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Research
Research EDITORIAL
Rabies: 100 per cent fatal, 100 per cent preventable B. Abela-Ridder Rabies is 100 per cent preventable by vaccination in animals and people, and yet it remains an under-reported and neglected zoonosis, which is endemic in many of the world’s poorest and underserved communities. Dog-to-human transmission accounts for 99 per cent of human rabies cases and can be eliminated at source by mass canine rabies vaccination campaigns. Eliminating rabies from dog populations significantly reduces human exposure to the disease and is the single most cost-effective intervention to control and eliminate canine rabies (WHO 2013). Despite many success stories in Latin America (Vigilato and others 2013) and other countries, endemic rabies in Africa and parts of Asia remains largely uncontrolled (WHO 2015). Proof-of-concept programmes on the elimination of rabies have shown that simplifying and streamlining canine rabies vaccination campaigns will ensure
B. Abela-Ridder, Department of the Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, CH-1211, Genève 27, Switzerland e-mail: [email protected]
148 | Veterinary Record | August 8, 2015
successful implementation and high coverage (WHO 2014). Research shows that approximately 70 per cent of the canine population should be vaccinated to effectively break the rabies transmission cycle (Coleman and Dye 1996, Cleaveland and others 2003). A more pragmatic approach when resources are limited, is to adopt a compartmentalisation system, which means vaccinating in areas with a high incidence of rabies, referred to as corridors or source areas, to limit the spread of disease and break the transmission cycle (Haydon and others 2006). This strategic approach is often more attractive to governments that have many competing priorities. Considering that the average lifespan of dogs in endemic rabies zones is three years or less (Davlin and Vonville 2012), it follows that a single three-year vaccination is sufficient to provide rabies prophylaxis for the lifetime of that animal. Traditionally, dogs under three months of age have not been included in mass rabies vaccination campaigns due to the potential interference of maternal antibodies with seroconversion (Day and others 2010, Hodgins and Shewen 2012). Taking into account that puppies
Downloaded from http://veterinaryrecord.bmj.com/ on August 10, 2015 - Published by group.bmj.com
Research
Photograph: Sarah Cleaveland
often make up a significant proportion of community dogs in rural areas, up to 39 per cent in some cases (Davlin and Vonville 2012), the implications of not vaccinating a puppy are significant. Specifically, if a puppy is not vaccinated during a campaign, this may in fact translate into it never receiving a vaccination in its lifetime, thereby leaving a large proportion of the dog population susceptible and available to continue the rabies transmission cycle. Puppies can make up a large proportion of community The results from the study dogs in rural areas, and the implications of not vaccinating by Morters and others (2015), them are significant which is summarised on page 150 of this issue of Veterinary Record, suggest that blanket vaccination of active at the forefront of programme all dogs regardless of age has the potential to delivery, that attaining zero human deaths simplify the implementation and maximise attributable to rabies is feasible and that the coverage of mass dog vaccination now is the time to seek out new ways campaigns. Translating research results into to overcome barriers and build renewed actions remains key to refining programme momentum. In the spirit of One Health, interventions for better impact. a global rabies conference convened by A further lesson learned from successful the World Health Organization and the elimination programmes is that the World Organisation for Animal Health integration of bite prevention education (OIE), in collaboration with the Food and is essential. Puppies have undeveloped Agriculture Organization of the United