Vaccinate now against rabies

By Nilma DOLE

Sri Lankans are animal lovers and they love having pets at home that are lovingly cared for and fed, like a loved one. In this way, the killing of animals has been banned and even though it is not a legal offence, Sri Lankans by nature, would never harm an animal. This is why we are blessed with the world's prized endemic species and have a wide variety of animals in our national parks due to our karma of animal love.

However, it becomes a difficult situation to determine the question of right and wrong when it comes to quelling a rabid animal. Are we allowed to kill a rabid animal? No matter how we feel about it, rabies is still present in every province of the country but only in the urban areas. "We have never heard or seen a case of an animal in a national park or in the wild having rabies which shows that the problem is very much in urban areas," said the Director Health, Public Health Veterinary Service of the Health Ministry Dr. P.A.L. Harischandra.

The best we can do is vaccinate ourselves so that if we are bitten, we can grin and bear it. No matter how many times medical experts ask people to vaccinate themselves against rabies, they only do it before it's too late. It's only when a dog bites you that you realise that you have to get a vaccination. "Instead of doing it beforehand, if we wait until it's too late, deadly consequences can happen," said the doctor.

Vaccination

The rabies vaccination is free and available at all national hospitals and general hospitals as well as dispensaries and clinics. "Earlier people were scared to take the vaccination because they thought that 21 injections were administered around the belly but this is a myth. Today, we have two injections administered on both arms of the victim over a course of five days," said the doctor. He said that once you go for the first few days, you should finish the entire course or else it won't be effective because it is no point doing the course half-way through."Rabies is a deadly disease which can make you insane in the head and people don't realise how deadly it is until they see a patient affected by it. Often children are most prone to dog-bites because they are always with pets," said Dr. Harischandra.

Legislation

He said that pet owners should be the first to take responsibility and get their dogs vaccinated and sterilised.

"The problem in Sri Lanka is that we spend five million annually to treat dog bite victims and we invest heavily in dog-vaccination and sterilisation campaigns but still the problem is present," he said. He said the dog population was estimated at 2.5 million.

Between 2,000 and 2,500 people are bitten each day by stray dogs, the official said, and there is one dog for every eight humans in the country of 20 million people.In 2007, chemical sterilisation was highly favoured over surgical sterlisation under animal birth control which is steadily growing in popularity.

If pet owners check their pets, then the rabies problem can be controlled without them getting the disease from other rabid animals. "Children love animals and they adopt stray animals which is a humane act of kindness but it's free to vaccinate their pets so why can't they use this service?" asked the doctor.

Rabies in Sri Lanka has been in existence since the colonists arrived, formulating a legislation to combat the disease. The Rabies Ordinance of 1893 and the Dog Registration Ordinance of 1904 are clear indicators of this. In 1953, Sri Lanka's first Veterinary Public Health (V.P.H.) Unit was established under the Ministry of Health and in 1956, a plan was formulated to eradicate rabies. "Nearly all of the Western countries have eradicated rabies but it's our own country who need to make a significiant change to achieve this goal," said the doctor. In 1965, the first anti-rabies dog vaccination campaign was conducted in the Western province with an imported vaccines to control an outbreak in Wattala and Ja-ela areas and in 1971, rabies was declared as a notifiable disease. "The formulation of a laboratory for production of fleury-type anti-rabies vaccine for animals was done at the Veterinary Research Institute of Ministry of Agriculture in Peradeniya in 1975," said the doctor. He said that rabies eradication programs from the 1970s to now have brought on latest technologies and the up-to-date vaccinations which have been effective in controlling the rabies problem. "This time, we have set up another rabies eradication program to eliminate the deadly disease by 2016," said Dr.Harischandra.

Strategies

Since 1998, Dr. P.A. L. Harischandra commenced innovation of strategies to reach inaccessible dogs via vaccinations which was given in food. According to the doctor, Vaccinia recombinant oral rabies vaccine was piloted in Puttalam district and it was possible to demonstrate that the ability of reaching over 75 percent coverage in 2003 in the district. In 2004, a new device to vaccinate stray dogs at a distance called auto vaccinator was introduced and stray dog vaccinations with parenteral rabies vaccines were commenced. These strategies resulted in reduction of human rabies deaths to 55 in 2005. "From the year 2007, we have administered animal birth control injections," said the doctor.

