Key myths that allow rabies to thrive

Mvita Sub County Animal Health Assistant Bernard Nzivo administers rabies control vaccine to a dog in Mombasa on November 8, 2013. PHOTO | KEVIN ODIT | NATION MEDIA GROUP

What you need to know:

  • Myths propagated in several communities often play a major role in the lack of proper prevention and treatment.
  • Kenya, like many other African countries, has insufficient tools for diagnosis of rabies in humans.
  • Another myth is that wildlife plays a significant role in rabies transmission and that only people living near forests are in danger.

The death of a little girl last year left an indelible mark on us, as practising veterinary surgeons.

Mary, 9, was bitten by a dog while on her way home from school in Bondo, Siaya County.

Her mother never noticed the alarm in the superficial wound the girl had suffered and treated it using a herbal concoction.

The wound healed alright, but after four weeks the girl began experiencing fever, headaches and episodes of vomiting.

Assuming it was malaria, her mother bought antimalarial drugs from a chemist in the nearby market.

PECULIAR SYMPTOMS

The girl did not get better. Instead, she developed peculiar symptoms such as too much saliva, fear of water, unusual aggression and paralysis.

Mary died within two hours of arrival at the hospital, 30 kilometres away. Had they known, the family would have suspected Mary having been infected with rabies from the dog after she was bitten.

Mary is just one of the hundreds of children in the rural areas, which are most vulnerable to rabies infections.

Sadly, despite the endemic status of the disease, not enough is known about it by a majority of the population.

Myths propagated in several communities often play a major role in the lack of proper prevention and treatment.

RARE DISEASE

Firstly, some people believe that rabies is a rare disease and does not, therefore, require public health attention.

Kenya, like many other African countries, has insufficient tools for diagnosis of rabies in humans.

This results in few confirmed cases being reported to national disease databases and a false perception of low incidence of rabies.

That couldn’t be further from the truth. The World Health Organisation says there are 55,000 human rabies deaths — one every 10 minutes — and Africa and Asia account for 95 per cent of all global fatalities.

In the last six months of last year, the Ministry of Health in Kenya received reports of 35,000 dog bites or, 35,000 potential rabies exposures.

MISDIAGNOSIS

Lack of sufficient tools for diagnosis creates room for misdiagnosis. A study in Malawi, for instance, showed that rabies was confirmed in four children who had initially been diagnosed to have cerebral malaria and meningitis.

Studies that actively look for rabies cases in communities in Tanzania and Kenya established that they are under-reported by between 100 and 200 times.

Another myth is that wildlife plays a significant role in rabies transmission and that only people living near forests are in danger.

Studies in the Maasai Mara-Serengeti area investigated human and domestic animal interaction and found no evidence that wildlife contributes to the spread of human rabies.

Interestingly, wild animals get rabies from interaction with infected domestic dogs. There is also a myth that there are more stray dogs than those kept in homes and that it is impossible to vaccinate stray dogs.

CONFINE DOGS

Our studies in December 2016 in Siaya showed that more than four in every five households in the county own a dog, but less than two per cent of these homes confine their dogs.

The same pattern has been observed in Makueni County. This, therefore, means that with the right channels of communication and community engagement more than 80 per cent of all dogs can be vaccinated.
Kenyans also believe that rabies is not one of the diseases that pose a public health concern or one that requires funding to prevent. Allocating funds to vaccinate dogs would save the country and households a lot of money.

Vaccinating a dog costs about Sh150, while a full course of human post- exposure prophylaxis after being bitten by a dog costs not less than Sh10,000 in direct medical expenses alone.

It has been proven in many developing countries such as the Philippines that by vaccinating 70 per cent of dogs in an area for at least three consecutive years, human rabies infections can be eliminated.

An infected dog, on average, only infects two other dogs.

CHAIN OF TRANSMISSION

So vaccinating a dog can break the chain of transmission. The money can also be used to educate people on decoding animal behaviour.

The furious rabies type makes the animals aggressive, but the paralytic form causes the dog paralysis in the limb or it becomes unusually friendly and stops fearing humans.

Many people mistakenly think that killing or culling the animals by baiting is an effective dog population and rabies control measure.

Local authorities conducted dog baiting campaigns even before independence, and this has not had any impact as the incidence of rabies is ever rising.

This strategy is bound to fail because rabies transmission is dependent, NOT on the number of dogs, but on several other factors, including contact between dogs and humans and the behaviour of dog owners.

Dr Muturi ([email protected]) and Dr Mwatondo (amwatondo@yahoocom) are both veterinary surgeons in the Zoonotic Disease Unit of the Ministry of Health