Strategies key for elimination of rabies

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Veterinarian giving vaccination injection to dog at 11th World Rabies Day ceremony in 2017. Photo: MNA
  • By: Dr. Than Aung Soe

Rabies is an infectious viral disease that is almost always fatal following the onset of clinical symptoms. Rabies is also called the Hydrophobia (fear of water). People with furious rabies exhibit sings of fear of light and loud sound. Death occurs after a few days due to cardio-respiratory arrest.
In the world, a person dies of rabies infection every nine minute. Despite it being easily preventable and controllable, for many reasons there is one human fatality from this disease every eight minutes, some statistics show that every fourteen minutes in the world.
Rabies is mostly present in Asia and Africa, and Myanmar also shares the burden of rabies infection.
Myanmar sees about 200 deaths of rabies annually. About 40 per cent of victims bitten by a suspect rabid dog are children under 15 and it was found that they were bitten by the dog while they were playing near it.

Rabies is a viral disease that causes inflammation of the brain in humans and other mammals. Early symptoms can include fever and tingling at the site of exposure. These symptoms are followed by one or more of the following symptoms: violent movements, uncontrolled excitement, fear of water, an inability to move parts of the body, confusion, and loss of consciousness. Once symptoms appear, the result is nearly always death. The time period between contracting the disease and the start of symptoms is usually one to three months, but can vary from less than one week to more than one year. The time depends on the distance the virus must travel along peripheral nerves to reach the central nervous system.
Rabies is caused by lyssaviruses, including the rabies virus and Australian bat lyssavirus. It is spread when an infected animal scratches or bites another animal or human.Saliva from an infected animal can also transmit rabies if the saliva comes into contact with the eyes, mouth, or nose. Globally, dogs are the most common animal involved. In the Americas, bat bites are the most common source of rabies infections in humans, and less than 5% of cases are from dogs.

Post-exposure prophylaxis (PEP)
Post-exposure prophylaxis (PEP) is the immediate treatment of a bite victim after rabies exposure. This prevents virus entry into the central nervous system, which results in imminent death. PEP consists of:
• extensive washing and local treatment of the wound as soon as possible after exposure;
• a course of potent and effective rabies vaccine that meets WHO standards; and
• the administration of rabies immunoglobulin (RIG), if indicated.
Effective treatment soon after exposure to rabies can prevent the onset of symptoms and death.

Extensive wound washing
This involves first-aid of the wound that includes immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.

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A dog lover feeds stray dogs in Yangon. Photo: Phoe khwar

Six Major Diseases
More than 99% of rabies cases in countries where dogs commonly have the disease are caused by dog bites. The World Health Organization-WHO, the Food and Agriculture Organization and the World Organization for Animal Health-OIE included the rabies in the three major diseases of the world. In Myanmar, Ministry of Agriculture, Livestock and Irrigation, Ministry of Health and Sports, Ministry of Natural Resources and Environmental Conservation considered the rabies as the most important diseases in the six major diseases (Zoonoses) of the country.
According to the latest figure, there are about 3.8 million dogs in Myanmar. From 150,000 to 200,000 people suffers from dog bites every year. There are over 180,000 cases in 2017 and over 190,000 in 2018 cases of dog bites in 2018. The most suspect cases of rabies were found correct after laboratory tests.
In up to 99% of cases, domestic dogs are responsible for rabies virus transmission to humans. Yet, rabies can affect both domestic and wild animals. It is spread to people through bites or scratches, usually via saliva.

The rabies virus is found in many animals. Bats are also the ribies virus carrier and it impossible to eradicate the disease as they carry the virus without suffering disease. We have to manage to reduce and to eliminate the disease. Meanwhile, WHO set an objective of “Zero Deaths by 2030”. The World Rabies Day is observed on 29 September.
This year’s motto for the World Rabies Day is “Rabies: Share The Messages Save a Life.”

Eliminating rabies in dogs
Rabies is a vaccine-preventable disease. Vaccinating dogs is the most cost-effective strategy for preventing rabies in people. Dog vaccination reduces deaths attributable to rabies and the need for PEP as a part of dog bite patient care.

We have a global framework that consists of socio-cultural, technical, organizational, communication, political, guidelines, resources, and acquiring funds. ASEAN has also laid down these strategies. Doctors, veterinarians and experts in Myanmar are also informing the public about rabies in the newspaper, magazines, journals, and on TV. Ah Raw Jan magazine wrote an article on how ignoring a drop of blood or a scratch from a dog can lead to fatalities.

Vaccination is needed
Cats are just as likely as dogs to have rabies; therefore, they must be vaccinated as well. It’s a safe bet to vaccinate both cats and dogs once a year starting from three months old. The main problem are the stray dogs. If we look at the states and regions, the problems mainly occur in Yangon, Mandalay and Bago regions where there are a lot of stray dogs. The city development committees used to feed poison to the stray dogs but now dog lovers and animal welfare standards don’t accept that. It’s a socio-cultural issue. The Myanma Livestock Journal wrote an article about how a doctor called to treat to a poisoned dog was angrily confronted by a staff following orders to feed poison to the dogs.

Cooperation between departments
This is intended to raise public awareness, and we need to increase our actions. Some time ago there was a canine sanctuary opened in Mandalay that took in stray dogs. Now you can see dog lovers banding together to help stray dogs on social media. All the departments in every township should cooperate on protecting stray dogs, spaying or neutering them, and vaccinating them for rabies under a set guideline.
Protecting both dogs and humans
Officials should collaborate with donors, local and international groups, NGOs, and INGOs to systematically vaccinate stray dogs. The OIE used to donate rabies vaccinations for 400,000 dogs in Myanmar. The Ministry of Health also purchased rabies vaccination for people. In 2015-2016 FY the ministry purchased 400,000 vaccinations, in 2016-2017 FY they purchased 450,000, and in 2017-2018 FY they purchased 330,000 vaccinations and 30,000 RIG cure medicine. These medicines have been spread throughout the hospitals in the states and regions.
It would be convenient if the Union Government sets a detailed plan to vaccinate stray dogs. It will also reduce costs. If we can vaccinate at least 70 per cent of stray dogs then it will greatly reduce risk of them contracting rabies. The number of foreign tourists will also increase if there is no fear of getting rabies. It has been experimented in Lewe, NyuangU, and Hmawby townships. We need to start working to eradicate rabies now. We must conduct research, connect with relevant organizations, set guidelines, and make financial plans which includes protecting humans and dogs by providing vaccinations and safeguarding them.
Even if we cannot safeguard all the stray dogs in the country yet, we should at least make budget plans to spay them. Officials should heed the need for systematic planning to curb rabies and save both animals and people.
Translated by Pan Dar Li

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