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Rabies in Africa: the fight against it rages on

17 August 2010 - Rabies is an acute viral disease of the nervous system of mammals that is caused by a rhabdovirus (species Rabies virus of the genus Lyssavirus). It is a deadly disease for which there is no cure. In Africa, rabies is usually transmitted through the bite of rabid dogs. This disease is typically characterized by increased salivation, abnormal behaviour and eventual paralysis, and fatal when untreated.

Of the 55,000 rabies-related deaths in humans per year around the world, 45 per cent of them (or 24,750) occur in Africa. After Asia, Africa is the second continent most affected by rabies. African health officials acknowledge that the true incidence of rabies is greatly underrepresented by the number of deaths officially reported: many patients may not seek medical treatment for its symptoms and die at home without proper diagnosis.

Available statistics reveal that children under 15 years of age are the most frequently exposed age group, accounting for almost half of human exposures in canine-rabies infected areas. Many people who are exposed to rabies do not seek medical treatment simply because they are not even aware of the risk of contracting this disease or because they live in rural areas that are too far away from health centres able to provide rabies post-exposure prophylaxis (generally located only in big cities). It is for this reason that school children, their parents or caregivers, and traditional community healers have been identified as priority target groups for communication programmes and rabies education campaigns.

In Africa, rabies-related deaths in humans are generally linked to lack of awareness and poverty. Human deaths can be prevented by the timely administration of appropriate prophylaxis. However, most Africans do not know what to do in the event of a dog bite: a thorough washing of the wound for 10 minutes with plenty of water and soap, detergent or iodine can prevent or reduce the risk of infection by eliminating or inactivating the virus.

Immediate action after a bog bite is critical because the physical infrastructure for the management of rabies exposure is scarce. There are limited quantities of modern post-exposure prophylaxis (PEP) vaccines and there is a general lack of rabies immunoglobulins. Given that PEP vaccination is subsidised only in a few African countries, the PEP-vaccines available may not be affordable to many patients, who have to pay for it.

In order to obtain the political commitment necessary to control rabies and reduce its mortality levels, national African authorities need to have reliable figures of the disease burden in their countries. It must not be forgotten that to apply for aid and technical assistance from international development agencies for controlling the disease requires an accurate evaluation of the situation in the ground. In view of this, it is therefore imperative to make rabies data reporting a priority.

Controlling rabies in Africa is a continental public good. Providing it will not be easy owing to limited resources and lukewarm political will. Increasing rabies awareness among African and international authorities and decision makers is pivotal for effective rabies management and control.

Some grassroots approaches are already taking place. For instance, AfroREB, the Africa Rabies Expert Bureau, is a network of medical and veterinary professionals with expertise in rabies. Additionally, the Partnership for Rabies Prevention (in which FAO is a partner) developed and launched the rabies blueprint intended to provide guidance to countries in setting up canine rabies control programmes. These and other disease-focused networks and activities could benefit from funding from national governments or the African Union.

 

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