
w Post-mortem meat inspection to look for
tubercles in the lungs and lymph nodes.
o Prevents unsafe meat from
entering the food chain and allows
veterinary services to trace the
herd of the infected animal, which
can then be tested and eliminated
if needed.
w Intensive surveillance including on-farm
visits
w Systematic individual testing of cattle
w Removal of infected and in-contact
animals
w Movement controls and quarantine
Pasteurisation of milk of infected animals to a
temperature sufficient to kill the bacteria has
prevented the spread of disease in humans.
Treatment of infected animals is rarely
attempted because of the high cost, lengthy
time and the larger goal of eliminating the
disease.
Vaccination is practiced in human medicine,
but it is not widely used as a preventive
measure in animals: the efficacy of existing
animal vaccines is variable and it interferes
with testing to eliminate the disease. A
number of new candidate vaccines are
currently being tested.
The role of veterinarians is to reduce the risk of exposure to bovine TB bacteria, especially on farms. A veterinarian should
have a good knowledge about bovine TB
transmission routes and available control
measures to raise awareness of possible risks
from contaminated aerosols in areas
frequented by farm workers and the
importance of good hygiene. Working with
livestock may involve close contact with
carrier animals or animals with active
tuberculosis. Relevant regulations require
farmers to adopt appropriate measures to
minimize exposure of employees and farm
visitors to infections that can be transmitted
to humans from animals.
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Veterinary Significance: Excerpt from IVSA 2015 Stop Tuberculosis Informative Leaflet
A veterinarian should advise people to:
w Wash hands thoroughly several times a day
and always before eating, smoking and after
finishing work for the day.
w Wash skin wounds immediately with soap and
running water and cover with a waterproof
dressing.
w Avoid drinking milk that has not been
pasteurised or boiled, or eating dairy products
made with raw milk.
w Do not drink, eat, or smoke in animal areas.
w Where possible, minimise handling of infected
cattle. If you must touch a potentially infected
animal, gloves and a facemask should be worn.
w Inform a veterinarian if there is a possibility that
an animal has the symptoms of tuberculosis.
w Inform a doctor if you have been in contact with
an infected animal or someone suffering from
tuberculosis.
Veterinarians and
doctors are working
together to make people
aware of the importance
of prevention.
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Event Ideas and Instructions: Excerpt from Guidance Manual World Rabies Day 2014 – A One Health Challenge
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1. Team Set up a team– a minimum of 2 and
maximum of 5 members, with at least
one veterinary student or one medical
student. Democratic decision-making
and nourishing of the team spirit are
important, but it should be clear who is
responsible for each part of the plan and
what each team member expects from
the event.
2. Ideas Brainstorm ideas and possibilities. There
are some examples of other events in
Ideas for One Health Challenge Events in
this manual and at:
http://rabiesalliance.org/world- rabies-
day/ideas/
3. Your activity Once you’ve decided on your activity, as
a team you need to determine the scope
of the event, the targeted beneficiaries,
your budget and partners.
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4. Set up a detailed action plan Initial meeting: at a convenient time and
place for all of you, discuss your event –
you may find the event checklist
(appendix 3) useful for this – and create a
detailed list of actions, a budget, a
timeline, and clearly identify who is
responsible for what. Prepare work
tables/sheets with specific tasks and go
through the plan one step at the time.
Be clear about what you expect each
team member to do. To avoid
misunderstandings and possible
resentments, make sure you all
understand what others are doing too.
Repeat the most important things more
than once – people tend to forget.
Continue to be transparent in your work
and communicate updates among
yourselves on a regular basis (at least
once a week), so that you all stay in the
loop. Organize other meetings according
to need.
Setting Up An Event
There are steps that will help you to organise your event – but please don’t forget to have a good time in the process!
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Event Ideas and Instructions: Excerpt from Guidance Manual World Rabies Day 2014 – A One Health Challenge
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5. Fundraising
Before you start fundraising carefully
consider exactly what you need. Then
determine who can help you and how
they can help you. Make sure you clearly
ask for specific things. The kind of
fundraising you do obviously depends
on what is acceptable in your country but
some examples are given below:
w Holding a cake (or bake) sale,
w Asking for sponsorship to complete
a task – e.g. a sponsored run, bike
ride or swim,
w Holding a raffle (local businesses
may supply prizes or you could
consider a 50/50 format where the
raffle winner takes 50% of the target
amount and your team takes the
other 50%.)
