Rabies, the neglected cause of mortality in developing countries

BACKGROUND:Rabies is a very deadly zoonosis, caused by a lyssavirus which belongs to the family Rhabdoviridae. The reservoirs include wild wolves, bats, skunks, raccoons and foxes. This disease satisfies all World Health Organization (WHO) criteria for diseases that are a priority for control. Contrary to expectations, its control is unfortunately neglectedespecially in developing countries. Rabies is recognized as one of the causes of many preventable deaths. Globally it causes 35,000 deaths annually and strikingly, 24,000 of the deaths occur in Africa. A multi-centre study from India reported 18,500 human rabies deaths per year, while in Tanzania 380-1,900 deaths have been reported to occur annually. Mostof the studies on rabies in Tanzania have been conducted by foreign scientists and the WHO and few Tanzanians-often junior researchers and research assistants. Currently, there is an on-going study at Ifakara on immunization of dogs and results are still pending. Rabies is a fatal disease that carries a very high mortality. Tanzanians are encouraged to carry out several studies in different regions especially in rural areas and congested urban areas where stray dogs are plenty so as to combat this deadly disease. There is paucity of information regarding the actual magnitude of this disease in developing countries including Tanzania, resulting in a gap that needs to be filled by conducting research on the subject. Scientists in Tanzania are therefore encouraged to carry out several studies in different regions especially in rural areas and congestedurban areas where stray dogs are in plenty so as to generate comprehensive information about rabies that will contribute to the control and prevention of this deadly disease.MAJOR FINDINGS: The global DALY (Disability Adjusted Life Years) value is about 1.16 million that is much greater than that of a disease like leprosy that has a DALY value of about 117,000, but the latter has been given prominence as a disease of public health importance. This observation signifies the need to promote public awareness regarding rabies and also the need to implement workable and effective interventions for control and prevention. After a review of different articles on this topic, it is evident that rabies affects children, with a prevalence of 26% among those aged between 0-4 years and 34% among those aged 5-14 years. Prevalences of 33%, 3.5% and 4.2% were reported amongindividuals aged 15-44 years, 45-59 years, and 60 years and above, respectively. Causes of neglect of this disease include lack of political commitment towards control of the disease, low awareness about the magnitude of the problem due to under reporting of cases, high cost of Post-Exposure Prophylaxis, low coverage of vaccination of dogs in developing countries and lack of proper ownership and care for dogs that turn out to be ‘stray dogs’ that serve as reservoirs for the infection.CONCLUSION: Rabies has caused significant preventable mortality in developing countries and affects mostly the juvenile population. Domestic dogs should be well vaccinated and reached with veterinary services, there should be a joint venture among the political leaders, health care providers, veterinary doctors and the mass at large to control this disease. There should be thorough mass education and facilitation to community participation. PEP should be available in close proximity so aiming at reducing mortality in population groups at high risk of infection