Domestic Cycle of Rabies Can Easily Be Stopped
*This article is based on real personal experiences in the line of duty in public service in Kenya. The identity of locations and other persons involved have been excluded to conserve confidentiality.
Rabies is one of the horrifying killer zoonotic diseases that is of concern in 150 countries of the world. In Kenyan history, rabies has been reported in domestic dogs, domestic cats, cattle, sheep, goats, horses, leopards, jackals, and humans.
The domestic cycle of rabies, also called urban cycle or dog-mediated rabies, refers to transmission of rabies from infected domestic dog to other dogs, humans and other farm animals. The world, under the auspices of the World Organization for Animal Health the World Health Organization, the Food and Agriculture Organization of the United Nations and the Global Alliance for Rabies Control has targeted the elimination of dog-mediated human rabies by the year 2030. Kenya has a strategy for eliminating human rabies. We aver that such elimination of rabies is both possible and tenable in our region.
We had been well briefed on rabies in the country through college education which was buttressed with government folder of important circulars, rabies suppression legislation and rabies control funds from government.
The reality of rabies and the impacts of omission or commission gaps in its suppression did not dawn on us until one sad day in 1998. A Catholic sister working at a nearby mission hospital came to our veterinary office to seek a second opinion on a human case in the hospital; the patient was being treated for cerebral malaria but had nervous signs. We saw the patient who was exhibiting the typical text-book signs of rabies: apprehension, restlessness, hypersalivation, hydrophobia and progressive paralysis. Further inquiry revealed that the person had fought with a dog that strayed into his house 19 days earlier, when he was bitted on the arm by the dog before he killed and buried it.
Back in the office, we held a “council of war”. We realized that society was vulnerable to rabies and it was our official and professional obligation to suppress the disease. We evaluated our strengths and weaknesses in the fight against rabies. We recognized that we had all the tools necessary to suppress rabies. We were well trained, we had the enabling legislation which had given us full powers to act, we had circulars that spelt out the standard operating procedures in suppressing rabies, and we had human and material resources and any gaps in that respect could be filled from the community.
We undertook a commitment, indeed a pledge, that never again will rabies be reported in animals or humans in our area of jurisdiction for the period of our tour of duty in the region.
We report here that we kept our commitment and for the next 6 years that we served in the region, no any other animal or human case of rabies was detected or reported.
How did we achieve that? It was not easy but it was do-able. First, we went to the drawing board to learn how best to tackle the problem. We identified a 5-point plan for suppressing rabies which comprised the following elements: understanding the epidemiology of rabies and the dog ecology of the region, mounting of a mass public health education and awareness programme on rabies in the region, carrying out mass vaccination of dogs (and cats), effective dog control and the monitoring and review of the activity.
We documented that the region had both sylvatic (or wildlife) and domestic cycles of rabies. We were neighbouring a national park which had such potential carriers of rabies such as jackals, hyenas, squirrels, wolves and mongoose. Such animals were likely to be interacting with domestic dogs in the environment. Using our field members of staff, we carried out a census of dog population in the region, using door-to-door visits. We recorded 4,000 dogs as the population.
We mounted a public education and awareness campaign. We edited a common rabies public education video into vernacular. We hired a van with television and generator capacity and used the video to teach about rabies in primary schools and churches. We invited parents to such fora and availed ourselves for question-and-answer sessions and for explaining our rabies suppression programme in the region. We announced in the fora that mass dog vaccination would be carried out the next day or two in specific centres in the village and that it would be compulsory. We also advised the dog owners to effectively restrain their dogs and to submit those dogs that were out of their control and those they are unable or unwilling to manage to our office for euthanasia. This campaign run a day or two ahead of the vaccination teams and went on for the two months of the programme.
We carried out mass vaccination of dogs. We targeted over 70% of the dog population, which is known to provide an effective barrier for the transmission of dog-mediated rabies. We administered the inactivated rabies vaccine and issued a vaccination certificate for each dog which was valid for one year. The first round of vaccination covered 3,300 dogs (which was 82%). But the public education and awareness had created a community vigilance that broached no vaccination defaulters. We therefore gave defaulters a second chance to comply and we covered another 300 dogs, reaching a coverage of 90%. The remaining unvaccinated dogs were euthanized by the office.
We instituted and supervised a dog control programme comprising the requirement of dog restraint and the prevention of straying by their owners, and the promotion of neutering. The office frequently sent field staff to monitor compliance with dog restraint and document the statuses. During such visits, the field staff also demanded to see vaccination certificates for the dogs for the purpose of monitoring vaccination compliance.
The rabies suppression programme was a continuous activity. The monitoring of dog population and the supervision of dog control became a continuous activity, with members of the community taking active interest. The public education, awareness and publicity component was carried out once a year ahead of the vaccination teams, with the video shows being replaced by a mobile public address system. A veterinarian would travel through the villages, stopping at populated and urban areas to educate the people, answer questions and announce mass vaccination dates. A record of key messages was done on compact disc and run through the mobile public address system along the village and rural roads.
Animal or human cases of rabies were not detected or reported to the veterinary and public health authorities in the next 6 years when the author was in charge of the region.
It was not all smooth-sailing and a number of challenges were encountered. The public sector supply of vaccines, equipment, vehicle fuel, and staff subsistence was erratic and unreliable and therefore we asked the members of the community to supplement with a vaccination fee which was Ksh 100 (about 1 US$). This collection was adequate to finance the cost of vaccines, equipment, certificates, vehicle fuel, and staff subsistence. Supervisors in high offices thought that we were unfairly making money from members of the community. They attempted to institute a disciplinary process, which attempt failed when higher offices were briefed on the objectives as well as the legal foundation of the charging of fees.
The aspect of compulsion of dog vaccination was challenged by a few of the big bosses in the community who were insisting that their dogs do not go out straying and therefore are not vulnerable to rabies. When the dogs of one such boss were baited by the office while outside his compound, he threatened legal action but this did not take off when the legal foundation of the action was explained to him by the state counsel.
The management of domestic cats was a big challenge. It was realized that though cats play a non-negligible role in rabies transmission in the domestic cycle, these animals were largely out of control of their owners and are largely untamed.
A number of lessons were learnt and need to be incorporated in any rabies suppression programme. Firstly, dogs have a high reproduction rate. In every new campaign an estimated 50% of dogs were new, having been born in the previous 12 months. Similarly, it was found that the overall life-span of dogs in the community was low, hardly 3 years. Therefore, though the inactivated rabies vaccine can protect for 3 years, it is necessary to carry out annual booster vaccination campaigns.
Secondly, the informed participation of members of the community in rabies suppression would assure its success. These persons own the animals and when they also own the problem and its solution, they provide the officer with critical support in terms of publicity, compliance monitoring and vigilance for the disease and for the factors for its occurrence and transmission.
*Dr Karugu is a director of Risk Analysis Services firm.