6. Extra volunteers If you need extra volunteers for your
event, start with a general call among
students at your university – it helps (but
is not essential) if they are from different
sectors, particularly if they are going to
be part of the team. Advertise in places
that students gather (mess hall,
dormitory, library, computer room,
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departmental notice boards, favourite
café or bar), as well on the university
email network or website, if one is
available to you. If you find it difficult to
recruit volunteers, try approaching local
NGOs or youth centres.
7. Externals Whether you’re coordinating the One
Health Challenge locally or nationally, do
some research on institutions, services,
governmental and non-governmental
organizations or special programs that
deal with rabies – these are called
externals. They can support your event
by providing other contacts, writing
letters of support, sharing their
publications and materials, providing
additional volunteers, facilities,
equipment or professionals (lecturers,
designers, etc.) and financial support.
Businesses may support you by either by
directly donating to your project
(sometimes in return for advertising at
your event) or by providing services in
kind (e.g. providing refreshments for
your volunteers, covering printing costs,
helping with sterile waste services, etc.)
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Event Ideas and Instructions: Excerpt from Guidance Manual World Rabies Day 2014 – A One Health Challenge
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pictures, video and comments from
attendees. Otherwise this is easily
forgotten and you need it for the report
and your own social media efforts.
Remember also to collect any press
clippings.
12. Debrief Have a final meeting after the activity to
evaluate how it went. What went well?
What could have been better? This is
valuable feedback for organizing events
in the future.
13. Thank you Remember to thank those who
supported the activity, especially if they
donated money or materials–a nice thank
you note goes a long way! It may make
people more willing to support you in
the future.
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8. Training It is always best to set aside at least 2
hours to discuss rabies (see All about
rabies – appendix 1, and
http://rabiesalliance.org/rabies/what-is-
rabies-and-frequently-asked- questions/,
how to best approach people or answer
questions when approached, and How to
handle the media (appendix 4). This
session will make your group more
cohesive, and give you the time and
opportunity to express your concerns or
ask questions.
9. Media Work with the media to maximise the
reach and impact of your activity. Issue a
press release. You could even consider
organizing a press conference! Again,
this is covered in How to handle the
media (appendix 4).
10. Review How are things going? Do you need to
make adjustments to your plan?
11. Conduct the event Use the checklist (appendix 3) – or your
modified version –to stay on track and
make sure nothing is overlooked. Make
one person responsible for taking
Remember to thank those who supported
your activity.
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Event Ideas and Instructions: Excerpt from Guidance Manual World Rabies Day 2014 – A One Health Challenge
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Ideas for One Health Challenge activities
w Organize World Rabies
Day information stands at
a community event or
centre
w Mobile team units /
outreach – distributing
materials in places where
you don’t have a
information stand, or
holding workshops in
remote communities
w Indoor stands in
pharmacies or drug stores
w Art performance /
installations – in the street
or following other
organised events
w Play or skits
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w Posters, photographs or
drawing exhibits
w Graffiti, creative writing or
art contests – for young
people
w Video airing – with or
without facilitated
discussions afterwards
w Joint efforts – candlelight
walk, ringing bells, holding
hands
w Together Against Rabies
theme parties or concerts
w National sport events –
have a short speech about
rabies and hand out
leaflets
w Local sport events –
organize a team Together
Against Rabies
tournament
Troubleshooting
All of the steps can be used anywhere in the world for the One Health Challenge, with
modifications according to your local/national situation. Some steps can be done in parallel,
while others really need to wait until the previous step is successfully completed. If you find
things aren’t going to plan, adapt and change them a bit to make it work.
Some ideas – like organizing community education workshops, having an information stand at
the university with educational materials and posters from http://rabiesalliance.org/resources/,
or organising a theme party – can be done with relatively few resources. Something can always
be done; be creative!
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w Peer education workshops
– for students from other
fields to increase
awareness about the
need for rabies
vaccinations
w Organize interactive
lectures or round table
discussions with externals
w Organise a mass dog
vaccination event with
your local clinic or animal
welfare group
w Organise sessions in
schools to teach about
dog bite prevention,
rabies and responsible
pet care - we have a lot of
resources for children –
http://rabiesalliance.org/re
sources/teaching-children/
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Event Ideas and Instructions: Excerpt from Guidance Manual World Rabies Day 2014 – A One Health Challenge
Sharing your activities Remember to share your wonderful work with everyone – put it on your website, if you have one,
post it on your Facebook page, send emails to your friends, families and supporters (if you’re part
of an organisation), add it to your newsletter, put it on the community notice boards, ask
journalists to cover the event in your local newspaper or magazines, speak on a radio show, write
an article for a student magazine, hold a press conference – these are just examples – there are
many other ways to share your work with your community and beyond.
