AGA IN ACTION
FAO taking steps to address rabies situation in DRC
FAO recently organized a three-day workshop in the Democratic Republic of the Congo to address the rabies situation in the country, where decades of conflict make vaccines for dogs and treatment for dog bite victims a rarity.
The FAO aims to kick-start the process among the government ministries responsible for human health and animal health, local administration, international agencies and NGOs, universities, civil society organizations and the network of primary and secondary schools to create the necessary consensus and momentum to make rabies prevention a priority nation-wide.
USAID provided financial support for the meetings as part of the “IDENTIFY” component of its work in addressing Emerging Pandemic Threats, or EPT programme. IDENTIFY aims to strengthen the capacities of countries’ laboratories in being able to examine and diagnose diseases emerging from the animal kingdom that could potentially trigger a global pandemic disease in humans. “IDENTIFY” traditionally focuses on diseases in hotspot areas for disease emergence, such as highly pathogenic avian influenza in areas of south east Asia or Ebola in the Congo basin.
However, given the known suffering and hardship rabies inflicts on families despite under-reporting, USAID agreed to support these initial meetings to address rabies beyond the normal focus of IDENTIFY. “Rabies is vastly under-reported in the DR Congo in humans and dogs,” said Katinka de Balogh, the FAO focal point for rabies. “Talking to people in Kinshasa, what struck me was the fact that many people had seen someone die from rabies,” she said. “It’s a horrific and painful death, and tragic in that it is entirely preventable.”
Rabies is a 100 percent preventable disease, thanks to the existence of animal vaccines and post-exposure prophylaxis (PEP) for people who suffer dog bites and scratches, which can prevent rabies from developing if administered promptly. But without the provision of PEP, once symptoms of the disease appear, rabies is almost 100 percent fatal, in people and animals alike.
Previous attempts to cope with rabies
In 2007, widespread rabies outbreaks in Kinshasa resulted in the virus being passed from dogs to humans, with a number of human deaths, mostly children. The government and the municipality of Kinshasa launched a campaign to vaccinate dogs, but the coverage was insufficient to have a lasting effect on the incidence rates of rabies in canines.
Some 8000 animals were vaccinated in 2 out of 24 districts in Kinshasa, which has an estimated dog population of 72 000 dogs, according to government statistics. That is equivalent to 11 percent of the population, whereas to eliminate rabies, the number of vaccinated dogs must remain above 70 percent to keep it from spreading and eventually decline.
Limited access to vaccines and treatment
However, since the DR Congo has experienced decades of conflict and instability, lifesaving PEP for human victims of dog bites are difficult to find. Even if the PEP is found, chances are most Congolese don’t have the cash to pay for the required rounds of rabies PEP, which in total cost some US$ 250. Over 70 percent of Congolese live on less than $1 per day.
“We drove to a number of pharmacies in the capital just to see if we could find rabies post-exposure prophylaxis, and one after another, they didn’t have them and sent us searching at other pharmacies,” de Balogh said.
In Kinshasa, however, exists the only government office in the country that specifically addresses rabies cases in dogs and humans: the Office for Vaccinations and Rabies Control, part of the Provincial Ministry of Agriculture, is the centre handling all cases of suspected dog bites in humans. The staff includes veterinary personnel as well as a medical officer and two nurses. However, the office is severely under-resourced.
Vaccines for dogs and the post-exposure prophylaxis for humans are in limited supply and only if one can afford the fee. As the office lacks a steady electricity supply and a fridge, vaccines are kept in a cool box, which is filled with ice at the beginning of each day. If vaccines aren’t stored at carefully controlled temperatures, they can easily become ineffective.
The office also lacks running water, so even to wash victims’ bite wounds presents the staff with a challenge.
“The first thing people should do if they are bitten or scratched by a dog is to wash the wound with soap and water well several times, to flush out and inactivate the virus that causes rabies,” de Balogh said.
“The DRC has a serious rabies situation on its hands, but it’s been completely overlooked among all the other hardships people face on a daily basis.”
Education and awareness
A main pillar of combating rabies involves education about rabies in schools about prevention and responsible dog ownership. Owners should shoulder the responsibility of preventing human deaths, especially among children, by having their dogs vaccinated.
With costs of up to $ 30 for each dog vaccinated, however, the concerted commitment from donors and partners is needed to ensure access to affordable dog vaccinations during large campaigns and lifesaving preventive interventions for humans.
Rabies remains a vastly under-reported disease, especially in Africa and Asia, where according to estimates, as many as 70 000 people die every year from the disease.