In many countries, rabies is a disease we’re concerned about but one that is rarely seen in domestic animals and is exceptionally rare in people. It’s easy to forget that people in other areas are confronted with a risk of rabies on a regular basis. Canine rabies is a major problem in Africa, leading to major challenges for veterinarians, public health personnel and the general population. Dr. Philip Mshelbwala is a veterinarian in Nigeria, with special interest on rabies research. He holds a certificate in Rabies Surveillance and Control of the University of Lausanne, Switzerland and currently works with the University of Abuja, Nigeria. Philip will be providing some front-line information about the challenges of rabies in Nigeria.
P.P. Mshelbwala: On February 23, 2017 a para-veterinarian brought a 3 month old puppy to the attention of a veterinarian in Gwagwalada, Federal Capital Territory, Abuja, Nigeria following unsuccessful empirical treatment of babesiosis. Further history from the owner revealed that 3 of his puppies were attacked 2 weeks earlier by a stray dog. One of the puppies died instantly from trauma, while the other two survived with bite wound injuries. Veterinary care was not sought until 2 weeks later, at which time unusual behaviour was observed. The para-veterinarian treated the dogs for babesiosis; however, one died during the course of treatment, which prompted him to call the attention of a private veterinarian. On presentation the puppy was recumbent, with clear spasms and muscle tremors . There was marked salivation, unusual violent biting behaviour and vocalization. The puppy was quarantined and died the following day.
The brain was removed and rabies was diagnosed by Fluorescent Antibody Test at the National Veterinary Research Institute Vom, Nigeria. A visit was then made to the house for contact tracing. Following questioning, it was determined that five people, including the para-veterinarian, private veterinarian, an owner, the owner’s security guard and a cousin, were exposed to the puppy. They were all advised to go for full post exposure prophylaxis (PEP), with each dose costing $10. Despite public education to those exposed, the security guard and para-veterinarian refused to undergo PEP.
An outbreak response vaccination campaign was also organized. Notices of vaccination and educational materials were prepared and distributed in all the households in a 50 km radius from the index case by team of 2 veterinarians and 10 veterinary students from the University of Abuja and VET Ville. A total of 220 dogs were immunized using house-to-house strategy. This required the support of many people, including the director Veterinary Teaching Hospital who provided a vehicle and vaccination supplies and the Federal Ministry of Agriculture and Rural Development, who provided the vaccines, as well as the people that did the investigation.
J.S. Weese: This report highlights the challenges of rabies. The cost and time commitments required here were major and it’s impressive that this degree of response was coordinated in such a short time. However, it’s much more cost-effective to vaccinate dogs than to do emergency response. The typical target for canine vaccination to control rabies in a region is 70%… with 70% of dogs vaccinated, eradication is possible. That’s a hard number to reach, especially in areas with large feral dog populations. While emergency response vaccination campaigns are important, more structured, large scale vaccination is needed to reach that goal. Campaigns such as Mission Rabies (something we’ll be reporting on later) are needed for both vaccination and education, with education being a critical and often overlooked aspect. Despite timely intervention, the vaccine couldn’t go around the whole community, as a case was reported in a community nearing that of the index case, three weeks after. Despite the history of dog bite, the para-veterinarian didn’t consider checking for rabies, showing knowledge gap. There is therefore the need to organize a large scale vaccination campaign to target 70% dogs. Also there is the need for large scale public education on rabies, both on radio and television as it is done for other diseases of public health significance. Veterinarians need to be stationed at each local government area to help in surveillance.