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On
28 September – World Rabies Day – rabies experts at WHO and around the world
are highlighting dog vaccination programmes as the most effective way to reduce
the risk of this disease that kills around 50 000 people every year.
September 2012
When a boy playing in the street in
Mumbai is bitten by a dog, he probably won’t tell anyone because he is scared
he will be punished for playing with dogs. This is a particular problem if that
dog has rabies. By the time the boy starts showing signs of the disease, it
will be too late to save his life. Symptoms, (which include fever,
hyperactivity, excited behaviour, difficulty swallowing or paralysis) may
appear any time between 2 to 8 weeks after the bite. The victim then usually
dies painfully in less than a week.
World
Rabies Day highlights dog vaccination programmes
On 28 September – World Rabies Day –
rabies experts at WHO and around the world are highlighting dog vaccination
programmes as the most effective way to reduce the risk of this disease that
kills around 50 000 people every year. Worldwide, dog bites are the cause of
almost all human rabies’ deaths, with much smaller number of cases occurring
each year from other domestic and wild animals, including bats.
“We have all the tools to eliminate rabies but
it’s an uphill battle to bring the disease to the limelight to initiate and
sustain large-scale, regional rabies elimination programmes,” says Dr
François-Xavier Meslin, from WHO’s Department of Control of Neglected Tropical
Diseases.
Asia
and Africa – 95% of human deaths
Potentially dog rabies threatens
over 3 billion people in Asia and Africa where more than 95% of human deaths
occur. Although the disease is present in more than 150 countries, China and
India together carry more than a third of the world’s health burden, with
thousands of rabies deaths per year.
WHO
recommendations
Rabies is a particular threat to
poor people living in rural settings where there are no measures to control the
disease in animals, low awareness of the need to seek health care after a dog
bite, and limited access to human rabies vaccines.
If a person is bitten or scratched
by a suspected rabid animal, WHO recommends immediate thorough cleansing of the
wound, multiple rabies vaccine injections and, in severe exposures,
administration of rabies immunoglobulin.
Cost-effectiveness
of rabies vaccination
Every year around the world more
than 20 million people are vaccinated against rabies after being bitten. Around
40% of them are under the age of 15. The cost of the full treatment is around
US$ 100. As this is equivalent to several months of income for many households
in Africa and Asia, a suspect bite can cause a lot of financial stress and
force families into debt to pay for the entire treatment schedule.
“Vaccinating dogs is a
cost-effective proposal in the long term as human post-exposure treatment is
not needed in rabies-free areas,” says Dr Meslin. Dog vaccination costs are as
little as US$ 0.50 per dog.
Kevin Le Roux, from the Department
of Agriculture in the South African province of KwaZulu-Natal manages a project
funded by the Bill & Melinda Gates Foundation that has cut the prevalence
of rabies in dogs by more than half in just 3 years.
“For the first time in 20 years, we
have had a period of 12 months in which there were no human deaths from the
disease in the province,” he says. “In KwaZulu-Natal, the number of humans
affected by TB or HIV by far exceeds that of rabies victims. But rabies is such
a horrific disease. It’s always deadly and we can stop it at relatively little
cost.”
Challenges
to controlling rabies in dogs
Controlling rabies in dogs is not
without challenges. One of the main hurdles is getting political commitment and
community support, says Dr Gyanendra Gongal, a scientist from WHO’s Regional
Office for South-East Asia. “In many Asian countries, the domestic dog is
neglected by veterinary services because, unlike livestock, they are not an economic
commodity,” he says. “Stray animal control often comes under the jurisdiction
of local governments and it can be a challenge to work with so many local
authorities.”
Dogs thrive in urban environments,
particularly near markets where food is easily accessible. Even dogs that have
owners are often left free to roam the streets.
WHO collaborates with animal welfare
organizations to promote “catch, vaccinate, sterilize and release” activities
and encourage responsible dog ownership as part of comprehensive human and dog
rabies control programmes.
“Neighbouring countries need to work
together to tackle this disease,” says Dr Gongal. “Infected dogs incubating the
disease can be transported by motorcycle, boat or car over large distances.
This can spread the disease to rabies-free areas, as has happened in Indonesia,
and across national borders.”
Targets
to eliminate rabies
Latin American countries have set
targets to eliminate human and dog rabies by 2015. Countries in South-East Asia
aim to do the same by 2020. Significant progress has already been made in
particular in Sri Lanka, where mass dog vaccination has reduced rabies deaths
from more than 350 in 1973 to 50 in 2010, and in Thailand where mortality from
rabies has fallen from 170 deaths in 1991 to 7 in 2011.
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