Vaccinate to Eliminate: Rabies kills, kill rabies!

28th September is World Rabies Day. It takes place each year on this date, the anniversary of the death of Louis Pasteur who, with the collaboration of his colleagues, developed the first efficacious rabies vaccine. This is a day that is commemorated to create awareness for rabies prevention. This year’s theme is “Rabies: Vaccinate to Eliminate” and focuses on vaccination as the foundation of all rabies control efforts. In this article, I discuss this theme by defining what rabies is, the devastating impact of rabies on public health, challenges of rabies control in Zambia and end with what you should and should not do after a dog bite.

What is rabies: Rabies is a zoonotic (transmitted from animals to man) viral infection of the central nervous system that is reported to be one of the world’s most deadly diseases (Bourhy et al., 2010).

The devastating impact of rabies on public health: Rabies has a mortality rate of 100% once symptoms occur. It kills approximately 25,000 people annually in Africa. This mortality rate translates to one (1) death in every 20 minutes (Dodet et al., 2015). Children under the age of 15 are the most affected, with four (4) out of every ten (10) deaths (Dodet et al., 2015).

Challenges of rabies control in Zambia
In Zambia, rabies is endemic, and it is mainly transmitted and maintained through domestic dogs. The prevalence of rabies in human and dogs in Zambia is unknown due to the lack of accurate data because many cases go either unrecorded or unnoticed. Rabies, despite being a deadly disease, it is classified under Critically Neglected Diseases (CNDs). Many cases of rabies in Zambia are not reported due to many reasons, among them socio-economic, political, institutional and technical factors. Despite the general increase in the burden of rabies in Zambia, the disease remains neglected with the highest-burden among the rural poor communities. Conversely, in certain medical circles, the disease is classified as a zoonotic disease of poverty due to the high burden that is experienced in remote poor settings. What could be the reasons behind increasing cases or failure to control rabies in Zambia? Among them are;

• Weak inter-sectorial collaboration among involved ministries,
• Absence of programs to track, prevent and control the disease,
• Absence of data on the burden of rabies disease making prioritisation of resources towards interventions difficult,
• Lack of health promotion and education: crucial role of pet owners in ensuring vaccination mostly not understood by most owners,
• Weak One-Health concept framework making recognition of roles and responsibilities of each stakeholder, as well as budgetary allocation challenging and in most cases non-existent,
• Weak legislation coupled with lack of willingness to enforce,
• The unwillingness of the private sector to support rabies elimination measures, i.e. mass vaccinations,
• Lack of awareness on both the general public and the technical personnel.

What do you do if a dog or cat bites you?
If a dog or cat has bitten you, whether it is healthy or sick;
• It would help if you quickly wash the wound with plenty of clean water,
• Immediately after washing report to the nearest police station then the police will issue a dog bite form,
• The victim, dog owner and dog, reports to a veterinarian with the police report and rabies certificate,
• The veterinarian recommends how the case is handled by the hospital (whether to receive injections of Post Exposure Prophylaxis or not) based on the physical examination of the dog and validity of the dog’s vaccination status.
The dog or cat responsible for the bite, whether vaccinated or not, should be confined and closely observed for a minimum of 10 days in case it develops signs of rabies. If the animal responsible for the bite is a stray, it should be destroyed or euthanized immediately as soon as possible and submitted for laboratory examination.

What shouldn’t you do if a dog or cat bites you?
Avoid using traditional methods (mwambo wa makolo) such as:
• Use of traditional herbs and tattoos,
• Use of hair from the tail tip or shoulder of a dog that has bitten you,
• Hiding from your parents that a dog has bitten you for fear of being scorned or receiving five (5) or more injections. This is common among kids and needs to be demystified.

Further, World Rabies Day is an opportunity to reflect on efforts to control this deadly disease and to remind ourselves that the fight is not yet over. The Global Alliance for Rabies Control (GARC) (https://rabiesalliance.org/world-rabies-day) recommends that we commemorate this year’s World Rabies Day’s theme, “Rabies: Vaccinate to Eliminate”, by raising awareness at many levels for instance:
• Let us use this theme as a reminder to dog owners, animal health professionals, Ministry of Local Government (respective local councils), Ministry of Fisheries and Livestock (Department of Veterinary Services), Ministry of Health etc. to ensure that dogs are kept vaccinated and that adequate stocks of Post-Exposure Prophylaxis are available in clinics. It is a legal mandate for every dog or cat to have them vaccinated against rabies.
• Let us use this theme as a reminder to human health professionals and educators in the Ministry of Health to help people in need to seek and obtain Post Exposure Prophylaxis.
• Let us use this theme as a reminder to the Government of Zambia through respective ministries to commit to the 2030 goal of eliminating rabies deaths though putting resources into rabies elimination.

This years theme, “Rabies: Vaccinate to Eliminate” reminds us that it is economically cheaper to vaccinate a dog which will cost about K20-50 per dog compared to human Post Exposure Prophylaxis (injections) after a dog-bite which costs more than K250-500 per person depending on location. It does not matter whether you own a dog or not; we are all susceptible to dog bites. Remind your neighbour, friend, relative, to take their dogs and cats for rabies vaccination. Rabies kills, kill rabies!

(The author is a Senior Lecturer of Livestock/Animal Health Economics at the University of Zambia, School of Veterinary Medicine. Email: cmumba@unza.zm, Mobile: +260977717258)

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