Executive summary
Rabies is a fatal viral and vaccine preventable zoonotic disease that can infect all mammals. Despite being a vaccine preventable disease, the 8240 rampant animal bites (proxy to rabies) in Uganda since 2013-2017 led to the deaths of at least 156 humans associated with rabies. Available evidence reveals that vaccination is one of the most successful global health interventions and cost-effective ways to save lives in humans and animals and prevent diseases such as rabies. Thus, there is an urgent need to review the rabies act of 1945 to include compulsory vaccination of pets against rabies to control rabies in animals and hence prevent spillage to in humans.
Context and importance of the problem
Rabies is a fatal viral and vaccine preventable zoonotic disease, that can infect all mammals (1–3). Worldwide, canine rabies causes at least 59,000 human deaths and 8.6 billion USD (95% CIs: 2.9-21.5 billion) economic losses annually (3). Rabies is transmitted majorly through the bite followed by licks or scratches of an infected rabid animal or through transplantation of tissues or organs from an infected individual (4–6). Most of the animal bites leading to human rabies cases are due to bites from infected dogs (7). In dogs, the incubation period of rabies is 3-8 weeks (8). Other findings indicated that the incubation period of rabies in dogs was 10 days to 6 months, with most cases manifesting signs between 2 weeks to 3 months (9).
A review of rabies surveillance data from 2013 to 2017 revealed that 8240 animal bites (proxy to rabies) in Uganda led to the deaths of at least 156 humans associated with rabies. This alarming number of animal bites usually forces governments to purchase and stock supplementary anti-rabies vaccines for prevention and treatment of the bite victims and its related conditions (10).
However, the challenge here is lack of adequate anti-rabies vaccines to conduct vaccination in pets. Even if the vaccines were enough, the other challenge would be ensuring that pet owners comply with vaccination of their pets against rabies.
Thus, though other findings indicated that the cost-effective method of controlling rabies is to prioritize canine vaccination rather than continued expansion of PEP in humans (7). Operationalizing canine vaccination would require that we review how vaccination of pets would be conducted in Uganda to ensure efficiency and effectiveness.
Critique of policy options
In developed countries, the mass anti-rabies canine vaccination coupled with oral vaccination in wildlife have greatly contributed to the elimination of rabies in canines and consequently a reduction in human rabies (7). Control of canine rabies is highly cost-effective and even cost saving (6). However to adopt vaccination in low developing countries such as Uganda, we need to borrow the principle that was used but customize the process such that it can be effective in Uganda.
Policy implications
If the pets are not routinely vaccinated against rabies, more people are likely to die due to rabies arising from dog bites (as is al-ready happening this year-2019). Annual vaccination of pets against rabies would minimize spillage of rabies to humans – thereby saving the cost of post exposure prophylaxis (PEP) in humans.
Policy recommendations
Adopting compulsory vaccination of pets for pet owners would reduce occurrences of spillage of rabies in humans in the country. This includes:- establishing the pet population, registration of pet owners, availability of subsidized rabies vaccines, establishment of pet vaccination centres for instance at sub-county headquarters, availability of trained officers to conduct pet vaccination and issuance of certificates, sensitization of the public about the significance of pet vaccination against rabies, and multi-sectoral collaboration for effective rabies control in the country.
Conclusions and recommendations
Rabies can be controlled in pets and prevent spillage to human population. The government of Uganda through the Ministry of Agriculture, Animal Industry and Fisheries (MAAIF), Ministry of Health (MOH), Uganda wild life Authority (UWA) needs to de-sign and strengthen collaborative strategies that enable compulsory vaccination of pets against rabies to ensure elimination of human mediated rabies by 2030.
References
1. Afakye K, Kenu E, Nyarko KM, Johnson SAM, Wongnaah F, Bonsu GK. Household exposure and animal-bite surveillance following human rabies detection in Southern Ghana. Pan Afr Med J. 2016;25(Suppl 1):12.
2. Yousaf MZ, Qasim M, Zia S, Rehman Khan M ur, Ashfaq UA, Khan S. Rabies molecular virology, diagnosis, prevention and treatment. Virology Journal. 2012 Feb 21;9(1):50.
3. Hampson K, Coudeville L, Lembo T, Sambo M, Kieffer A, Attlan M, et al. Estimating the Global Burden of Endemic Canine Rabies. PLOS Neglected Tropical Diseases. 2015 Apr 16;9(4):e0003709.
4. Tenzin T, Namgyal J, Letho S. Community-based survey during rabies outbreaks in Rangjung town, Trashigang, eastern Bhutan, 2016. BMC Infectious Diseases. 2017 Apr 17;17(1):281.
5. Sudarshan MK, Madhusudana SN, Mahendra BJ, Rao NSN, Ashwath Narayana DH, Abdul Rahman S, et al. Assessing the burden of human rabies in India: results of a national multi-center epidemiological survey. International Journal of Infec-tious Diseases. 2007 Jan 1;11(1):29–35.
6. Crowcroft NS, Thampi N. The prevention and manage-ment of rabies. BMJ. 2015 Jan 14;350:g7827.
7. Fooks AR, Banyard AC, Horton DL, Johnson N, McElhin-ney LM, Jackson AC. Current status of rabies and prospects for elimination. The Lancet. 2014 Oct 11;384(9951):1389–99.
8. Velasco-Villa A, Mauldin MR, Shi M, Escobar LE, Gallardo-Romero NF, Damon I, et al. The history of rabies in the Western Hemisphere. Antiviral Research. 2017 Oct 1;146:221–32.
9. fe8045260f0f3bbb74fd1aa9775fa94d6f48.pdf [Internet]. [cited 2019 Mar 10]. Available from: https://pdfs.semanticscholar.org/b80d/fe8045260f0f3bbb74fd1aa9775fa94d6f48.pdf
10. Dehghani R, Sharif A, Madani M, Kashani HH, Sharif MR. Factors Influencing Animal Bites in Iran: A Descriptive Study. Osong Public Health and Research Perspectives. 2016 Aug 1;7(4):273–7.