Inside the Global Campaign to Get Rid of Rabies by Erik Stokstad
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As featured in Jan. 19, 2017 Inside the global campaign to get rid of rabies By Erik Stokstad ON A SUNDAY EVENING last July, relative urged her to travel the die from rabies worldwide Flora Gichonge was walking with 16 kilometers to the nearest each year, almost all infected her friends to church near the hospital to get immunized by dogs. Malaria, HIV, and village of Gesarya, Tanzania. against rabies. Her husband, tuberculosis take much higher Suddenly, they were attacked by a businessman, had the $40 tolls. But the horrible suffering something hellish: A rabid dog, to buy three doses of the life- caused by rabies—some foaming at the mouth, charged saving vaccine from a pharmacy. patients have convulsions and out of the dense bushes lining A few days later, she was back become aggressive, just like the dirt road. “We tried to run at work, gathering and selling rabid dogs—and the fact that away, in fear,” the 25-year-old nuts. She knows she was lucky, many victims are children led recalls. But she tripped and fell. although now she’s afraid of the World Health Organization The dog lunged and bit her in strange dogs. (WHO) and other groups in 2015 the backside before her friends to announce a goal to eliminate drove it away by throwing stones. Many others are less fortunate. rabies deaths worldwide by After Gichonge limped home, a An estimated 59,000 people 2030. In theory, nobody should die from rabies. It’s one of the few viral Taking aim at a global scourge diseases where administering The World Health Organization and other groups have announced the goal a vaccine after exposure can of eliminating rabies as a public health problem. The key to fighting it: still save your life. Developing vaccinating dogs. countries try to provide enough doses to hospitals and clinics. Unfortunately, supplies often run out. People who can’t afford to buy the jabs from private pharmacies, or don’t get them in time, are doomed. Untreated rabies is the deadliest of all diseases, fatal almost without exception. That’s why the global plan calls for cheaper and faster treatment for people. But its long-term bet (GRAPHIC) J. YOU/SCIENCE; (DATA) K. HAMPSON ET AL., PLOS NEGLECTED TROPICAL is on vaccinating domestic dogs, DISEASES 9 (16 APRIL 2015) ©PLOS ONE which pose the biggest threat to people in the developing world. “It’s the only way you’re going to eliminate the problem,” says A campaign pays off Louise Taylor, scientific director Some developing countries have succeeded in eliminating rabies. Others of the Global Alliance for Rabies have made great progress. As Sri Lanka ramped up dog vaccinations, for Control, an advocacy group based example, human deaths declined. The country has also spent heavily on in Manhattan, Kansas. To rid a postexposure vaccines, further cutting deaths. canine population of the virus, vets aim to immunize at least 70% of dogs for several years. After that, a lower coverage level suffices to keep outbreaks at bay. This strategy has stopped rabies as a killer in developed nations. Elsewhere, the challenges are enormous, and nowhere bigger than in sub-Saharan Africa. Poor countries can hardly pay for millions of dogs to be vaccinated, J. YOU/SCIENCE; (DATA) PUBLIC HEALTH VETERINARY SERVICES, SRI LANKA MINISTRY OF and their governments often have HEALTH trouble organizing vaccination campaigns across vast rural they often face obstacles. The welfare charity near Arusha, areas—even if they have the veterinary teams that typically Tanzania. “The connection with political will. Big donors, for their run them don’t work together saving human lives is not there.” part, prefer to work on diseases with public health authorities and with a higher death toll or believe tend to prioritize cattle and other Now, in pilot projects underway in that reaching enough dogs is too valuable livestock, which usually Tanzania, Kenya, and a few other complicated. die of other diseases. “In Africa, African countries, scientists are what’s a dog? It’s worth nothing,” testing strategies for reaching and In fact, dog campaigns are says Jens Fissenebert, who vaccinating dogs more efficiently. relatively straightforward, but runs Mbwa Wa Africa, an animal They are also collecting data to pin down the toll of rabies, demonstrate the connection On its way out between dog vaccination and Countries in Latin America and the Caribbean have made steady progress human health in poorer countries, toward eliminating canine rabies. With help from the Pan American Health and quantify the economic benefits Organization, they jointly purchase and share vaccines, use standardized of national campaigns. surveillance, and coordinate vaccination along borders. Although the 2030 target seems improbable, if not