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9 October 2014

Preventing rabies: the dog jabs that can save humans

Responsibility for treatment of infected people falls on human health services. It is difficult to create an alliance against rabies until animal and human health experts co-ordinate.

By Michael Brooks

By the time you read this, more than 3,000 people will have died in the current Ebola outbreak in West Africa. Barack Obama has said that the world is not doing enough to counter the disease. This may be true but there are other diseases more worthy of an international collaborative effort.

Ebola has a strange power over us. Its rapid spread and dramatic symptoms (bleeding from the eyes, for instance) and high kill rate evoke a panic response. But as Seth Berkley, who leads the Global Alliance for Vaccination and Immunisation (Gavi), has said, we should probably be more concerned about the resurgence of measles, the persistent killing power of dengue shock syndrome and the creeping number of cases of rubella and pertussis, also known as whooping cough. And then there’s rabies. The disease has an almost 100 per cent fatality rate, accounting for 69,000 deaths a year. It kills 75 children each day. The progression of the disease is, like Ebola, a slow agony that ends with multiple organ failure. But unlike Ebola, this disease is entirely preventable – and has been since 1885, when the first vaccine was developed.

In the 26 September issue of the journal Science, a group of researchers called for mass dog vaccination to counter the threat. Their pilot programme in Tanzania achieved 70 per cent immunity in the dog population by administering a rabies vaccine. This was enough to reduce the human rabies infection rate in the region from 50 per year to almost zero.

The main reason the rabies threat hasn’t been tackled is what the researchers term the “responsibility gap”. As they point out, the only infectious diseases we have ever eradicated are smallpox and rinderpest. One is an exclusively human infection; the other exclusively animal. Dogs, which are the main reservoir for the rabies virus, are the province of veterinarians. Responsibility for treatment of infected people (95 per cent of whom are in Africa and Asia) falls on human health services. It is difficult to create an alliance against rabies until animal and human health experts co-ordinate to pool funding.

It wouldn’t take vast resources. A dog vaccination programme would cost significantly less than is spent on treating people who have been exposed to the virus (the saving would be particularly valuable in Asia, where 90 per cent of such treatments take place). Initially, vaccination requires about $200 per square kilometre, the researchers estimate. Once the local pooches are rabies-free, the cost of maintaining the required 70 per cent immunity is about half that.

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And don’t be sidelined by the myth that roaming packs of strays are a problem. Studies show that less than 11 per cent of dogs in African countries are ownerless and the trial programmes have successfully vaccinated what the researchers coyly term “community dogs”.

Not that rabies is an exclusively canine issue. The most recent death in the UK, which occurred in 2002, came from a bat bite. That’s also true of the US: in 2011, a woman in South Carolina died of rabies after being bitten by a bat that had flown into her bedroom. Yet bats are not big reservoirs for the virus. In the UK, the infection rate is about ten per 12,000. The last time a British bat was found to be carrying rabies was in 2008.

This low level of bat-borne infection may be because we have been so successful with our canine immunisation programmes. Research in Africa suggests that other animal species in the locality become rabies-free once local dogs are immunised.

What is needed now is a coalition committed to make that happen. Ebola can wait.

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