In 2002, a circular was issued on guidelines for the prevention of rabies by anti-rabies post exposure therapy (PET) to all hospitals. The production of anti-rabies vaccines for post exposure treatment of persons bitten by rabid and suspected animals is now on-going at the Medical Research Institute (MRI) and has been successful for the past few decades. According to the Ministry of Health, 30 deaths have been a result of rabies and it was 49 last year. Dr. Harischandra said, "In other countries, with the mass culling of dogs, that alone is not effective to control rabies in any country. There is no evidence that removal of dogs alone has ever had a significant impact on dog population densities or the spread of rabies."

Campaigns

He said that canine vaccination campaigns have been the most effective measure for controlling canine rabies provided there is an effective policy and strategy in place. Surveillance of rabies is the basis for any program of rabies control and veterinary surveillance of rabies and laboratory submission of reports of suspected animal cases is also essential for management of rabies," said the doctor.

Also speaking to the Sunday Observer was Omala Wimalaratne, Medical Virologist and Vaccinologist and Head of the Department of Rabies and Vaccines of the Medical Research Institute (MRI). She said, "A person dies of rabies almost every ten minutes in the world but it is 100 percent preventable." She said that worldwide, almost half of all rabies deaths occur in children under the age of 15 years.More than three billion people, about half the world's population, are living in countries/territories where dog rabies still exists and are potentially exposed to rabies. It is estimated that at least 55,000 human rabies deaths occur yearly in Africa and Asia following contact with rabid dogs.Dr. Harischandra said, "Rabies control measures launched in Sri Lanka since 1975 have had a tremendous effect on the incidence of human rabies.

The number of human rabies deaths declined from 377 in 1973 to 58 rabies deaths in the country in 2009." However, we shouldn't sleep at night or walk the streets thankful that there are few people who die of rabies.

If only we understand the gravity of the disease then we will vaccinate ourselves. Dr. Harischandra said, "Even though people think that within a few hours of getting bitten by a rabid dog, we can quickly get the rabies vaccination and survive, but we can't leave it up to chance because prevention is better than cure."

Mother's milk, the best:

Combined effort to overcome unethical milk food promotion

by Ruwan GODAGE

In a changing world, what role does the media play in relation to the advertising sector? In 'developed' countries aggressive advertising of infant milk powder has been done, which has led to several complications in these societies, ending with calls for a ban on advertising of such products.

Many companies are not allowed to advertise formula milk for babies. As how tobacco companies found their way through loopholes in legislation restricting advertising of cigarettes, milk companies are finding ways to exploit ambiguity in the law and drive their products ever-so subtlely to parents, they argue.

According to the World Health Organisation's recommendation, babies must be given breast milk for the first six months, and a mother should continue to breastfeed till the infant is two years. A resolution was passed by the WHO to control unethical advertising in 1974, and thereafter periodically amendments were enacted, particularly with regard to milk food in 1981 at the World Health Assembly, where special laws were adopted to the existing ones.

The reason for not breast feeding a child has been attributed to 'pragmatic decision based on personal circumstances'. A mother should be encouraged to breastfeed the infant within 30 minutes of birth. This enables developing a strong bond between mother and child.

In Sri Lanka, advertising milk food for children needs closer scrutiny than as being done at present. Many countries have developed detailed code provisions relating specifically to food marketing communications to children, but in Sri Lanka many advertisers are able to get away after engaging in unfair practices despite laws being enacted to curb such practices.

This code cannot be controlled by a single authority, but through a combined effort of the media, health ministry and professionals.

Until and unless national self regulatory codes and ethics are developed in greater detail, infants and mothers are prone to fall prey to shrewd and subtle advertising drives.

A call for a total ban on infant milk food advertising and dragging the wrong-doers to courts is, however, not the aim of the Health authorities in Sri Lanka. 'There are instances where milk powder may have to be given as a substitute to mother's milk.

'The ministry's main focus is that self-regulatory codes of conduct should be developed in greater detail, and all parties must make a concerted effort to refrain from unfair practices. More effort should be taken by advertising companies to adapt marketing strategies to balance food advertising to children, and to undertake self-regulatory initiatives.

