The Rabies Threat: Fighting the Virus Abroad — and at Home
In honor of World Rabies Day on Saturday, Sept. 28, Vetstreet veterinary advisory board member Dr. Carrie La Jeunesse recounts her recent up-close and personal experiences with rabies. Dr. La Jeunesse recently visited a developing African nation where fatalities from the dreaded disease are a tragic but all too common occurrence.
Traveling to Liberia, West Africa, this summer while working for Veterinarians Without Borders U.S., I became more intimately familiar with rabies than I would have preferred. It happened on only the fourth day into a monthlong mission I was leading, and during the first of several rabies vaccine clinics in some of the poorest communities on the globe. Our vaccine campaigns for dogs were part of a larger public health and international development effort in Liberia where VWB has an ongoing and long-term commitment to supporting redevelopment of veterinary care and reliable and healthy food sources. This effort is critical because virtually all of the country was destroyed during 14 years of civil war.
We were there during the rainy season, so imagine damp dogs, wet Liberians and wilting and steamy Americans. Gathered in unnaturally close quarters, the dogs were anxious and not all that easy to handle. Late in the afternoon on the day of our first clinic, I was bitten. The bite was very mild. The rabies concern was very real.
Little did I know, but back home in the U.S., rabies had been posing similar problems this summer all around the country.
When Global Becomes Local
One does not have to watch Cujo or Disney’s Old Yeller to find dramatic plot lines based on an all too real threat to public health. “Crazy like a fox” took on a whole new meaning when a rabid fox attacked people and a dog in New Jersey. And who would think that a miniature donkey at a county fair (New Jersey again) would be a rabies threat? In Washington state, bats were found to have rabies — one after biting a woman who was rafting and another after being dragged into the house by a cat. Thank goodness the offending animals were identified and tested so that the people exposed could receive post-exposure vaccines. That’s not always the case.
Because rabies is pervasive in Africa, people there are all too aware of the gruesome neurologic symptoms experienced by those infected. With only a handful of documented rabies survivors throughout all of recorded medical history, infection without immediate post-exposure treatment results in a 100 percent fatality rate. There is no cure. Some feel rabies is the most important zoonotic (contagious between animals and humans) disease in the world. Rabies is difficult to diagnose (brain tissue must be tested), and the most affected countries and communities have little access to laboratory facilities. Because of this, the estimated death rate from rabies (55,000 each year) is just that — an estimate. Most of those affected live in Asia and Africa, and 90 percent or more of those who die are bitten by rabid dogs. Of that number, more than 50 percent are children. Unlike in the U.S., where even in poor and remote communities there is access to life-saving post-exposure vaccines, in most of Asia and Africa, rabies is a death sentence.
In Liberia and many other parts of the world, people live in continual fear that their dogs could become infected and that people in their family and communities could die if bitten. At that first vaccine clinic I attended in Liberia, dog owners waited patiently, braving flooding and long waits, grateful for the rabies vaccine that protects dogs and people both. The rabies certificates we provided were handled carefully as they were precious documentation that their dog had been vaccinated. If the dog bit someone, certificate in hand, perhaps the dog would not have to be killed and the loved ones of a human bite victim would not need to worry.
Normally, for aid workers, a dog bite in Africa means you’re on the next flight out to the closest place (not necessarily the U.S.) where the first post-exposure vaccine can be administered. Time is critical, as the first shot must be administered within 24 hours of the bite. Immediately after I was bitten, I aggressively disinfected the small wound. After the rabies clinic ended, our Liberian friend and partner, Craig, flew into action. He was terrified I would die of rabies and had seen his own father die after being bitten by a rabid dog. As it happened, we knew there was human rabies vaccine in Liberia, but the question was how to access it. While I started making arrangements to fly out, Craig started working with another colleague, Jackson, at the vaccine storage facility in Monrovia to find out if vaccine could be made available for me. It was gratifying to see these kind men spring into action on my behalf. Accessing vaccine in Liberia would not have been possible without the help of our in-country partners. Doing so, however, would mean that I would be able to stay and finish the projects planned for the next few weeks.
Complacency and Your Role in Public Health
In the 1940s and 1950s, most human rabies cases in the U.S. occurred after being bitten by a rabid dog. Vaccinating pets has saved untold lives, and now exposure risk here is primarily from wildlife. Thankfully, we don’t have to live in fear that contact with the animals we love could kill us. We are very lucky. But we should not forget what a deadly disease we are dealing with.
Vaccinations save lives, and at some point, owning pets carries with it an ethical obligation to public health. Protecting our families and communities through responsible pet ownership is something we may not think of when it comes to vaccines.
In the U.S., it is easy to become complacent. While there is ongoing debate about and research around vaccination protocols for companion animals, there is no room for guessing with rabies. Rabies vaccines are very clearly labeled to provide immunity for one to three years based on specific vaccination guidelines. Rabies is not a disease we can afford to play with. It was heartening to see Liberians so understanding of the need for vaccination, to be grateful for our efforts to protect both animals and humans and to want to learn how to continue the effort after we had gone.
In our world so wonderfully enriched through our interactions with other animals and nature, there is some risk to us. Veterinarians are at the forefront of the efforts to ensure that those interactions are as safe as possible, not just in Africa, but in our own backyards. And the Veterinarian’s Oath requires that veterinarians promote public health. So when your veterinarian recommends rabies vaccination, remember we care about the health of families and communities, as well as the health of your animal companions.
The Centers for Disease Control and Prevention says it best: “Your pets and other domestic animals can be infected when they are bitten by a rabid wild animal. When ‘spillover’ rabies occurs in domestic animals, the risk to humans is increased… Pets are vaccinated by your veterinarian to prevent them from acquiring the disease from wildlife and thereby transmitting it to humans.”
I don’t have much to add to that other than rabies does not discriminate: Vaccinate your pets.
The Rest of My Rabies Story
Because of Craig and Jackson’s concern and quick action, arrangements were made for me to acquire the rabies vaccine I needed in Liberia. I received the first of my post-exposure injections from a dedicated and kind nurse at the Duport Road Free Clinic in Monrovia. She had seen three patients die of rabies in the past month and was determined that I should receive the vaccine “because you are a human being, too” and because getting the vaccine would mean I could stay in the country to continue our work. She wanted more dogs vaccinated, and after meeting her, we held another clinic to support the Duport Road community. Good outcome all the way around, and we continued our work and vaccinated many hundreds more dogs over the following three weeks.
Souvenirs, Hope and Worry
My “souvenirs” now that I am home from my “summer vacation” are a sore arm (thanks to the rabies vaccine), memories of the work done and friendships made and a deep appreciation for the value of working together to promote health around the world.
As it happens, during the time we were in Liberia, there was a rabies outbreak. A friend, a livestock agent who works for the Ministry of Agriculture, met me “up country” where we were teaching and running more vaccine clinics. I gave him the rest of the vaccine, syringes, needles and disinfectant, some leashes, did a brief training on safe and humane dog handling, and watched as he and his team from the Ministry of Agriculture drove off to try to stop the outbreak. With a lack of refrigeration throughout much of the country, trying to keep vaccines stored properly while attempting to administer field clinics in outlying regions is a challenge. It’s difficult to think about the risk these good people face daily in their work.
If you want to learn more about rabies and what you can do, check out the World Rabies Day website. This Global Alliance for Rabies Control annual educational and charitable event aims to prevent rabies wherever it occurs. It is important work. Veterinarians Without Borders is also a proactive organization that welcomes donations to help support its vaccine clinics and other efforts in the poorest areas of the world.