Thursday 11 June 2015

Rabies is still a danger to development

Border control after outbreak in Ireland / Rossographer

Under control in much of the west, this deadly disease runs wild elsewhere, but it can be stopped

With HIV, Ebola and other terrifying diseases in the news it is easy to forget that an older virus like rabies is still around, despite being almost eliminated from mainland Europe.

The disease is usually transmitted to humans through an animal bite, usually a dog. Without treatment patients suffer and die.

Today, almost all rabies victims are in the developing world, especially Africa where traditional challenges and conflict is hampering the treatment of the disease and the harm it does to development ambitions.

New Europe discussed the issue with one of the world’s leading experts, Professor Louis Nel, Executive Director of the Global Alliance for Rabies Control. He is also on the steering committee of the Gates Foundation/World Health Organization rabies control panel.

Nel is a full Professor at the University of Pretoria where he specialises in molecular biology (lyssaviruses and rabies).

New Europe: Some people don’t really understand what rabies is, could you give us a little background on the disease?

Louis Nel: Rabies is one of the most fearful diseases on the planet. It’s deadly, and has the highest fatality rate of all diseases. It’s viral and very well-adapted to the mammalian brain. It really transforms the host individuals and creates aggressive behavior and evolves a mechanism to ensure its own transmission. The virus migrates from the brain into the salivary glands to allow for its transmitting to other animals.

Could you tell us a bit about the distribution and affects of the disease?

Rabies was very controlled and well eliminated in dogs throughout Europe, but this is not the case in other parts of the world. Africa and Asia, specifically, the major burden of rabies is on these two continents. Dog rabies is an epidemic in these developing countries and is the cause of 99% of human cases of rabies. To some extent, it is a disease that affects the poorest of the poor which is why it sometimes loses visibility

How many fatalities does it cause?

The latest estimate puts it between 60-75,000 human cases per year. You know, rabies is not only the most deadly disease on Earth, but it’s also one of the only diseases that has preventative measures both before and after transmitting the disease.

So each case represents a double failure, to prevent and to treat

Correct. Accessibility and affordability of the vaccines needed are the priorities to prevent human deaths by rabies.

If we could put in place systems to provide vaccines there would be spin-off benefits for healthcare

That’s very true, but you know we are looking at another paradigm—rabies is essentially an animal disease so the cases in humans are what we call spillover, or incidental. Even though, that number is unacceptably high, but the paradigm would be to eliminate or prevent the disease in the reservoir (or domestic dogs). The long-term solution is to eliminate rabies in dogs to prevent it in humans, and this can be done it’s been shown in Europe.

How realistic is it for that to be an achievable goal?

It is a large task I do not doubt that. But it can be done. It’s been done in Europe, America and isolated countries elsewhere. We have to have a target to have something to work toward. All the rabies preventative organizations have come together to generate a blueprint on how countries can prevent rabies with step-by-step procedures. That’s a plan that can be measured and get us toward the goal of eliminating it.

Is this something that has to be regional? The animal world does not recognize borders

That’s a good point. It’s a trans-boundary disease, for that reason regional approaches and good neighborliness comes into play. Hopefully countries can influence one another through the successes of the control programs.

It’s Europe’s year of development, and there has been a lot of talk of working with impoverished communities, are we conscious enough of the effects of rabies?

From our perspective at the Global Alliance for Rabies Control, we do not believe rabies gets the attention it needs. There are many reasons for that. A lot of times this disease is affecting people in large numbers in certain parts of the world but only one case of it is actually recorded or treated. So, the numbers are just not there, and that’s what we set out to do. We are creating awareness through things like World Rabies Day, and this has helped but we definitely need to do more.

How has Europe responded to your message?

People want to do good and make a difference. Of course, there are many causes in the world to care about. I believe the response to what we are trying to do has been very positive, and I am thankful for that.

You seem to be in a good position to move forward

Absolutely. We have the biologics, the methods, the support and global buy-in—it is just about putting all this together and staying the course.

Is money much of an issue with this?

Money is always an issue, but we need to be careful to understand that money won’t drive the success of this program. Investors will know where to put their money and where it will be of most importance, but we need people to support and believe in it first.

And in our lifetime we could see an end to rabies?

Absolutely, I think we could

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