Vet Times The website for the veterinary profession https://www.vettimes.co.uk Mission Rabies: one year on Author : Luke Gamble Categories : Vets Date : November 17, 2014 TIED to a tree with 20ft of slack wasn t an ideal scenario to allow for a thorough clinical examination of an agitated animal with 3ft horns. Considering the poor creature was unable to drink on its second day of suffering in the baking heat, it could be excused an aggressive streak. I moved around the tree trunk as the confused animal charged Nigel, on cue, raised the rope. The cow, tangled and exhausted, tripped and I quickly doubled back, closing to administer the deserved rapid sedation. Euthanising cows in India is a sensitive issue but no matter what religion, no one wants to see an animal cruelly suffer for days on end, especially one harbouring the world s deadliest zoonotic disease. The village had had three dogs and two cows die of rabies in the space of four weeks. No one would tell me about the boy who got bitten. Rural, isolated and impoverished, there was nothing else to do, but burn the carcase. So that s what we did. It wasn t my first encounter with rabies in India. I remember a rabid dog being brought into a shelter in Andrah Pradesh, thrashing and biting through a blanket in which it was casually wrapped. It had bitten several other dogs in the village. I watched the dogs scamper away in the dirt. No one could catch them; the shelter wouldn t euthanise them unless they were showing clinical signs. They explained they would be mobbed if they did. Small children played close by, oblivious to the fact these animals were soon going to be potentially more lethal than a lion. Having just become a dad myself, it was a scenario that hit home hard. It often isn t the big scary dogs you have to watch for. In Goa, just a few weeks ago, a sweet little puppy bit 14 people. The brain sample came back rabies positive. The team implored everyone to get a course of post-exposure rabies vaccine, but the crowd dispersed immediately after the puppy was picked up and the results took more than a week to come back. People might have washed the wounds, some might have gone for jabs and one might have paid for the concurrent immunoglobulin shot. Typically, most of the expenditure for post-exposure prophylaxis is borne by those who can least 1 / 5
afford it. For example, in India, patients pay nearly half the financial burden of rabies and estimates by WHO indicate a full course of post-exposure vaccine represents as much as 31 days wage on average in Asia and 51 days wage on average in Africa. A paper in The Lancet in 2012 stated that in the previous year, the Queen Elizabeth Central Hospital in Blantyre, Malawi, recorded the highest incidence of child rabies deaths from a single institution in the whole probably because the hospital goes to the expense of diagnosing rabies and because a huge number of dogs carry rabies. Statistically, at least one child dies of rabies in the world every 20 minutes. There is no treatment once clinical signs show, more than 99 per cent of cases are transmitted through dog bites. In India, according to national dog bite statistics, it has been calculated that someone is bitten every two seconds. The WHO global incidence of rabies is regarded as a huge underestimation because, in most developing countries, no one actually records rabies deaths. It is not notifiable, it is expensive and risky to test for and people don t want to go to hospital to be treated in parts of India it means being locked in a cage. Knowing a rabies vaccine costs about 25p and that the all-in costs for vaccinating an Indian street dog come in just under 1, it is very hard to walk away from taking this disease on. As a profession, it is completely within our grasp. This one is in our court and here s the thing; rabies is 100 per cent preventable. We can, will and should eliminate it as swiftly as possible. Louis Pasteur nailed the vaccine, and Sarah Cleaveland (University of Glasgow) has shown that vaccinating 70 per cent of a given population of animals should crack it. So all we have to do is pick up a syringe and do just that. Of course, it isn t quite that easy. That would be to discredit the huge enthusiasm, dedication, energy and commitment of the 500-plus volunteers from more than 14 countries that have participated in the Mission Rabies programme to date. Catching dogs sounds fun, but it s hard going and quite dangerous. Slipping through the back streets of an Indian slum wielding a dog net is an activity best suited for the nimble. Three to four-hour stretches at dawn and dusk takes its toll in 30+ C and while you might look like a vision of yellow in the Mission Rabies costume, you won t feel it. The pay is shocking, the hours horrendous; you will curse, ache and possibly cry, but you will never have felt so great about vaccinating animals. The kids will smile, strangers will pick you up if you fall you will make friends for life. Never before have I experienced such a calling as a vet through administering vaccinations. This animal welfare for human welfare is addictive stuff. Achievements 2 / 5
India is ongoing. Since launching in September 2013, we have vaccinated, on average, one street dog every four minutes. Our Goa programme to eliminate the virus from the entire state in three years is powering on. In the past five months we have picked up three to four confirmed rabid dogs every week. Our epidemiological GPS mapping of vaccinated dogs is fantastic, using smartphones to tag the dogs and ensure we hit the 70 per cent coverage required every year for at least three years in a given area is the benchmark we re aiming for. We ve also launched a concurrent community education and awareness programme that has reached 70,000 children in Goa alone. Be kinder to dogs, they bite you less, vaccinate to eliminate that sort of thing. It seems to be working, with stats on dog bites coming down where we are based. We are also working on the humane population control fewer dogs next year means fewer dogs to vaccinate to hit the 70 per cent. So we ll have neutered 20,000 street dogs in Goa in six months if 12,000 of them are female and if, say, 10,000 of them would have had one litter of six puppies in the following 12 months, that s 60,000 fewer street dogs to vaccinate. The future There is lots to improve on, lots we can fine-tune and lots more to do. It is all down to the most incredibly committed and hard working team of vets, nurses and educationalists. Kate Shervell (international projects director), Andy Gibson (epidemiology and logistics), Ros Johnson (education) and Fred Lohr (international liaison) spearhead the UK team and the volunteers that sign up are the lifeblood of the charity (WVS and Mission Rabies). Our sponsors are amazing: Dogs Trust being our key champions, MSD being supportive with the vaccines, Davies Specialists, WSAVA, BSAVA, RVC, Medimark, Afscan, Techniks, Centaur, Mayhew International, Daray, WTG, University of Bristol, W and H, Vipex the list goes on and on. It promises to be bigger in 2015 we re going to blast Blantyre and get that sorted; we re going to take on Nepal, Sri Lanka and Ethiopia. The world isn t so big we can do this by 2030 if the team keeps growing. Please think about joining us. No matter what your discipline or speciality, you can make a huge difference. It will be an unforgettable two weeks and you ll genuinely save lives. I am not sure it will cover for complete personal redemption, but it s good for the soul. Sign up at www.missionrabies.com A quote in an LVS Congress Times story referred to WVS as a company when it is, in fact, a charity. We apologise for this oversight. 3 / 5
4 / 5
Powered by TCPDF (www.tcpdf.org) 5 / 5