Sunday Times 2
Fatal viral illness is 100% preventable
The Global Alliance of Rabies Control marks World Rabies Day, today, with the theme ‘Together Against Rabies’. The World Health Organisation (WHO) estimates that over 60,000 people die of rabies annually the world over. Rabies is prevalent in more than 150 countries, including Sri Lanka. (The actual number is believed to be in the range of 75,000 deaths annually).
Of these unfortunate deaths, nearly 99% take place in poor countries. It is even sadder that between 40 to 50% of these victims are children less than 15 years of age.
The largest contribution has been from Asia where the estimated death toll is over 50,000. Dog bites have been responsible for more than 98% of deaths due to human rabies.
As described by the world health governing body, the WHO, it is well and truly a neglected disease. Since it affects the poorest of the poor and voiceless people in developing countries, there is no visible and palpable political commitment and priority to handle this global situation.
Historical aspects of Rabies (Hydrophobia)
Rabies is perhaps the oldest communicable disease known to the mankind. The bond between man and dogs had its beginning many millennia ago somewhere in Eurasia where a reciprocal relationship between them first emerged. The Greeks called rabies lyssa or lytta, which means “madness”. The Latin world rabere means rage or rave.
Rabies became widespread in Northern, Western and Eastern Europe during the 19th century A.D. The Anti Rabies Vaccine was discovered by Louis Pasteur in 1885 in France.
Rabies is a 100% preventable, yet once acquired, 100% fatal viral illness affecting the central nervous system (brain) causing encephalomyelitis, potentially affecting any mammal (cattle, even elephants!). The disease in man was described as Hydrophobia (fear of water). The patients with established rabies develop spasms of the throat for water or even at the sight of water.
It has a relatively long incubation period (time taken to manifest the disease after entry into the body), usually a few weeks to three months. But it could be as short as 10 days or as long as one / two year(s) depending on the extent of the bite (exposure level) and closeness to the head (brain fever) /face.
The early symptoms of rabies are fever and often pain and unusual unexplained tingling, pricking or burning sensation at the wound site. As the disease progresses, symptoms of encephalitis (brain) will appear and the sufferer will face death within a few days.
Rabies in dogs
Two forms can exist:,
1. Furious type – excited behaviour, hyperactivity – going on attacking people and other animals.
2. Dumb rabies – dogs are quiet and sleepy (may be more dangerous as far as transmission in concerned, particularly with children for non recognition of the problem)
After a dog bite
Cleaning the bite site immediately with running water and soap (or any disinfectant) for about 15 minutes is the most important step in prevention of rabies. If soap is not available immediately, one should not delay washing with water. Immediate washing with water is crucial.
Once the wound is thoroughly washed, seek medical advice for vaccination. At a medical facility, the doctors are trained to assess the situation. If the patient falls into the severe exposure category, the patient must be given both Anti Rabies Vaccine (ARV) and Serum (Immunoglobulin – Ig).
One golden rule: if bitten by a stray dog (where the dog’s whereabouts are not known), the patient must receive both ARV and Serum (Immunoglobulin). There should not be any compromise or deviation from this position. (The injection given as tetanus toxoid to prevent tetanus should not be confused with ARV). The patient must make sure that the entire series of vaccination is completed.
It is important to note that all dog bites do not cause rabies. For someone to develop rabies, the suspected dog must be harbouring rabies virus at the time of bite (the animal has to be infectious).
Rabies in Sri Lanka
Although the number of deaths due to human rabies have been on the decline over the last a few years, the government spends an inappropriately large amount of money to prevent deaths due to human rabies. The majority of funds is spent on post exposure (after animal bites) prophylaxis or treatment. What should ideally happen is prevention of dog bites rather than giving vaccinations after dog bites as the latter is always very expensive.
Eradication of Rabies
Since rabies is a public health issue, community participation and support are essential prerequisites to eradicate rabies. Since Sri Lanka has an excellent literacy (over 90%) – especially female literacy, one can assume the appropriate message can easily be disseminated across the population.
To eradicate rabies, over 75% of dogs (particularly stray dogs) have to be vaccinated within a short period of time (4 – 6 weeks). Is it achievable in our country? We have over 2 million dogs in Sri Lanka and more than 50% would be completely stray dogs.
Our people, regardless the social and educational level, tend to believe that feeding stray dogs with their leftover food is a meritorious act. This encourages the growth of stray dogs in our environment. Our environment should be kept clean, devoid of food and stray dogs should not be fed. This will mwake the stray dogs leave the particular locality seeking food elsewhere. If the entire country adopts the same, it will lead to gradual decline of stray dogs.
Sri Lanka is close to achieving near eradication of human rabies. Hence, if we all make a strong commitment in the right direction we could make our country rabies free.
Removal of stray dogs and killing them would not offer a long term solution. As long as puppies are abandoned on our streets, irresponsible disposal of our garbage consisting of food and feeding strays with leftover food, the stray dogs will continue thrive and breed faster than our removal.
Therefore, the approach ought to be from multiple fronts.
Creating public awareness by health education and community participation, increase availability of vaccines, having a stray dog free community, exhibition of increased community responsibility and the political commitment are essential if we were to eradicate rabies from our country.
Of all these, the most effective, important, simplest, and the cheapest step that the general public can take is to stop feeding stray dogs
Achievement of stray a dog free environment is the way forward to eradicate rabies and it will create a safer environment for our children.
( The writer is attached to the Department of Community Medicine, Faculty of Medicine, Peradeniya.)