A brush with rabies

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.

Rabies, dog programs and dogmanship

With Dr Jan Allen (AMRRIC), Dr Charles Douglas (NT Centre for Disease Control), Dr Helen Scott-Orr (former Chief Veterinary Officer of NSW), Dr Malcolm Anderson (NT Chief Veterinary Officer), Charlie King (our brilliant MC and commentator) and Dr Joe Schmidt (from the Northern Australia Quarantine Strategy).

For those who don’t know we’re currently based at the Animal Management in Rural and Remote IndigenousCommunities (AMRRIC) 10^th Anniversary Conference, held in sunny (and sticky) Darwin.

A major theme underlying this conference is One Health and – no matter how you interpret the term – an incursion of rabies into Australia is one event that would certainly be a “One Health” issue.

Yesterday we ran an exercise to look at how communities, local and Federal Governments and other organisations might respond to a hypothetical rabies outbreak in Arnhem Land, and it got the audience very excited. 

Many questions were raised including how quickly the virus may spread between dogs, who might be available to participate in mass vaccination programs given most Australians aren’t vaccinated for rabies (so there may be a lag before some people could help), what has happened in poorly managed outbreaks overseas and how local knowledge about communities and dogs could reduce infection and save lives.

What I came away with is a sense that rabies preparedness is not about being ready to respond in the event of an outbreak. It is about developing relationships with communities and dogs over time, about involving veterinarians and health workers with local knowledge, and ensuring communication and education occur well in advance so that panic is minimised. And that can help manage other health and infectious disease problems in the meantime. We're also very fortunate in that a number of researchers in Australia are currently looking at what might happen if rabies were to emerge here.

I'm not really whinging about the weather. Its perfect. Although not quite prepared to take a dip. (Loved the signage. They're happy to admit that crocs and box jellyfish can kill you but someone forgot to mention that cigarettes kill more people than these animals do).

Other highlights of the day were Dr Ganga de Silva’s discussion of the rabies control program run by the Blue Paw Trust in Sri Lanka. We are very fortunate in Australia not to have rabies, but worldwide someone dies of rabies every ten minutes – around 55,000 people per year.

Rabies infects humans and animals, but dogs are the main reservoir. The only way to reduce the R0 (the basic reproductive rate – which for rabies is 1-2) is to control rabies in dogs.

The Blue Paw Trust has done fantastic work in vaccinating many dogs against rabies. Together with post-exposure prophylaxis, rabies vaccination of dogs reduces human infections. Eliminating rabies from Sri Lanka, an island, is doable, but requires ongoing cooperation from Government and organisations. Dr de Silva’s talk about the work of her team was inspiring.

Dr Kirsty Officer, who has volunteered with a number of organisations including Animals Asia, AMRRIC and Vets Beyond Borders, gave a brilliant talk about dog programs. She argued that we need to think about the big picture – programs are “more than just spaying dogs”. Really, volunteers should be aiming to “do themselves out of a job”. The aim is to ensure that locals are left with a sustainable program.

But the little picture itself is really important – every dog counts. A dog management program should never be about how many dogs you could desex in a day. The welfare of those animals should be optimised at each stage of the process. She suggested that dog catching was the limiting factor in many dog projects and one where welfare gets compromised often. There is a need to understand, role model and promote humane handling.

Easy-to-catch dogs are often caught first while the aggressive, problem dogs on the fringes may be considered too-hard. But programs that ignore these dogs don’t help in the long term – those dogs are the ones that hang around and breed, and their offspring inherit/learn the same ways.

She also discussed the need for minimum standards of veterinary care, which can be a challenge to maintain in tough conditions. They are essential in optimising animal welfare but also ensuring programs are sustainable.

Another highlight was Professor Paul McGreevy’s talk on dogmanship. We are all familiar with the term horsemanship – horsey people just seem to be better at being around horses, not irritating them, engaging with them, handling them better and so on. Professor McGreevy argued that the same applies with dogs.

Studies have shown that good dog trainers are consistent in their behaviour, optimise the timing of cues and rewards, and can effectively communicate with animals (i.e. they can grab their attention and keep them engaged) – but what about just generally good dog people?

His team are looking at peer-reviewed evidence for elements of dogmanship (different attributes that impact a dog’s level of arousal and mood). Some of these include whether an individual dog is familiar with us, ability to capture the animal’s attention, activity sharing and even using a clear, higher-pitched voice around dogs.

What was less clear was how the attachment of the animal to the person, or vice versa, impacted the relationship.

If we could work out the elements of what makes a person good with dogs and break these down into bits we could teach people that are likely to encounter dogs – any person who might meet and greet dogs in their work (e.g. a postie), or anyone handling, training or caring for a dog.