Does it bite? Beating rabies, saving lives

Ferocious but obedient

Stray and tramp

Good-natured

Huge and lanky

Shaggy

Smooth

Brave

These are words that describe man’s best friend; the dog.

But did you know that dogs are the main source of human rabies, contributing up to 99% of all rabies transmissions to humans?

Today we delve into a little-spoken area of science where rabies falls. Zoonosis; a disease which can be transmitted to humans from animals.

It’s been a hundred years since rabies was first reported in a dog in Kenya. And did you know that two out of every five people bitten by suspect rabid animals are children under 15 years? We take a minute to understand this disease.

What is rabies?

Thumbi Mwangi, a Clinical Assistant Professor at the Washington State University, defines rabies as a zoonotic viral disease transmitted to humans mainly through bites by rabid animals.

“Once the virus is introduced through a bite or scratch by an infected animal, the virus finds its way to the brain where it multiplies and symptoms of the disease are manifested. All patients with symptoms of the disease die,” Prof Thumbi said.

Of the tens of thousands of deaths occurring annually all over the world due to rabies, 95% of the cases are reported in Asia and Africa. Closer home and digging from the archives, the first rabies outbreak in Kenya was traced in a dog in 1912 in the outskirts of Nairobi and the first case of human rabies was documented in a woman from the Lake Victoria basin region in Western Kenya in 1928.

Prof Thumbi estimates that about 2,000 people die annually of rabies in Kenya after being bitten by rabid dogs. However, he believes that the true burden of the disease is likely to be underestimated due to under reporting and political neglect in many developing countries. Most of the deaths that occur in Kenya today are due difficulty in accessing timely, affordable, adequate post-exposure treatment. Sadly, there is no effective curative treatment for rabies once clinical signs have appeared. Almost all patients with rabies will die.

The good news is that rabies can be prevented if the person is vaccinated before they start developing symptoms. “Once the symptoms start to show, the disease has spread to the brain, hence little can be done, “he said.

“It is devastating for family members to witness their loved ones descend into madness. What’s worse is that rabies is preventable,’ Prof Thumbi said adding that if we vaccinate dogs we can go a long way to keep humans free from risk of rabies infection.

What do the numbers show on who is mostly affected by dog bites?

“Unfortunately, a majority of these deaths are in children because they are more likely to play with dogs, and when bitten, the bites are in the upper parts of their body which carry more risk of rabies transmission,” Prof Thumbi noted.

The symptoms or rabies include;

• Severe headaches
• Confusion
• Hyperactivity
• Fear of water
• Aggression in animals with an inclination towards scratches and bites

And in case of a suspected dog bite, how do you manage it?

1. Immediate and thorough washing of the wound for a minimum of 15 minutes with soap and running water, detergent, povidone iodine or other substances that kill the rabies virus.
2. Seek immediate treatment at the health facility to receive post-exposure vaccines to prevent you from contracting the disease.

So, how do you handle man’s best friend? Here are four golden rules;

• Never leave a young child unsupervised with a dog – regardless of what type of dog it is and its previous behaviour
• Treat dogs with respect – don’t approach them suddenly, run around screaming in their presence, or interrupt them when they’re eating or sleeping
• Avoid stroking or petting unfamiliar dogs – when greeting a dog for the first time, let it sniff you before petting it.
• Make sure the dog is protected from rabies through vaccination

How can Kenya eliminate rabies?

A 2019 paper by Prof Thumbi and colleagues published in the African Academy of Sciences research portal looks back data in Kenya from 1912 to 2017.  Titled, ‘A hundred years of rabies in Kenya and the strategy for eliminating dog-mediated rabies by 2030,’ observes that for countries that have eliminated rabies, this has been supported by scientific findings that domestic dogs are the reservoirs of the rabies virus and not wildlife, and that most dogs can be reached for parenteral vaccination. (Vaccines are usually administered by injection).

In another 2019 paper done in Siaya County by Prof Thumbi, Emmah Kwoba and others on dog health showed that majority (61%) of the dogs were allowed to roam freely, 38% had their movement partially restricted while 1% of the dogs had their movement strictly confined within the household all the time and only 5 % of the dogs had been vaccinated against rabies.

The study further noted that a large population of unvaccinated dogs supports widespread circulation of rabies and although the majority of the dogs are free roaming, they were owned and are likely to be available for vaccination when campaigns are organized.

Prof Thumbi puts each one of us to an economic challenge whenever we delay or ignore vaccinating dogs. Is it cheaper to get the dog vaccinated or to have the rabies vaccine after a dog bite?  Let’s do some maths here;

“The cost of vaccinating a dog is less than 100 Kenyan shillings whereas the cost of a full dose of vaccinations for a person bitten by a suspected rabid dog is easily 10,000 shillings,” he said.

So, what needs to be done?

Prof Thumbi acknowledges that Kenya has already made a commitment to end rabies by 2030, and is leading Africa in this quest.

“A rabies elimination strategy for Kenya has been launched, a National Rabies Elimination Coordination body is in place, and some counties such as Makueni has started vaccinating their dogs,” he says adding that more counties should be proactive in eliminating rabies disease in Kenya.

A January 2019 publication in the Lancet journal of Infectious Diseases  by Thumbi and colleagues demonstrate that even if people who have been bitten get to a treatment centre and post-exposure treatment is available, its cost is often unaffordable.

What next?

Prof Thumbi calls for mass dog vaccination where at least 70% of the dog population should be covered in order to break the cycle of transmission in dogs, and to humans.

Prof Thumbi is optimistic that elimination of rabies is possible, and there have been success stories including in Kwa Zulu Natal in South Africa, and in developing countries including Philippines and Bali in Indonesia.

He is optimistic that if and when everyone is on the table, Kenya will be on her way to become the first country in Africa to eliminate rabies.

‘Our success will be closely watched by other African countries, which continue to experience huge losses of human lives due to rabies,’ Prof Thumbi concluded.

So is your dog vaccinated?

And if you do not own one, what about that neighborhood dog that’s always playing with your children?

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