RABIES in West Africa

Dear partners in rabies elimination,

Following several considerations for investigation and action on the rabies cases in Bongo and Bolgatongo on which Dr. Becker and I have corresponded, she has suggested that I share these considerations with you. I wish it were possible for me to join you in investigation and action, but that may not bee possible until further funding shall be obtained. My focus is on rabies in dogs in communities in tropical countries, which is quite different from the traditional focus in Europe and the United States.

Dog groups

In tropical countries as Ghana, dogs in upper socioeconomic class communities are predominantly stable, owned and restricted, and in fenced or on leashes in neighborhoods. They are predominantly vaccinated against rabies, and are available for essentially all vaccination. In lower socioeconomic urban communities, in smaller towns and villages, and in rural farming communities, dogs are predominantly unrestricted, either recognized as owned or as belonging in the community. Where these communities are stable, the resident dogs act to keep outside wandering dogs from entering, and act as guards of homes and of children at play. These dogs are usually unvaccinated but are available for vaccination.

How does Rabies enter?

Rabies may enter these stable communities in two ways: first the "mad" dog form of rabies causes the infected dogs to charge into the communities, bringing in rabies and biting other dogs, people and other animals. The second situation is where the communities have been destabilized by capture and removal or by killing normal dogs in large numbers, opening the way for wandering dogs from wild areas, forests, or large garbage piles to enter, possibly bringing rabies to remaining unvaccinated dogs.

Rabies control measures and strategies

Priorities for rabies control in the areas of Bongo and Bolgatongo should follow the following:
Public education on the hazards of dog bites and rabies. Promptly scrub bite wounds with soap and water and apply antiseptics. This can be done as emergency patients at hospitals or if more than half an hour would be spent getting there, scrubbing can be done at home.
If available, postexposure globulin and vaccine are important for immediate treatment of persons who have been bitten. Investigation is needed to identify all persons who may have been bitten in the community.
The next investigations are veterinary. Were the the biting dogs resident in the community? They should have been promptly killed and if possible examined for rabies. If in higher class neighborhoods, the biting dogs could be captured, caged, and observed for signs of rabies during a ten day period. If they die, laboratory diagnosis for rabies is desirable.
The next investigation is whether the rabid dogs had bitten any other dogs or cats. If they had, the exposed animals should be killed. If the rabid dogs had bitten any cattle, sheep or goats, these animals should be watched for any inability to eat or drink or for any developing paralysis during the next three months. If these animals develop such signs, they should be killed and deeply buried. If these animals are normal, they should still not be used for food or milk during the 3 month observation period.
The next investigation should be to determine where the biting dogs came from. Did they enter the community from outside? If so, were any other cases of rabies in dogs or exposures of dogs, people and other animals identified? If the sources of the biting dogs were identified, these would be the critical communities to conduct population vaccination of the dogs.
Further vaccination priorities would be within three kilometers of the biting incidents or sources of the biting dogs.

I would be happy to discuss education, investigation and vaccination by e-mail or conference telephone calls if desired.

George W. Beran, DVM, PhD, LHD, Diplomate, American College of Veterinary Preventive Medicine, American College of Epidemiology