Authors: Tiyeyosibina Jegede, Gacheri Damaris, Ifteqar Hassan.
Rabies is one of the most overlooked zoonotic and fully vaccine-preventable viral diseases with 100% case fatality rate. Rabies is caused by rabies virus which belongs to the genus lyssavirus and family Rhabdoviridae. Warm blooded vertebrates such as dogs and bats serve as the natural host for the virus though research shows that the infection may be spilling over to cold blooded animals causing further risk to the human population. These animals pass the infection to the humans via a bite or scratch. Even after exposure, a timely post-exposure prophylaxis can prevent death, however, after clinical signs and symptoms appear following a bite, treatment is almost ineffective and mortality is inevitable.
On an average, rabies causes about 60,000 human deaths with a chunk coming from Africa and Asia. Recently, several major international organizations have come together to authorize the global goal of elimination of deaths caused by rabies in humans by 2030.
In Asia, 96% of human rabies causes are often as a result of dog bites. In this region, approximately 35,000 human deaths (accounts for 59% of global deaths) happens per year, while in Africa, an approximate of 22,000 human rabies deaths are documented per year. India is the leading country which accounts for most human rabies deaths. After India, China is another country that experiences the most severe impact of rabies. In the WHO southwest Asia region, 8 countries are endemic to rabies leaving about 1.4 billion people at risk of being infected by rabies.
Recent studies have concluded that most people become rabies victims as a result of ignorance, carelessness and poor or unavailable primary health care services. The incidence of rabies is high in children in poverty-dominant areas (where hospitals that are equipped with rabies vaccines or treatment methods are located in the urban areas) and they end up not being noticed or reported which reduces the chances of availability and access to post exposure prophylactic treatments, leaving a high number of children getting infected and dying with undiagnosed rabies. There are various impediments that some countries in south and southeast Asia share for the control of rabies. Such as insufficient help, lack of political obligation to control strategies, lack of consensus on strategy, weak intersectoral coordination and insufficient management structure, improper surveillance strategies, limited access to rabies vaccine and supply chain problem, lack of public perception and cooperation and prevalence of misconceptions and religious fact.
The endemic nature of the disease has led to economical and socio-psychological effects on the affected populations because of lack of manpower and decreased productivity due to loss of lives as well as emotional effects of dealing with bites from rabid animals. This has led to a vicious cycle of cause and effect.
In Africa, kenya has placed rabies as one of the top five zoonotic diseases that affect people in the country and it is estimated to cause an average of 2000 deaths each year in the country, and in the past 3 years, they have launched strategic plans that would steadily decrease deaths in humans caused by rabid dogs making the country free from the disease by 2030.
Strategies that have been implemented in the elimination of rabies are vaccination of dogs annually, (Pre-exposure vaccination of both dogs and humans with an emphasis to vaccinate all dogs, even the free ranging ones, has proven to be an economical and simple way of putting an end to the endemic disease), provision of prompt post exposure prophylactic treatments to persons bitten by suspected rabiddogs, organization of campaigns and awareness against rabies and also importance of vaccination of dogs against rabies. In very remote communities, paying home visits for both animal and human vaccination for the high risk population. Also, promotion of accountable pet ownership and dog population control programmes in the prevalence area in a collaborative manner e.g: like One Health approach at all level with other organisations, expanding the disease surveillance system in different areas, promote and perform operational research program in a susceptible area, expanding communication and advocacy, enhancement og partnership and collaboration with government and NGO’s can contribute to eliminating rabies by 2030.
REFERENCES
US national library of medicine National institute of health; Human Rabies in the WHO southwest Asia Region: Forward steps for elimination, 2011.
Thumbi Mwangi , the conversion. 2017.
International Student One Health Alliance 