One morning, Emma Laudon asked her son, Joseph, why he did not want go to school that day. He told her he had a bad headache and could not drink water or eat food. Later, he began to vomit and foam at the mouth.
A visit to Queen Elizabeth Central Hospital in Blantyre, Malawi, revealed Joseph had rabies. He was exhibiting signs of hydrophobia or fear of water – an advanced symptom of the disease. Because of hydrophobia, saliva was accumulating in his mouth and he was unable to swallow.
Once a person is symptomatic for rabies, treatment is ineffective. All the family could do was wait for Joseph to die.
“As soon as you see the first symptoms of rabies, even the very first – a tingling in the hands or a child becomes slightly disoriented – death is inevitable,” says Dr Neil Kennedy, Dean of Medicine at Queen Elizabeth Central Hospital.
Not long after the diagnosis, Joseph died. His family was devastated.
“I still think of the way my child died,” says Emma. “It always gives fear in my heart. Even if I see a dog, I am always afraid.”
Need for dog vaccination
In Malawi, nearly 500 people die each year due to rabies. Of the more than 400 000 dogs in the country, only 0.5% are vaccinated against rabies annually.1 A vaccination coverage of 70% of dogs is necessary to protect the more than 16.4 million people in Malawi from dog-mediated rabies.
Sometime in the past, Joseph was bitten by a unvaccinated dog, but the wound healed long before he got sick. Signs of rabies can appear anywhere from 1 week to more than a year following the bite of an infected dog. On average, symptoms appear within 1-3 months.Even if Joseph had been brought to the hospital right after being bitten, they did not have the necessary rabies post-exposure treatment available. In Malawi, there is an inadequate supply of the vaccine and the out-of-pocket cost for affected families is prohibitive.
Joseph’s case is just one of many Queen Elizabeth Central Hospital has seen. In 9 months between June 2011 and February 2012, the hospital recorded 10 paediatric rabies deaths, the largest number of paediatric rabies cases described from a single institution in Africa.2
Across the country many of the dog-transmitted human rabies cases go untreated and unreported as a result of the absence of a rabies control programme, inadequate laboratory capacity, lack of surveillance and funding, and poor collaboration between human and animal health sectors.
Think big, start small and demonstrate success
In response, Mission Rabies, an organization working with WHO, the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) to eliminate rabies worldwide, organized a campaign with the Malawian Department for Animal Health and Livestock Development to vaccinate most of the dogs in Blantyre in 2015 and annually for the next 3 years.
Within 20 days, the organization had vaccinated more than 35 000 dogs, covering 79.5% of the population – a rate exceeding the minimum for interruption of dog-to-dog transmission by 9.5 %. The organization is now expanding the programme to cover the entire district.
“Mission Rabies is pledging to make Blantyre the lowest incidence of child rabies deaths in Africa rather than the highest,” says Luke Gamble, the founder of Mission Rabies.
Expanding the scope of vaccination
WHO, in collaboration with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) are working towards making safe and efficacious vaccines more accessible and affordable for rabies programmes in endemic countries.
Demonstrating the success of these programmes will trigger further local or foreign investment. “Making vaccines more easily available provides the stimulus to rabies control and elimination programmes that generates local capacity and data, and the 'can do' confidence in endemic countries that this disease can be overcome. The larger community, including NGOs like Mission Rabies, is helping deliver services and increase capacities in countries and thereby expand the resource base to combat rabies and make this horrific disease a disease of the past.” says Dr Bernadette Abela-Ridder, Rabies Lead in WHO.
Rabies is a disease that families, like Joseph’s, should not have to think about.
¹ Hampson, Katie et. al. "Estimating the Global Burden of Endemic Canine Rabies." PLOS Neglected Tropical Diseases 9.4 (2015): 1-20. PLOS.org. 16 Apr. 2015<http: article?id="10.1371/journal.pntd.0003709"></http:>
² Depani, Sarita et. al. "World Rabies Day: Evidence of Rise in Paediatric Rabies Cases in Malawi." The Lancet. 380.9848 (2012): 1148. Elsevier Inc., 29 Sept. 2012