Preventing rabies - cheaper and more effective:

Colombo: By 2018 rabies free

By Carol Aloysius

Each year over 50,000 people die of rabies throughout the world, more than 31,000 of these deaths occur in Asia. The virus when it takes hold, is among the world's deadliest diseases: only one un-vaccinated survivor has so far been recorded.

While rabies prevalence in Sri Lanka has been on the decline, the disease is endemic in the animal population and therefore poses a continuous public health concern. The Ministry of Health spends a substantial amount of its health budget on anti-rabies treatment on people.

In Sri Lanka, people bitten by animals thought to be rabid receive Post-Exposure Prophylaxis (PEP) at no cost. While treatment is free for the patient, it costs the government US$173 without immunoglobulin and US$177 with equine immunoglobulin to administer the post exposure treatment. This includes all direct medical costs associated with PEP.

Given the high cost, health officials are now giving priority to prevent rabies which is much cheaper and more effective. Over the past few years, the Colombo Municipal Council's Veterinary Department successfully reduced the number of stray dogs and brought the number of positive rabies cases to almost zero within the city.

A vaccination program for all dogs in the city - stray and owned is responsible for the sharp decrease in the number of cases. If vaccinations continue, the authorities are confident of reaching their goal of a 'Rabies Free city' by 2018.

"To combat rabies in Colombo we first surveyed the dog population, counting around 5,000 stray dogs in the city. We then conducted a massive immunisation program," Chief Veterinary surgeon , Colombo Municipal Council, Dr Vipula Dharmawardene said.

Dr Dharmawawardene explained that teams 'scoured' public roads, roundabouts, bus stands, railway stations, shanties, playgrounds and parks to find stray dogs. They used special equipment and sedatives to capture the dogs and administer the anti-rabies vaccine.

The dogs were also sterilised leading to a long-term decline in the stray dog population.

Figures show that the stray dog population in the city has decreased from 5,000 in 2006 to 2,500 in 2015.

With fewer disease carrying vectors and higher imunisation rates, Colombo may soon be rabies free but while this represents real progress, it does beg the question, is freeing one city of rabies enough? Vaccination rates in secondary cities and rural areas are lagging and crucially the volume of data collected on vulnerable animal populations in those areas is limited.

At present, the Health Ministry relies heavily on private studies in hospitals or by the Medical Research Institute (MRI) where samples of suspected rabid animals (mostly dogs) are examined. Data collected between 1999 and 2010 shows that over 85% of rabies cases detected by human occur in dogs, cats account for 7.9% and wild animals 2%, with humans and livestock making up the balance.

A systematic effort has not or vaccinate dogs in other troublespots and without an on-going and country-wide program it remains possible that migrant animals might bring the disease back to Colombo, which means a rabies free country is still some way off.

[Signs/Symptoms of Rabies in animals]

When rabies infection occurs, the virus grows in muscle tissue and may go undetected for several days or months. During this incubation (or latent) period, the animal appears healthy and shows no sign of infection. Usually within one to three months, the virus migrates to the nerves near the site of the infection and spreads to the spinal cord and brain (i.e., the central nervous system). It usually takes from 12 to 180 days to spread through the peripheral nerves to the central nervous system. At this point, the disease progresses rapidly, and the animal begins to show the classic behavioural signs of rabies. The virus spreads to the saliva, tears, breast milk and urine. The animal usually dies in four or five days.

Rabies causes typical symptoms. The infection progresses in a predictable manner, from the initial prodormal phase to the excitative, or furious, phase to the final paralytic phase.

The first sign usually is a change in behaviour. Pet owners should be aware that behavioural changes can occur as a result of many conditions, from digestive disorders to poisoning.

Rabid animals usually stop eating and drinking, and may appear to want to be left alone. After the initial onset of symptoms, the animal may become vicious or begin to show signs of paralysis. Some rabid animals bite at the slightest provocation and others may be somnolent and difficult to arouse. Once the animal shows signs of paralysis, the disease progresses very quickly and the animal dies.

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