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Using social media More and more people are using
social media to find information
about health and you can use
social media to promote your One
Health Challenge activities. This
document provides an outline of
how to get results from social
media for those who are not
familiar with these networks.
How to get results: Partner, Promote, Cross-Promote The interactive nature of social
media provides an ideal
opportunity to share your World
Rabies Day messages with current,
new, and emerging audiences.
Reaching these audiences across
social media involves three steps:
partner, promote, cross-promote.
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Partner - Establish relationships with organizations involved
in rabies prevention and overlapping issues
w Health departments, colleges of public health and
veterinary medicine, human health care, animal
welfare organizations
w Like:
o facebook.com/thescoh
o facebook.com/ifmsa
o facebook.com/GlobalAllianceforRabiesControl
w Follow
o @rabiesalliance
o @IvsaScoh
o @ifmsa
Promote - Distribute your messages to them
w Send messages or tweets about rabies to friends,
post educational or awareness messages, update
your status to include a countdown to World Rabies
Day
Cross-promote - Interact with audiences to create links
between different rabies resources and messages
w Retweet, follow media outlets and watch for
opportunities to alert them to events
Event Ideas and Instructions: Excerpt from Guidance Manual World Rabies Day 2014 – A One Health Challenge
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How to handle the media Contacting the media may seem daunting at
first but journalists are always looking for new
stories. Every year World Rabies Day makes
the news and more news means greater
awareness about rabies.
What are you going to say? New press releases that you can modify will
be available on rabiesalliance.org from
September 1, 2014. These will include the
latest facts and figures about rabies and
quotes from leading figures. You can also
include references to other events taking
place in your country, comments from
relevant government departments (health,
agriculture and/or animal health), and rabies
statistics.
When are you going to contact them? We recommend that you send your press
release to the media one week before your
event. Follow up again with a telephone call
later in the week.
Who are you going to contact? Finding the best person to contact is
sometimes challenging. It is often worth
making enquiries about who to contact as
part of your planning. Study the publications
you plan to approach. These could be local or
national newspapers, relevant magazines and
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websites, and TV and radio news channels.
Note the names of journalists who have
covered other public health related issues.
Most press releases are sent via email and this
is quickest and cheapest. However,
sometimes a traditional letter can stand out as
something different and attract a journalist’s
attention long enough to engage them in
your story. Whatever you do, follow up with a
telephone call later in the week to see if they
have had a chance to read the press release
and ask if they want more information.
Why will they be interested in your story? This is an important question to ask yourself.
To answer it you need to think about whom
you are contacting, who their audience is, and
how you can tailor your approach. It may
sound obvious but local outlets will be
interested in local stories, national outlets will
require details of national significance,
publications aimed at young people will want
a story that appeals to their audience, and so
on. You can use appendix 1, All About
Rabies, and other documents on
rabiesalliance.org to help you to add relevant
details.
The Amnesty International Campaigning
Manual has a press conference guide list.
"Mycobac t e rium t ube rculos is " Pho t o Cred it : Janice Carr Cont e nt Providers (s ) : CDC/ Dr. Ray But le r; Cent e rs for Dis eas e Cont rol and Prevent ion' s Public Hea lt h Image Library (PHIL) "Gruzlica pluc2 " by Krzys zt ofM at p l.wikipe dia. Lice nsed unde r CC BY-SA 2 .5 via Wikimedia Commons "Mycobac t e rium t ube rculos is MEB" by NIAID on Flickr. - Lice nse d under Public Domain via Wikimedia Commons "VariousPills " by Morgue File : se e [1 ] . Licensed under CC BY-SA 3 .0 via Wikimed ia Commons “Tube rculos is Med icat ion” from: ht t p :/ / sc it echdaily.com/ t uberculos is -res is t ance-t o-backup-drugs-increases / “Hand milking a cow” By St at e Library of Sout h Aus t ralia (Flickr:) via Wikime dia Commons By De part ment of Fore ign Affairs and Trade , Aus t ralia , via Wikimedia Commons
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