With most industrialized countries said to have eliminated rabies from domestic dog populations, the report however has it that Africa accounts for 36.4% of the 59,000 rabies deaths in humans annually.
According to a World Health Organization report, the estimated rabies deaths are due to widespread underreporting and uncertain estimates, it is likely that this number is a gross underestimate of the true burden of the disease which is said to be disproportionally borne by rural poor populations and half the cases attributable to children under 15.
Rabies considered to be one of the world’s most deadly diseases, has become a huge health burden for Africa and has been linked to poverty, poor health systems, and lack of education thus health experts have questioned, why are there still so many deaths from rabies in Africa?
Rabies is thus a vaccine-preventable disease with a timely immunization even after exposure to the deadly virus, it is also said that there are effective vaccines for dogs, the main vector and transmitter of rabies to humans.
Mass vaccination of dogs is recognized as the most cost-effective and sustainable way to eliminate rabies in humans.
However, reports have it that Sub-Saharan Africa lacks rabies prevention centers, where bite victims can find the life-saving biologicals (vaccine and immunoglobulin) and that the healthcare centers equipped for rabies prevention are scarce and are limited to capital cities making them not accessible to the rural population and the biologicals for rabies prophylaxis may not be available or affordable for bite victims.
Furthermore, dog rabies remains enzootic in much of the world, and attempts to control dog rabies in Africa are either non-existent or unsuccessful. This being largely due to a lack of inter-sectoral collaboration between ministries and the considerable challenge posed by the integration of budgets across ministries.
Washington State University -WSU Paul G. Allen school of global Health is championing the “Rabies Free Africa” and also working with international partners to eliminate rabies as a cause of human suffering and death as part of the Zero by 30 initiative by combining game-changing vaccine research with community-based programs, leading to the development and deployment of the much-needed strategies to eliminate rabies.
The research conducted by the WSU through Rabies Free Africa aims to reduce the cost and increase the efficiency and effectiveness of mass-dog rabies vaccination programs with researchers focusing on questions related to the vaccine, and its efficacy under different storage and distribution conditions while also developing cost-effective approaches to deliver the vaccine at scale across remote landscapes.
WSU -Paul G. Allen school of global Health is also focusing on strategies and tools countries can use to design mass-dog vaccination campaigns and surveillance for rabies in people and animals in areas where limited, or no, resources have been previously deployed.
Although, in many developing countries, progress is slow and some of the obstacles identified include low levels of political commitment, partly owing to the absence of data on the true public health impact of the disease.
Apart from these interventions, an important aspect of ending deaths from rabies is ensuring that healthcare workers are aware of the disease and knowledgeable about what to do.
According to the W.H.O report, many healthcare workers didn’t know that encephalitis – inflammation of the brain – is a differential diagnosis for rabies. They, therefore, didn’t suspect rabies in patients with encephalitis. Less than a quarter of the healthcare workers were aware of the WHO categorization of bite wounds that guides the use of post-exposure prophylaxis. One in 12 reported they knew the indication of rabies immunoglobulin.
In addition, healthcare workers were not fully informed about the latest WHO recommendations on the appropriate treatment of patients presenting with dog bites.
A good example is the route of administration of the vaccine. WHO has recommended injection within the layers of the skin rather than injecting the vaccine into muscles. By adopting this dose-saving route, the healthcare system could serve up to five times more bite patients for the same vaccine amount that treats one patient.
In the past few years, many countries have strengthened rabies control efforts by scaling mass dog vaccination programmes. They have also provided pre-exposure and post-exposure vaccines and educated communities about rabies.
Man’s best friend, the domestic dog, is the primary source of human cases of rabies. Following a risky bite, two critical steps need to be taken in quick succession to prevent disease and death.
First, the wound needs to be washed thoroughly with clean running water and soap for at least 15 minutes.
This should be followed by an injection of rabies vaccine on the day of the bite.
Multiple injections over the course of one month must follow. In the case of a severe bite, the patient would need immunoglobulin as well as the vaccine.
The reduction of risk of exposure to rabies depends on the type of treatment received at a health facility. A person bitten by a dog carrying rabies is more likely to develop the disease if the wound isn’t cared for properly and if they don’t receive the rabies vaccine (and immunoglobulin for severe exposure). This can be due to a lack of awareness of bite management by healthcare workers, unavailability of rabies vaccines and immunoglobulin, or availability of poor-quality vaccines.
