|Rabies vaccines may not be accessible to all those who need them.|
Rabies is a disease that is invariably fatal. It is also preventable. But an email from a colleague last week provides some insight into the challenges of rabies prevention in rabies endemic countries. She has given me permission to share it.
This colleague is volunteering in the South of Nepal with the Himalayan AnimalRescue Trust, an organisation that does important work by providing desexing and vaccination of dogs. This is important not just in terms of controlling dog overpopulation, but of reducing the spread of rabies. Unfortunately, dog bites are a very common route of transmission in rabies endemic countries.
She was bitten by a dog, as can occasionally happen even when the utmost care is taken. As with all of the volunteers, she has been vaccinated against rabies. Nonetheless, given the consequences of rabies infection are catastrophic, post-exposure vaccination is required. (In fact it is recommended that the wound be washed with soap under running water for at least 15 minutes – difficult in areas with limited water supply; then alcohol or povidone iodine applied to the wound before consulting the nearest doctor).
It was getting the vaccination that proved challenging, as she wrote:
One of the vet technicians was sent with me on the trek to find a rabies vaccine. This was really scary as we went to so many hospitals that didn't have any. The large government hospital closes at 2pm so we went to the emergency clinic. I really can't see the logic as the out of hours emergency had no access to vaccines. We were told if I came back the next day and went to the emergency ward tomorrow when the hospital was open then I probably could get a vaccination. What upset me was how difficult it was to find a vaccine. Nowhere we went did anyone offer to ring around and find where we might find one. This is a 100% fatal disease if untreated.
Eventually she got the vaccination. In developed countries we are used to life-saving drugs being readily available – or at least rapidly sourced. But in countries where rabies is endemic, there may be barriers to access which ultimately mean that some people succumb to what is a preventable disease.
At least in this case the dog bite victim was aware of how serious potential rabies exposure is, and how pressing the need to find a vaccine, and she persisted until she found the required treatment. Many dog bite victims are children and they don't appreciate how important it is to tell someone they've been bitten. Education is critical in this regard.
If you have not done so already, it’s worth completing the Rabies Educator Certificate via the Global Alliance forRabies Control website. It is free of charge, reasonably straightforward to complete, and it just might save a life. Click here to sign up.