impossible, proponents point to a few successful efforts—including the brief defeat of dog rabies in N’Djamena, the capital of dirt-poor Chad—to show that the disease can be beaten back even in Africa. (GRAPHIC) V. ALTOUNIAN/SCIENCE; (DATA) M. C. SCHNEIDER ET AL., CADERNOS DE SAUDE PUBLICA, RIO DE JANEIRO, 23 (9): 2049–2063, SET, 2007; PHILOSOPHICAL TRANSACTIONS “It’s not going to be fast, easy, OF THE ROYAL SOCIETY B 2013 368, 20120143 (24 JUNE 2013) or inexpensive,” says Charles Rupprecht, a rabies expert and consultant near Atlanta. “But it can rabies, and almost all had been at face of the planet, as smallpox was, be done.” least partially immunized. because so many mammal species harbor it. These reservoirs pose THE RABIES VIRUS IS A MARVEL Louis Pasteur developed the first a continuing, albeit minor risk for of biological ingenuity, cruelly rabies vaccine, made from the humans: In the United States, one manipulating its host’s behavior dried spinal cords of infected or two people still die each year to further its own reproduction. rabbits, and famously used it to after being bitten by rabies-infected After a dog becomes infected, save the life of a 9-year-old Parisian bats. In Eastern Europe, rabid foxes usually through a bite by another boy in 1885. Today’s versions are a concern. dog, the virus travels to the brain are produced from virus grown and renders the animal hyper- in cultures of human cells, then As with other neglected diseases, aggressive and excitable, with a chemically sterilized; they are more it is difficult to know the exact hoarse howl. The virus also spreads effective, far less painful, and human toll. Asia currently suffers to the salivary glands, which start have fewer side effects. Three to the highest number of deaths, producing saliva laden with billions five jabs over several weeks will an estimated 35,000. Africa has of viral copies. By interfering prevent the virus from reaching fewer, but the individual risk of with the pharyngeal nerves, the the brain if given quickly enough. dying of rabies is particularly high virus makes it hard for the dog to A dose of rabies antibodies is in sub-Saharan countries (see swallow, leading to more saliva and also recommended for people not map, p. 241) because of the many increased chances of transmission. previously inoculated. unvaccinated dogs—they’re widely used for guarding livestock and The disease is similarly gruesome Dog vaccines were first developed homes—and underfunded health in humans. In what’s known as in the 1920s. Still, it took decades systems. paralytic rabies, about one in five to eliminate rabid dogs as a public patients slips into a coma and dies health threat in Europe, Japan, “DANGER! DANGER! RABIES of respiratory and heart failure. and elsewhere. Now, Latin America KILLS” says the poster on the Furious rabies is even worse, with is on the verge of replicating the mud-brick building. A makeshift symptoms including fear of water— success (see timeline, below), clinic has been unloaded from a even to drink—spasms, terror, and following a concerted and battered Land Rover in Ligamba, aggression. Human-to-human coordinated campaign that reaches a small village in the Mara region transmission of rabies is believed 40 million to 50 million dogs each here, to offer free shots for dogs. In to be extremely rare, and has only year. the shade of a tree, Imam Mzimbiri been documented from a few organ wields a hypodermic needle. He or cornea transplants. Only 15 Rabies can never be wiped off the tells a middle-aged man to grasp people are known to have survived the neck of his large dog. The man Park from rabies. In 2002, the researchers are trying to quantify digs his sandals into the sand, U.S. National Science Foundation the benefits of dog vaccination. but the dog leaps away and nearly provided $1.5 million for a study Ahmed Lugalo, a veterinary breaks his rope leash. Mzimbiri, of carnivore disease ecology in the epidemiologist affiliated with a veterinarian with the Serengeti park. As part of the work, veterinary Sokoine University of Agriculture Health Initiative run by the Lincoln epidemiologist Sarah Cleaveland in Morogoro, Tanzania, follows Park Zoo in Chicago, Illinois, of the University of Glasgow in the up on dog bites and rabies casually walks off and then circles United Kingdom and colleagues cases recorded in logbooks back behind the dog. He darts in started vaccinating dogs around from clinics and hospitals. He and jabs the needle into its thigh. the borders, hoping to keep rabies also has a network of dozens “This one was hard to handle,” he from spreading to other wildlife in of paraveterinary assistants in says. the Serengeti. surrounding villages who keep an ear out for reports of rabid dogs, conduct interviews, and, when possible, take brain samples of dogs suspected to have died of rabies.