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Working together on rabies

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NEXT Saturday (September 8) has been designated World Rabies Day with a view to raising awareness of the disease and the means available to prevent it. Building on the ‘one medicine’ concept, which advocates better integration of veterinary and medical expertise in the fight against disease (see VR, July 28, 2007, vol 161, p 109), the initiative is being driven by scientists and professionals working in the field and is supported by the World Health Organization (who), the World Organisation for Animal Health (oie) and the us Centers for Disease Control and Prevention, among others. The theme for the day is ‘Working together to make rabies history’, and various events are planned internationally. As its own contribution in advance of the event, The Veterinary Record this week carries a number of articles discussing the thinking behind the initiative, and the role that veterinarians can play in tackling the disease worldwide.

Living in a country which is free of rabies, it is easy to forget its impact elsewhere. Although the disease has essentially been eliminated from many countries, including much of Europe, two-thirds of the world's population still live in a rabies endemic area. The who and oie have described rabies as a neglected disease and, looking at the statistics, it is easy to see why. More than 50,000 people die of rabies each year, principally in Africa and Asia, with more than 99 per cent of human cases being the result of transmission by dog bites. Most of these cases occur in children, principally in children less than 14 years old. The tragedy, as Dr Deborah Briggs and Dr Cathleen Hanlon argue in an article on pp 288-289, is that these deaths need not happen, because all of the tools needed to prevent rabies are available. Even in the poorest regions of the world where canine rabies continues to be endemic, human cases could be prevented by increasing awareness of the causes of the disease and how to prevent it. One of the aims of World Rabies Day is to help raise awareness of how to prevent rabies exposure and infection at all levels of society. At its simplest level, this might involve disseminating information about avoiding exposure from the main animal source and proper wound cleansing if exposure occurs.

Prevention at the animal source is the key to dealing with a prevalent and perennial zoonosis like rabies and, given the major role played by dogs as a reservoir and source of rabies in many parts of the world, tackling the disease effectively means dealing with the problem in the dog population. This, in turn, requires a ‘joined-up’ approach to rabies control, with medical and veterinary efforts being better coordinated. Vaccination represents the most effective and only acceptable method of controlling the disease in dogs and, as Professor Tony Fooks argues in an article on pp 289-290, offers the greatest hope for future rabies control in the developing world. Given the relative costs of vaccinating dogs and postexposure prophylaxis in humans, canine vaccination is also the most cost-effective approach. However, many countries where rabies is endemic lack the veterinary infrastructure that is needed for concerted vaccination campaigns, or do not possess the basic diagnostic, reporting and surveillance tools. Without these resources, and investment in the supporting veterinary infrastructure, he says, rabies will remain a neglected disease.

Speaking at an oie/who/eu conference on rabies in May this year, Dr Bernard Vallat, director general of the oie, emphasised the importance of prevention and argued that it was a ‘prime responsibility’ of the veterinary profession to apply its knowledge and skills in animal disease control to ‘creating a buffer between the animal source of the disease and susceptible human beings’. Good governance of veterinary services, better laboratory diagnostic capacity and vaccination campaigns were, he said, key actions to be taken, and emphasis should also be placed on raising public awareness of rabies and the need for collaboration with other professions involved. At the same conference, Dr François Meslin, of the who, remarked, ‘Governments should consider investing in dog rabies as the best way to reduce escalating costs of postexposure prophylaxis. They should establish mechanisms for a fair distribution of the costs and benefits of dog rabies elimination between the various sectors involved, particularly health and agriculture.’

Other articles in this issue discuss some of the efforts being made to prevent rabies in different parts of the world, with some success, albeit in difficult circumstances. The key message to emerge is that rabies is preventable and is primarily a disease of poverty, ignorance and neglect. In a country in which discussion of rabies tends mainly to revolve around the finer points of the Pet Travel Scheme, some of this may seem hard to grasp. If, as is hoped, World Rabies Day can increase awareness of the issues and help create a will internationally to put mechanisms in place to tackle the problem effectively, it will have achieved something worthwhile.

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