bite inhibition in addition to a normal Nations and supported by the Global developmental tendency to explore and Alliance for Rabies Control, will take play using their mouths (Landsberg and place in Geneva in December 2015. The others 2013). This, coupled with a higher conference, which will include participants relative incidence of rabies reported in dogs from national institutions, international younger than 12 months in endemic areas organisations and the private sector, as (Belcher and others 1976, Mitmoonpitak well as international experts, will shape a and others 1998, WHO 2013), could forward vision with shared purpose among increase bite risk and potentially rabies the different players for the elimination of transmission from puppies to people in dog-transmitted human rabies and build endemic areas. Bite prevention education support for investment. campaigns, coupled with mass canine vaccination programmes, reduce not only References the frequency of dog bites but also the BELCHER, D. W., WURAPA, F. K. & ATUORA, transmission of rabies. D. O. (1976) Endemic rabies in Ghana. American Journal There is a clear consensus among of Tropical Medicine and Hygiene 25, 724-729 CLEAVELAND, S., KAARE, M., TIRINGA, P., health experts, national bodies and those
MLENGEYA, T. & BARRAT, J. (2003) Dog rabies vaccination campaign in rural Africa: impact on the incidence of dog rabies and human dog-bite injuries. Vaccine 21, 1965-1973 COLEMAN, P. G. & DYE, C. (1996) Immunization coverage required to prevent outbreaks of dog rabies. Vaccine 14, 185-186 DAVLIN, S. L. & VONVILLE, H. M. (2012) Canine rabies vaccination and domestic dog population characteristics in the developing world: a systematic review. Vaccine 30, 3492-3502 Day, M. J., Horzinek, M. C. & Schultz, R. D. (2010) Guidelines for the vaccination of dogs and cats. Journal of Small Animal Practice 51, 338-356 HAYDON, D. T., RANDALL, D. A., MATTHEWS, L., KNOBEL, D. L., TALLENTS, L. A., GRAVENOR, M. B. & OTHERS (2006) Low-coverage vaccination strategies for the conservation of endangered species. Nature 443, 692-695 HODGINS, D. C. & SHEWEN, P. E. (2012) Vaccination of neonates: problem and issues. Vaccine 30, 1541-1559 LANDSBERG, G. M., HUNTHAUSEN, W. L. & ACKERMAN, L. J. (2013) Developmental, social, and communicative behavior. In Behavior Problems of the Dog & Cat. 3rd edn. Saunders. pp 13-28 MITMOONPITAK, C., TEPSUMETHANON, V. & WILDE, H. (1998) Rabies in Thailand. Epidemiology and Infection 120, 165-169 Morters, M. K., McNabb, S., Horton, D. L., Fooks, A. R., Schoeman, J. P., Whay, H. R. & others (2015) Effective vaccination against rabies in puppies in rabies endemic regions. Veterinary Record doi: 10.1136/vr.102975 VIGILATO, M. A., COSIVI, O., KNÖBL, T., CLAVIJO, A. & SILVA, H. M. (2013) Rabies update for Latin America and the Caribbean. Emerging Infectious Diseases 19, 678-679 WHO (2013) WHO Expert Consultation on Rabies: Second Report. WHO Technical Report Series 982. http://apps.who.int/iris/bitstr eam/10665/85346/1/9789240690943_eng.pdf?ua=1. Accessed August 5, 2015 WHO (2014) Report of the sixth meeting of the International Coordinating Group of the World Health Organization and the Bill & Melinda Gates Foundation project on eliminating human and dog rabies. Durban,, September 22 to 24, 2014. www.who.int/rabies/ WHO_HTM_NTD_NZD_2015.1.pdf. Accessed August 5, 2015 WHO (2015) Investing to overcome the global impact of neglected tropical diseases. Third WHO report on neglected tropical diseases. http://apps.who.int/ iris/bitstream/10665/152781/1/9789241564861_eng. pdf?ua=1. Accessed August 5, 2015
doi: 10.1136/vr.h4196
August 8, 2015 | Veterinary Record | 149
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Rabies: 100 per cent fatal, 100 per cent preventable B. Abela-Ridder Veterinary Record 2015 177: 148-149
doi: 10.1136/vr.h4196 Updated information and services can be found at: http://veterinaryrecord.bmj.com/content/177/6/148
These include:
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Research
Research EDITORIAL
