Most dog owners have no doubt heard about the horrors of rabies, an infection that’s usually transmitted through dog bites. The bullet-shaped virus begins replicating, quietly, in a dog’s muscle. Then it travels to motor neurons in the central nervous system, and eventually reaches the brain. It wreaks inflammatory havoc there, leading the dog to become confused and extremely aggressive. Then the virus travels through the dog’s peripheral nervous system to the salivary glands. There it makes its host foam at the mouth, leaving the virus fully exposed, in perfect position to infect the next piece of muscle the crazed animal bites into.
The scariest thing about rabies is its potency: If your dog gets rabies, your dog will almost certainly die. And if a rabid dog bites you, you will almost certainly die, too, unless you get a vaccine within 10 days.
And yet, rabies isn’t a problem in developed countries. Last year exactly one person was diagnosed with rabies in the United States (after being bitten in Guatemala), and nobody got it in Western Europe. There’s a very simple explanation for our lack of rabies: We vaccinate our dogs.
That’s not wholly true, of course; some dog owners don’t get their pups the vaccine and some dogs don’t have owners. But in the state of New York, where I live, the law dictates that “every dog, cat and domesticated ferret” be vaccinated. The same goes for most other states.
In developing countries the situation is sadly quite different, as I learned in a commentary published in today’s issue of Science. There, rabies kills at least 69,000 people every year (and because of underreporting, the real number may be many times higher than that). Some 40 percent of victims are children. Rabies in people is a lot like rabies in dogs: It causes confusion, hyperactivity, excessive drooling, and delusions. The new commentary opens with a gut-wrenching photograph of a 16-year-old boy suffering through rabies; he is lying on a pillow with his eyes closed, biting down hard on a wooden stick, with three people holding him down.
If I were to get infected with rabies today, I would go to the hospital and receive a ‘post-exposure prophylaxis‘, or PEP, which is essentially a vaccine that works after the fact. In 1885, Louis Pasteur gave a version of this treatment to a 9-year-old boy bitten by a rabid dog, saving his life. These treatments are available in developing countries, but usually only for affluent people. But it’s poor people who are more frequently exposed to rabid dogs, and who don’t have access to medical facilities or money, the Science authors point out. “It is the poor who die.”
Here’s the rub: Poor people shouldn’t even need access to PEP, which is relatively expensive. The whole problem could be dealt with, just as it is here, by vaccinating dogs. So why isn’t this done?
A big part of the problem, according to the Science piece, is that in many countries the budgets and administration of veterinary medicine and human medicine are kept entirely separate. And the powers that be in veterinary medicine are primarily concerned with preventing economic losses from livestock illnesses. But rabid dogs — which tend to be domestic dogs, not strays — don’t have much effect on livestock. “As rabies does not cause a high burden of disease in livestock,” the authors write, “dog vaccination has not been prioritized by veterinary services in low-income countries.”
There are many countries where these problems have been addressed without much monetary expense, mostly in Latin and South America. They could be used as models for Asia and Africa, the authors say. Some small-scale change has been made in certain regions already. The government of Kenya, for example, has created a Zoonotic Disease Unit that includes leaders from the country’s health and agriculture departments. The unit has a coordinated, long-term strategy for combating rabies that hinges on “sustained mass dog vaccinations.”
Because the virus doesn’t move all that quickly between dogs, full vaccination coverage isn’t necessary for this strategy to work. Vaccinating just 70 percent of the dog population, in fact — which doesn’t cost much more than vaccinating 20 percent — “reduces outbreak probability close to zero,” the authors write. That means the disease can be contained even without vaccinating stray dogs. (Unfortunately, despite all this data, the first strategy against rabies tends to be mass killing of strays.)
The authors have demonstrated the effectiveness of this strategy over the past decade in Tanzania. As part of the Serengeti Health Initiative, the researchers have vaccinated thousands of dogs in 180 villages, ultimately reaching a 70 percent vaccination rate. Since the launch of the project, the number of people dying of rabies dropped from 50 a year to nearly zero.
I generally avoid writing stories about public health in developing countries because the problems always seem so big and so dire. Ebola, Malaria, Tuberculosis, HIV — these are crazy-difficult problems with no easy solutions. Rabies is different. It can be contained quickly and cheaply, ultimately saving money in medical costs, not to mention many human lives. All that’s needed is the political will.
Go Further
Animals
- This ‘saber-toothed’ salmon wasn’t quite what we thoughtThis ‘saber-toothed’ salmon wasn’t quite what we thought
- Why this rhino-zebra friendship makes perfect senseWhy this rhino-zebra friendship makes perfect sense
- When did bioluminescence evolve? It’s older than we thought.When did bioluminescence evolve? It’s older than we thought.
- Soy, skim … spider. Are any of these technically milk?Soy, skim … spider. Are any of these technically milk?
- This pristine piece of the Amazon shows nature’s resilienceThis pristine piece of the Amazon shows nature’s resilience
Environment
- This pristine piece of the Amazon shows nature’s resilienceThis pristine piece of the Amazon shows nature’s resilience
- Listen to 30 years of climate change transformed into haunting musicListen to 30 years of climate change transformed into haunting music
- This ancient society tried to stop El Niño—with child sacrificeThis ancient society tried to stop El Niño—with child sacrifice
- U.S. plans to clean its drinking water. What does that mean?U.S. plans to clean its drinking water. What does that mean?
History & Culture
- Meet the original members of the tortured poets departmentMeet the original members of the tortured poets department
- Séances at the White House? Why these first ladies turned to the occultSéances at the White House? Why these first ladies turned to the occult
- Gambling is everywhere now. When is that a problem?Gambling is everywhere now. When is that a problem?
- Beauty is pain—at least it was in 17th-century SpainBeauty is pain—at least it was in 17th-century Spain
- The real spies who inspired ‘The Ministry of Ungentlemanly Warfare’The real spies who inspired ‘The Ministry of Ungentlemanly Warfare’
Science
- Here's how astronomers found one of the rarest phenomenons in spaceHere's how astronomers found one of the rarest phenomenons in space
- Not an extrovert or introvert? There’s a word for that.Not an extrovert or introvert? There’s a word for that.
- NASA has a plan to clean up space junk—but is going green enough?NASA has a plan to clean up space junk—but is going green enough?
- Soy, skim … spider. Are any of these technically milk?Soy, skim … spider. Are any of these technically milk?
Travel
- Could Mexico's Chepe Express be the ultimate slow rail adventure?Could Mexico's Chepe Express be the ultimate slow rail adventure?
- What it's like to hike the Camino del Mayab in MexicoWhat it's like to hike the Camino del Mayab in Mexico