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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.
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.
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.