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Close friend, carrier of deadly disease

By Milliam Murigi
Monday, November 23rd, 2020
Rabies Immune Globulin (RIG).
In summary

Milliam Murigi @millymur1

Dog has always been man’s best friend, but without responsible ownership, they are turning to be the worst man’s enemy because of rabies.

The deadly virus spread to people from the saliva of infected animals, usually through a bite.

Warm-blooded animals serve as reservoirs for rabies, with unvaccinated dogs as the main reservoir worldwide. 

Florence Ndinda from Makueni county is one of those who can’t stand a dog’s presence after her two granddaughters, who she is taking care of, were bitten by her own dog, which was rabid.

She remembers vividly how two years ago one of her granddaughters, Florence Mbithe (then eight), was bitten by one of her puppies.

Mbithe was playing with other children outside their house when a puppy came running to her. Before Florence could rescue Mbithe, the puppy had already bitten her. 

Confused without knowing what to do, Ndinda took her granddaughter to the nearby dispensary for first aid.

After receiving help, she was connected to the Makueni Rabies Surveillance team who came and took samples from that dog and the result showed it was rabid.

They were also referred to Makueni Level Five hospital for Mbithe’s treatment.

“I was advised to isolate the dog for 10 days as the rest were getting the vaccine, but I didn’t. I felt that since it was a puppy it won’t harm any other person,” she says.

Since she couldn’t manage to go to Makueni hospital that same day, she had to go there the following day.

While away, the same puppy attacked her youngest granddaughter Abigael Ndinda then aged four.

Florence Ndinda explains how puppies with rabies attacked her granddaughters. (left) and Jane Nduku with her vaccinated dogs. Photo/PD/MILLIAM MURIGI

With no Post-Exposure rabies Prophylaxis (PEP) vaccine at the hospital, she was forced to buy it from the nearby pharmacy.

It was not easy to get the required five doses per person for both her granddaughters.

With a dose going for Sh950, she only managed to buy them three doses each.

She also vowed to never ever keep dogs in her compound and even her neighbour’s dogs are always chased away when spotted in her compound.

“PEP is compulsory if you are bitten by a dog, cat, or another animal that is rabid or is suspected to be infected with rabies.

An exposed person who has never been vaccinated against rabies should get four doses of the vaccine and another shot called Rabies Immune Globulin (RIG).

A previously vaccinated person should get two doses of the vaccine. They do not need RIG.

Always, make sure you complete the dose,” says Dr Emily Mudoga, Animals Campaign Manager at World Animal Protection.

The vaccine is made up of the dead rabies virus. When it is injected into the body, the immune system immediately starts to produce antibodies to fight off the perceived infection.

Multiple shots ensure the levels of antibodies remain elevated so that even if the live virus is already in your system, the antibodies will neutralise it.

Besides humans, rabid dogs attack livestock. Makueni county alone lost 300 livestock in the last five years. The number, however, is suspected to be higher since most cases go unreported.

Jane Nduku is one of the residents who lost her cow after it was attacked by a rabid dog. It took some days before she realised the cow had been bitten.

She only found when she called the veterinary to report that the cow was suffering from foot and mouth disease as it couldn’t swallow anything. The veterinary confirmed otherwise.

“When the veterinary visited us, the dog that had attacked the cow had started showing rabid signs, but hadn’t gone crazy.

So after taking samples and the result turned positive, we were advised to kill both the cow and the dog. That is exactly what we did,” says Nduku.

Richard Muteti, a veterinary who also doubles up as a field officer for rabies surveillance for Kenya Medical Research Institute in Makueni county, says some cases go unreported because livestock owners confuse rabies with foot-and-mouth disease, hemorrhagic septicaemia or choking.

Disease surveillance

To ensure farmers are able to differentiate rabies from the above, he says they have been creating awareness about rabies and advising farmers to report if a dog attacks their animals.

Because of these, reported cases of livestock being bitten by dogs have increased unlike before when people used not to report.

“At Makueni sub-county alone, we have been getting about 12 cases of dog or animal bites weekly.

Since not all dog/animal bites are rabid about 20 cases turns positive annually,” says Muteti.

Currently, over 70 per cent of the county is now reporting any dog /animal bite witnessed. Muteti reveals they are targeting 90 per cent.

To make sure all bite cases have been captured at the county level, Dr Daniel Ksee, Acting Director, Veterinary Services in the county, says they are set to unveil an Integrated Bite Case Management (IBCM), an approach for rabies surveillance that directly and formally links workers in public health and veterinary sectors to assess risk of rabies among animal bite patients and biting animals, respectively.

“This approach will help us with contact tracing, and we will be able to come up with concrete data about rabies in the county. We hope this approach will be embraced by other counties,” says Ksee.

Apart from this approach, Ksee says other initiatives in place include: annaul mass dog vaccination, that have seen about 300,000 dogs vaccinated; and training the community and teachers about responsible dog ownership.

He says most farmers don’t know the importance of vaccinating their dogs. Farmers have been focusing on animals that generate some income such as cows, goats, pigs and donkeys.

“We decided to use teachers because they can easily reach the students. They have been integrating responsible dog ownership topics in their programmes and we have recorded a decrease of stray dogs across the county,” adds Ksee.

It is recommended for puppies to get the vaccination at three months for the first time, followed at nine months, and then yearly boosters.

In some cases, the first vaccination can be given as early as two months, but with precaution.

For adult dogs, the first vaccination should be given as soon as possible, and a local veterinarian should be consulted.

In Kenya alone, about 2,000 people die annually because of rabies yet it is 100 per cent vaccine-preventable.

The World Health Organisation says rabies is estimated to cause 59,000 human deaths annually in over 150 countries, with 95 per cent of cases occurring in Africa and Asia.

Due to widespread underreporting and uncertain estimates, it is likely this is a gross underestimate of the true burden of disease.

“In Kenya, domesticated dogs are responsible for transmission of over 98 per cent of all human rabies cases.

Apart from dog bites, the virus can also be transmitted when saliva enters any open wound or mucus membrane,” says Mudoga.

Although the campaign to make Kenya a rabies-free country has been running for the last 100 years, we are yet to eliminate the virus because, according to Mudoga, there is lack of political goodwill. 

“Rabies vaccine has not been prioritised by counties despite that it is easier to vaccinate than to treat.

The government needs to make this vaccine mandatory, put more resources for the campaign, and bring communities on board.

With all that done, it will be possible to have zero human deaths from dog-mediated rabies by 2030,” adds Mudoga.

Survival chances

Generally, it takes between 30 to 50 days for rabies symptoms to develop. They appear once the virus reaches the spinal cord or brain.

However, in some cases, symptoms can appear in just 10 days or it even over a year.

The duration depends on factors such as location of virus entry and viral load. Initial symptoms are flu, difficulty swallowing followed by fever, a headache and vomiting.

“Currently there is no cure for raibes. If you are bitten, you should visit your doctor right away.

The incubation period can be as little as five days, so don’t assume you can wait for a week to see if the animal that bit you is unwell before seeking medical attention.

The chances of survival are extremely low once the patient becomes symptomatic,” adds Mudoga.  

And what should one do if bitten by an animal? 

Mudoga says the most effective first-aid treatment against rabies is to wash and flush the wound immediately with soap and water for 10–15 minutes.

If soap is not available, flushing it with water alone is also acceptable.

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