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Kevin Le Roux & Bernadette Abela-Ridder
03 Jun 2015 13:15
A veterinarian injects a dog with an anti rabies vaccine in suburban Manila on March 7 2015, during a free vaccination event. (Jay Directo, AFP)
Human evolution has been inextricably linked with our interactions with animals. Whether for food, transport or security our species
has depended on other animals for millennia.
But this close relationship also comes
Yet, despite being possibly the oldest recognised
disease spread to humans from animals, rabies rarely makes the news. This dog-transmitted
disease – first recorded centuries ago as a terrifying way to die – continues
to be a silent daily disaster for many of the world’s poorest and underserved people.
There is no
cure for rabies once symptoms develop. Bite victims invariably die a slow and painful
death. A disproportionate number are children, those most likely to innocently
play with an infected dog. There is a window of time between being bitten and
developing symptoms when post-bite treatment can work. But this requires
awareness of what needs to be done and the ability to access prompt and
affordable treatment, an impossibility for many of the rural poor. As a result,
most victims die at home.
Since so few rabies cases ever reach health
facilities, health experts have long suspected that official reports seriously
under-represent the true death toll. A recent study puts the figures even higher than feared – at least 160 people every day. Nearly 40% of these
deaths are in Africa alone – more than 20 000 persons annually – just from
reported cases. In South Africa, the death rate is
estimated to be five to 20 confirmed per year,
though many cases are thought to go undiagnosed and un-recorded.
The tragedy is
that these people are dying needlessly. Rabies is 100% vaccine-preventable in
animals and humans. Research shows that rabies can be eliminated from the human
population once 70% of dogs are vaccinated, effectively stopping the disease at
By far the
most effective way approach is mass-vaccination of dogs, coupled with health
interventions, including raising community awareness.
This approach needs strong coordination between the
veterinary and health sectors at all levels, professional and political. But
health bodies may consider that interventions need to be led by their
veterinary counterparts who, in turn, may regard controlling dog rabies a lower
priority than livestock health and production. This weakness, compounded by
factors such as lack of investment and low political will, allows rabies to
Despite these seemingly overwhelming
obstacles, senior health experts are now convinced that elimination of rabies worldwide
is possible. Their confidence stems from a ground-breaking project in
KwaZulu-Natal. Until only recently, KwaZulu-Natal had been plagued by dog
rabies for decades and was home to 80% of South Africa’s human cases of the
disease. Then in 2009 a small village initiative linked vets, medics and the community
to fight the common foe. Local “champions” were trained and supported to
vaccinate dogs, provide post-exposure prophylaxis to bite victims and raise
community awareness. The project spread to reach the entire province of 10-million
people. The impact reduced the recorded death rate from 29 per year in 1995 to zero
in 2014, during the process more than three million dogs have been vaccinated
since the beginning of the project in 2009. In the past two years there have
been no human deaths from rabies in KwaZulu-Natal.
successes have extended further – stopping importation of the disease into the
province and building momentum within other provinces and neighbouring
countries. Prevention is itself infectious. Kenya and Namibia have recently
launched national strategies. Swaziland and southern Mozambique have made
progress with a sister project in Tanzania. Many organisations are getting on
board – not just because rabies control is a worthy cause but also because it is
now demonstrably possible.
Based on this experience,
the World Health Organisation’s Strategic and Technical Advisory Group for
Neglected Tropical Diseases has announced that, with increased investment and
country support, global rabies elimination is now feasible. Africa stands ready
to take up this challenge: the first Pan-African meeting for rabies control in
Johannesburg next month will launch a continent-wide strategy.
Yes, the task seems
daunting. Animal and human health sectors need to work hand-in-hand. Vaccines
and post-bite treatments cost money and need a strong, coordinated delivery
infrastructure. Community mobilisation efforts need to be supported and
this: thanks to the efforts in KwaZulu-Natal, countless children and adults
have been spared an agonising, premature death from this wholly preventable
disease. The rest of the world deserves the same. The response to emerging
diseases this century, such as avian influenza, has shown that the world can
mobilise effectively against new disease threats of animal origin. Surely the
elimination of rabies, our oldest animal-borne scourge, is also worthy of investment?
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