Rabies is a disease that’s met with an interesting mix of inherent fear and dismissiveness in most developed countries, where canine rabies has been eradicated. It’s also a disease that’s often poorly understood in areas where it causes large numbers of deaths. As an almost completely preventable disease (with proper post-exposure treatment), and one for which we have highly effective vaccines (for people and animals), barriers to accessing these critical prevention tools need to be assessed.
Like a lot of things in infectious diseases, the science is (relatively) easy. Application of the science is another story.
As we recognize World Rabies Day, here’s a post from Dr. Philip Mshelbwala, a colleague and collaborator from Nigeria who is currently studying rabies at the University of Queensland.
Why we need to boost community knowledge in rabies endemic countries
Over 59, 000 people die due to rabies each year, the vast majority in Africa and Asia, where the domestic dog is the major culprit. The World Health Organization (WHO) and other partner organizations have targeted the year 2030 for elimination of dog-mediated rabies. In order to achieve this aim, people in endemic countries need to know how to recognise the disease and report it to appropriate authorities for effective action as well as discourage practices that may hamper its control.
This is just one example of barriers that are present.
In June, a dog was presented to a private veterinary hospital in Umuahia, Abia State, Nigeria as a suspected case of rabies. The dog was bitten by a stray dog on the foreleg some weeks back. The dog had been vaccinated against typical canine diseases but not rabies. It had a clearly identified risk factor for rabies and had clinical signs consistent with rabies… anorexia, drooling, loss of tongue tone… but the owner treated it initially with coconut water as a local cure for suspected poisoning. As the dog deteriorated, veterinary care was sought and the veterinarian immediately suspected rabies. The owner was informed and the dog was taken home.
The veterinarian contacted the state epidemiologist and senior colleagues for guidance. However, by the time the owner was reached the next day, the dog had been slaughtered and eaten. Testing could not be performed but rabies was most likely.
This case highlights one of the many challenges of rabies control in developing countries. The mere attack by a stray dog should have pointed his attention to rabies in an endemic area, leading to prompt isolation of the dog and investigation of the need for post-exposure treatment of human contacts. Too often, case reports like this are prompted after a human death, such as a bite to children in the household or someone caring for the sick dog. Fortunately, that was not the case here, but that was more related to luck rather than any measures taken to prevent rabies in the exposed household.
Various educational opportunities are highlighted by this case.
The owner of the dog went to the cost and effort of getting their dog vaccinated but failed to have it vaccinated against rabies. Most dog owners in Nigeria are aware of common canine diseases like parvoviral enteritis, because it commonly affects dogs at their early stage of life, with a high mortality rate. Unfortunately, with less knowledge of rabies (despite the ever-present threat in the area), rabies vaccination was not elected. Education of owners about the rabies, including the need for vaccination, remains an important need. An ability to access rabies vaccination is also needed, another issue in some areas because of availability or cost barriers. Education about dog bite avoidance and when to seek medical care is also needed. Parallel education of human and veterinary healthcare providers to ensure appropriate responses to rabies exposures or questions is also critical.
Many opportunities were missed in this case, including many aspects of disease prevention, diagnosis, human healthcare and education. Testing of the dog would have allowed for a definitive diagnosis, and if positive, would have prompted contact tracing and post-exposure vaccination (provided there was adequate access to supplies and healthcare… another issue in some developing regions). Diagnosis also helps increase awareness, potentially leading to different behaviours and more vaccination. For Nigeria to eliminate rabies, the general public need to be empowered with good knowledge about rabies and how to prevent it.
2030 is an optimistic date for elimination of dog-mediated rabies in people. Is it still realistic now that we’re well into 2020? Probably not. Does that mean we should give up? No. Whether it’s 2030, 2040 or some other date, elimination of canine rabies is an important goal and one that is achievable with the right support.