Combating the nemesis of a preventable disease

Ending poverty in all its forms everywhere, ensuring healthy lives, and promoting well-being for all ages are among the global agenda of the sustainable development goals (SDG 1 and 3) after the phasing-out of the millennium development goals. Though 100% preventable, rabies is among diseases of poverty that affect many in low and middle-income countries, including Ghana. Many players have contributed to the persistence of the disease both globally and locally.

As we celebrate the 17th session of World Rabies Day, our team from the Council for Scientific and Industrial Research – Animal Research Institute believes that a one health outlook through awareness creation is additionally crucial for Ghana to meet the elimination target set for 2030 on rabies. We draw lessons from past incidences of rabies and show that it is possible to deal with the disease.

The naivety of the vaccination status of you or a neighbor’s dog or cat until the demise of a child is worrying and cruel, knowing the preventable nature of rabies. To dispel doubts and reduce the risk of rabies to everyone and prevent such unfortunate incidents, dog owners may be required to commit to spending about $4 or more to get their dog(s) vaccinated and also reduce straying. The value of human life and the benefit of a companion animal outweigh the estimated amount to be spent on yearly dog vaccinations and post-exposure treatments in humans.

Herd immunity against rabies in dogs is achievable but will require 70% or more vaccination coverage to break the cycle of spread in dog populations and ensure protection for humans. The support and donations from groups and individuals towards increasing dog vaccination coverage above the current 0.8% in Ghana will also help strengthen the human and veterinary health systems.

Early initiation of PEP is effective in preventing human deaths due to rabies. Few victims of rabies bites and wounds, access PEP within 24 hours of exposure,
however, wounds such as scratches may easily be underrated but can be deadly,
regardless of size. Non-access to PEP may be due to cost implications and the non-cooperation of dog owners to support victims in their treatment, with the knowledge that PEP interventions are expensive and a significant challenge in low and middle-income countries.

Eliminating the disease will mean deliberate government programs to reduce the cost of receiving PEP. Efforts should be made to ensure adequate distribution of PEP to health facilities, especially in places where they are needed most. Everyone also matters as this year's WRD theme suggests, hence deliberate
interventions from communities, groups, and individuals to subsidize and make available PEP to communities should be encouraged. Improvement of Health system delivery may also be required to ensure that health personnel deliver prompt and
comprehensive care for victims and are also abreast with current disease
management tools for rabies.

Fever, flu, weakness, and headache are the first non-specific symptoms
characteristics of the infection, followed by acute neurological symptoms, including, among others, hyper-salivation (drooling with saliva), hydrophobia (fear of water), and confusion. In most cases, the onset of these symptoms is often highly fatal if PEP treatments are not received earlier. Bites, scratches, and compromising contact with a rabid animal or dog should not be underrated. Urgent medical advice should be sought to determine the need or not for initiating PEP or Pre-exposure prophylaxis.

Persons working directly with animals, wildlife, or others dispatched to communities where PEP treatments are not readily available may be highly susceptible to contracting rabies and must receive Pre-exposure prophylaxis to offer protection before exposure to the rabies virus.

The situation in Ghana is alarming at a time when it is expensive to access and seek healthcare. Rabies is preventable, and the measures outlined below will help in its elimination. Dog population census will be required to learn more about distribution patterns and changing population dynamics to inform public health decisions.

Elimination of stray dogs off the street and subsidizing spay and neuter programs will help reduce the proliferation of stray dogs. The establishment of dog shelters and fostering or rehoming stray dogs after training will be required. Also, the introduction of heavy fines for dog owners with unvaccinated or outdated rabies vaccinations will serve as a deterrent for irresponsible pet ownership behaviors.

On the human front, early PEP treatment initiation and adherence to the treatment schedule is crucial and victims must ensure they receive all doses to get full protection. As the theme for this year indicates, "All for one, one health for all", it is everyone's business to fight against rabies. While governments re-evaluate the support for rabies management within the country and resource internal production and development of vaccines. Communities and individuals can consider adopting special locale-specific programs to absorb or reduce the cost of receiving PEP alongside government programs.