An open dialogue should be made available to all parties connected with the promotion of any milk product', it transpired at a seminar on The Sri Lanka Code for Promotion, Protection and Support of Breastfeeding and Marketing of Designated Products, last week. Stringent codes of conduct and company initiatives can ensure that advertising and marketing strategies are carried out responsibly, and do not undermine balanced diets and healthy lifestyles. No powdered milk can ever match mother's milk, and why mothers tend to opt for powdered milk is mainly a result of milk foods propaganda. Breast milk, unlike powdered milk, can be given to a child at any time, and without having to go through the process of preparing it. Howevermuch advertising is done, breast milk is the only food that is totally attuned to the child's needs during the developing stages. Breast feeding also reduces the risk of having breast cancer.

The Government is increasing its efforts to encourage breastfeeding through a range of benefits to mothers of new-borns.

Mothers should also be persuaded to give natural food and fruits to their children and cultivate a need for more such foods. Our challenge is to draw the child's mind to not 'wolf down sausages like their cricketing heroes', but to go for nutritious foods. It is also the responsibility of fathers to help promote and encourage breastfeeding. A father's role too is important for timely breastfeeding of the child, Deputy Health Minister Lalith Dissanayake said.

Emphasising the need for effective implementation encouraging breast feeding in Sri Lanka, WHO Country Representative Dr. F. R. Mehta said, Sri Lanka was on the threshold of a very fast and rapid socio-economic development. And with this development, the workforce will expand to provide more opportunities for women to go out for employment. 'When more women go to work, the issue is not only the question of marketing a designated product, but also looking at all the environments - the work environment and the home environment which should be conducive for the woman to continue her duties of breast feeding.'

Breastfeeding, he noted, also reduces the risk of cancer of the breast and, non communicable diseases. Sri Lanka is moving fast and systematically to address this issue. The media, the health ministry, advertisers and the health sector have a pivotal role to play in working together in a continuing process to make Sri Lanka a shining example in this regard.

Participating at the seminar organised by Family Health Bureau, Health Education Bureau and WHO were also Deputy Director General of Health Services Dr. R. R. M. L. R. Siyambalapitiya, Sri Lanka College of Paediatricians President Prof. Asvini Fernando, Dr. Sarath de Silva and K. W. T. N. Amaratunga.

Preventing childhood obesity

Targeting children aged six to 12 with school-based programmes that encourage healthy eating, physical activity and positive attitudes to body image are among a range of interventions that can help reduce levels of obesity, according to a new review of the evidence.

While some people argue against taking action because they worry that the action could itself do harm, evidence of harm due to the interventions themselves was not found across the studies.

"There is now compelling evidence that strategies can be implemented to halt the growing rates of obesity in children.

We know that doing nothing is likely to result in increases of overweight and obesity, particularly in countries where the prevalence continues to rise", says researcher Prof Elizabeth Waters, who works at the McCaughey Centre at the University of Melbourne, Australia. Childhood obesity can cause social, psychological and health problems, and is linked to obesity later in life and poor adult health. An international team of researchers have updated a previous Cochrane Review by searching for new evidence from existing studies to see which forms of intervention could have maximum effect in helping children to avoid becoming obese.

Trials

They found that since 2005 the number of trials had increased from 22 to 55. With this increased pool of information they could make a more thorough assessment of the various approaches people had taken. Becoming obese is strongly linked to inappropriate nutrition and low levels of physical activity, so unsurprisingly many of the programs aimed to improve either or both of these behaviours. The studies varied in terms of what programs they evaluated for preventing obesity and the degree of benefit they identified. Nevertheless, taken together the review indicates that the interventions had a positive impact on average bodyweight.

"Our findings show that obesity prevention is worth investing in. Given the range of programs included in this review, it is hard to say exactly which components are the best, but we think the strategies to focus on are those that seek to change environments, rather than just the behaviour of individuals," says Waters.

Policies

The evidence identifies a number of promising policies and strategies that could be considered for implementation.

These include: Including healthy eating, physical activity and body image in school curricula. Increasing the number of opportunities for physical activity and the development of fundamental movement skills during the school week. Improving the nutritional quality of food supplied in schools.

Creating environments and cultural practices within schools that support children eating healthier foods and being active throughout each day.

Professional development and capacity building activities which help to support teachers and other staff as they implement health promotion strategies and activities. Giving more attention to parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen-based activities.

"Research that aims to reduce childhood obesity must now concentrate on finding ways of embedding effective interventions in health, education and care systems, so that we can make population-widew, long term impacts on the levels of obesity," says Waters.

- MNT