Rabies: 100 per cent fatal, 100 per cent preventable B. Abela-Ridder Rabies is 100 per cent preventable by vaccination in animals and people, and yet it remains an under-reported and neglected zoonosis, which is endemic in many of the world’s poorest and underserved communities. Dog-to-human transmission accounts for 99 per cent of human rabies cases and can be eliminated at source by mass canine rabies vaccination campaigns. Eliminating rabies from dog populations significantly reduces human exposure to the disease and is the single most cost-effective intervention to control and eliminate canine rabies (WHO 2013). Despite many success stories in Latin America (Vigilato and others 2013) and other countries, endemic rabies in Africa and parts of Asia remains largely uncontrolled (WHO 2015). Proof-of-concept programmes on the elimination of rabies have shown that simplifying and streamlining canine rabies vaccination campaigns will ensure
B. Abela-Ridder, Department of the Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, CH-1211, Genève 27, Switzerland e-mail: [email protected]
148 | Veterinary Record | August 8, 2015
successful implementation and high coverage (WHO 2014). Research shows that approximately 70 per cent of the canine population should be vaccinated to effectively break the rabies transmission cycle (Coleman and Dye 1996, Cleaveland and others 2003). A more pragmatic approach when resources are limited, is to adopt a compartmentalisation system, which means vaccinating in areas with a high incidence of rabies, referred to as corridors or source areas, to limit the spread of disease and break the transmission cycle (Haydon and others 2006). This strategic approach is often more attractive to governments that have many competing priorities. Considering that the average lifespan of dogs in endemic rabies zones is three years or less (Davlin and Vonville 2012), it follows that a single three-year vaccination is sufficient to provide rabies prophylaxis for the lifetime of that animal. Traditionally, dogs under three months of age have not been included in mass rabies vaccination campaigns due to the potential interference of maternal antibodies with seroconversion (Day and others 2010, Hodgins and Shewen 2012). Taking into account that puppies
Downloaded from http://veterinaryrecord.bmj.com/ on August 10, 2015 - Published by group.bmj.com
Research
Photograph: Sarah Cleaveland
often make up a significant proportion of community dogs in rural areas, up to 39 per cent in some cases (Davlin and Vonville 2012), the implications of not vaccinating a puppy are significant. Specifically, if a puppy is not vaccinated during a campaign, this may in fact translate into it never receiving a vaccination in its lifetime, thereby leaving a large proportion of the dog population susceptible and available to continue the rabies transmission cycle. Puppies can make up a large proportion of community The results from the study dogs in rural areas, and the implications of not vaccinating by Morters and others (2015), them are significant which is summarised on page 150 of this issue of Veterinary Record, suggest that blanket vaccination of active at the forefront of programme all dogs regardless of age has the potential to delivery, that attaining zero human deaths simplify the implementation and maximise attributable to rabies is feasible and that the coverage of mass dog vaccination now is the time to seek out new ways campaigns. Translating research results into to overcome barriers and build renewed actions remains key to refining programme momentum. In the spirit of One Health, interventions for better impact. a global rabies conference convened by A further lesson learned from successful the World Health Organization and the elimination programmes is that the World Organisation for Animal Health integration of bite prevention education (OIE), in collaboration with the Food and is essential. Puppies have undeveloped Agriculture Organization of the United bite inhibition in addition to a normal Nations and supported by the Global developmental tendency to explore and Alliance