The Spotlight Should Be On Rabies



By Dr Katy Johnson

An email came across my desk last week posing an interesting question, "Why are we so concerned with swine flu and avian flu, yet nobody talks about rabies?"

It's an interesting question. Especially when considering the World Health Organisation (WHO) rates it as one of the top ten infectious causes of death. Unsurprising really, when you consider 50,000 people die every year globally as a result of rabies and over 10 million people have receive post-exposure treatment. Perhaps rabies doesn't get the exposure it deserves because many of the first world countries that drive the news have successfully eradicated rabies from their shores?

The ability to successfully eradicate rabies is the irony of a disease that kills thousands of individuals around the globe every year. The rabies virus is transmitted in the saliva of rabid animals and is passed as a result of being bitten, licked or scratched. Transmission can also be a consequence of predation. This is often the case with wild animals that have come into contact with domestic carriers of the disease. Stray dogs living on the boundaries of National Parks are a particular threat to predators such as lions, leopards, hyena and wild dog.

"Luckily in the Kruger National Park we have only ever had one case of rabies in a wild animal", explains state vet Lin-Marie de Klerk-Lorist, "that was a side-striped jackal at Orpen Gate. Unlike domestic animals with rabies that often become more aggressive, wild animals will appear tamer. This increases the risk of humans contracting the disease, as the temptation to approach them is much greater".

"In many respects we are incredibly lucky in the Kruger National Park that there are not more cases of rabid animals. In the communities neighbouring the Park rabies is rife. There is always an interface between wild and domestic animals and so transmission is inevitable. However the private reserves on the western boundary act as a buffer. These reserves tend to have very good road networks and border patrols, so domestic animals crossing into the reserves are quickly picked up and dealt with."

All this is doing however, is dealing with the effects of rabies rather than addressing the cause and the sad fact is the cause could be addressed. Rabies vaccinations have been used effectively in many countries to effectively control and eradicate rabies, saving hundreds of lives every year.

Once the symptoms of rabies present themselves then an excruciatingly painful death is inevitable. In 2008 it is estimated that over 24,000 people died of rabies in Africa, most of whom were children. Initial symptoms are flu like, mild fever, itching at the bite site, headaches, nausea and loss of appetite. Full blown rabies then develops in one of two ways; either as ‘paralytic rabies', or ‘furious rabies'. Paralytic rabies is where the patient experiences an ascending flaccid paralysis.

Whereas furious rabies results in hallucination, hydrophobia, fluctuating consciousness and finally culminates in respiratory spasms and cardiovascular arrest.

If you do find yourself bitten by a rabid animal, don't despair, as the prognosis is not totally hopeless. Rabies can be treated if action is taken immediately. It is essential to rinse the wound under running water for 15 minutes prophylactic before seeking emergency help. The same prophylactic drugs used to vaccinate humans and animals can also be taken post-exposure. The prophylactic vaccination, as well as additional immunoglobulin treatment, is administered on days 0, 3, 7, 14 and 28 after being in contact with a rabid animal.

Prevention however, is always better than a cure. Using a preventative vaccination rather than a treatment is what we should aspire to. In South Africa, all animals over three months are required by law to be vaccinated; unfortunately very few domestic dogs are, despite initiatives providing vaccination for free. Now out of desperation some of the private reserves have started to vaccinate their wildlife, but unless domestic pet owners mirror this then their efforts might be in vain.

It is unlikely Africa will ever be free of rabies. The continent is too vast, and resources are already overstretched. Yet if everyone takes a stand and ensures their pets are vaccinated then it is a massive step in the right direction.



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