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Joining up on rabies

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MONDAY September 28 is World Rabies Day — an annual event 'to raise awareness about the impact of human and animal rabies, how easy it is to prevent it, and how to eliminate the main global sources'. Now in its third year, the initiative continues to gather momentum and has moved on considerably since the first World Rabies Day in 2007, when The Veterinary Record marked the occasion by publishing a number of articles discussing the thinking behind it and the role that veterinarians can play in tackling the disease worldwide (VR, September 1, 2007, vol 161).

Numerous international, national and local events, embracing a wide range of activities, are planned to mark this year's World Rabies Day, many of which are listed on the website, www.worldrabiesday.org. Among them, rabies will feature prominently in a high-level one-day conference in Brussels organised by the EC's Directorate General for Health and Consumers. The conference marks the launch of European Veterinary Week, which runs from September 28 to October 4 under the overarching theme 'Animals + Humans = One Health'. Emphasising the relationship between animal and human health, and promoting the 'one health' concept, the theme of the conference will be 'EU health professionals working together to ensure good health for all of us', and rabies will be the subject of one of the two plenary sessions and four panel discussions that are planned. Rabies is an ideal topic for discussion in this context, because it provides an excellent illustration of how the 'one health' concept could be applied more widely to great effect.

World Rabies Day was initiated by the Alliance for Rabies Control, formed by scientists and professionals working in the field. From the start, it has boasted an impressive range of partners, including the World Health Organization (WHO), the World Organisation for Animal Health (OIE) and the US Centers for Disease Control and Prevention — and the list of partner organisations continues to grow. A key message of the campaign is that awareness must be raised, and action taken, at every level in meeting its objective of 'working together to make rabies history'.

Although rabies has essentially been eliminated from many countries, including much of Europe, two-thirds of the world's population still lives in a rabies-endemic area. The WHO describes it as a neglected disease — and no wonder. More than 55,000 people die of rabies each year, mainly in Africa and Asia, with the vast majority of human cases being the result of transmission by dog bites and with children being at greatest risk. The tragedy is that these deaths could be avoided, because all of the tools needed to prevent rabies are available. Many human deaths could be prevented by increasing awareness of the causes of the disease and how to prevent it. There is also a need to enhance access of those who might have been exposed to rabies to appropriate medical care. However, prevention at the animal source is key — 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 will mean dealing with it in the dog population through vaccination. As the OIE pointed out earlier this year, vaccination of dogs and humane control of excessive stray dog populations represent an efficient and cost-effective means of tackling rabies, and should rank high on the agenda of developing countries' health and veterinary services programmes (VR, April 11, 2009, vol 164, p 445).

Recognising this, and in a significant development since the first World Rabies Day, the Bill & Melinda Gates Foundation has awarded a grant under its Global Health programme of nearly US$ 10 million to the WHO Department of Control of Neglected Tropical Diseases for a project to demonstrate the feasibility of, and promote an evidence-based strategy for, controlling and eliminating human rabies in low-income countries through control and elimination of the disease in the domestic dog. The five-year project is being implemented in regions of three countries where dog rabies is endemic (in Tanzania, South Africa and the Philippines), and it aims to achieve a 'paradigm shift' in strategic planning and implementation of activities in these regions and to provide additional information on the effectiveness of this kind of approach. The objectives are to improve targeted delivery of postexposure prophylaxis to exposed patients; to control and eliminate rabies in domestic dogs while respecting the natural world; to improve surveillance and diagnostics; and to build a strategy ensuring sustainability of the rabies-free status. Tackling rabies effectively requires a 'joined-up' approach, with improvements to veterinary infrastructures and with medical and veterinary efforts being better coordinated. The project deserves attention, as it represents an excellent example of the 'one health' concept in action.

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