for Rabies Control, will take play using their mouths (Landsberg and place in Geneva in December 2015. The others 2013). This, coupled with a higher conference, which will include participants relative incidence of rabies reported in dogs from national institutions, international younger than 12 months in endemic areas organisations and the private sector, as (Belcher and others 1976, Mitmoonpitak well as international experts, will shape a and others 1998, WHO 2013), could forward vision with shared purpose among increase bite risk and potentially rabies the different players for the elimination of transmission from puppies to people in dog-transmitted human rabies and build endemic areas. Bite prevention education support for investment. campaigns, coupled with mass canine vaccination programmes, reduce not only References the frequency of dog bites but also the BELCHER, D. W., WURAPA, F. K. & ATUORA, transmission of rabies. D. O. (1976) Endemic rabies in Ghana. American Journal There is a clear consensus among of Tropical Medicine and Hygiene 25, 724-729 CLEAVELAND, S., KAARE, M., TIRINGA, P., health experts, national bodies and those
MLENGEYA, T. & BARRAT, J. (2003) Dog rabies vaccination campaign in rural Africa: impact on the incidence of dog rabies and human dog-bite injuries. Vaccine 21, 1965-1973 COLEMAN, P. G. & DYE, C. (1996) Immunization coverage required to prevent outbreaks of dog rabies. Vaccine 14, 185-186 DAVLIN, S. L. & VONVILLE, H. M. (2012) Canine rabies vaccination and domestic dog population characteristics in the developing world: a systematic review. Vaccine 30, 3492-3502 Day, M. J., Horzinek, M. C. & Schultz, R. D. (2010) Guidelines for the vaccination of dogs and cats. Journal of Small Animal Practice 51, 338-356 HAYDON, D. T., RANDALL, D. A., MATTHEWS, L., KNOBEL, D. L., TALLENTS, L. A., GRAVENOR, M. B. & OTHERS (2006) Low-coverage vaccination strategies for the conservation of endangered species. Nature 443, 692-695 HODGINS, D. C. & SHEWEN, P. E. (2012) Vaccination of neonates: problem and issues. Vaccine 30, 1541-1559 LANDSBERG, G. M., HUNTHAUSEN, W. L. & ACKERMAN, L. J. (2013) Developmental, social, and communicative behavior. In Behavior Problems of the Dog & Cat. 3rd edn. Saunders. pp 13-28 MITMOONPITAK, C., TEPSUMETHANON, V. & WILDE, H. (1998) Rabies in Thailand. Epidemiology and Infection 120, 165-169 Morters, M. K., McNabb, S., Horton, D. L., Fooks, A. R., Schoeman, J. P., Whay, H. R. & others (2015) Effective vaccination against rabies in puppies in rabies endemic regions. Veterinary Record doi: 10.1136/vr.102975 VIGILATO, M. A., COSIVI, O., KNÖBL, T., CLAVIJO, A. & SILVA, H. M. (2013) Rabies update for Latin America and the Caribbean. Emerging Infectious Diseases 19, 678-679 WHO (2013) WHO Expert Consultation on Rabies: Second Report. WHO Technical Report Series 982. http://apps.who.int/iris/bitstr eam/10665/85346/1/9789240690943_eng.pdf?ua=1. Accessed August 5, 2015 WHO (2014) Report of the sixth meeting of the International Coordinating Group of the World Health Organization and the Bill & Melinda Gates Foundation project on eliminating human and dog rabies. Durban,, September 22 to 24, 2014. www.who.int/rabies/ WHO_HTM_NTD_NZD_2015.1.pdf. Accessed August 5, 2015 WHO (2015) Investing to overcome the global impact of neglected tropical diseases. Third WHO report on neglected tropical diseases. http://apps.who.int/ iris/bitstream/10665/152781/1/9789241564861_eng. pdf?ua=1. Accessed August 5, 2015
doi: 10.1136/vr.h4196
August 8, 2015 | Veterinary Record | 149
Downloaded from http://veterinaryrecord.bmj.com/ on August 10, 2015 - Published by group.bmj.com
Rabies: 100 per cent fatal, 100 per cent preventable B. Abela-Ridder Veterinary Record 2015 177: 148-149
doi: 10.1136/vr.h4196 Updated information and services can be found at: http://veterinaryrecord.bmj.com/content/177/6/148
These include:
References Email alerting service
This article cites 9 articles, 1 of which you can access for free at: http://veterinaryrecord.bmj.com/content/177/6/148#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
