Rabies Just Can’t Get Any Respect

Rabies Just Can’t Get Any Respect

Rabies Just Can’t Get Any Respect

rabies-infographic-2015.jpg

What does a killer disease have to do to get attention these days? Last year, people watched with horror as Ebola ravaged West Africa and spread fear around the globe. Now it’s the turn of the upstart Zika virus to grab the headlines as an international health emergency.

Meanwhile, I’ve just been quietly doing my thing, killing about 60,000 people per year in the most gruesome way imaginable. But hey, I’m just rabies — nothing to get worked up over, right?

I’ll admit Ebola and the Zika virus are particularly nasty. Aided by air travel they are capable of spreading at jet speed, infecting susceptible populations across the globe. Adding to the fear factor is the fact that at the start of the recent outbreaks, no vaccines were readily available.

Every death is devastating to family and friends, so maybe comparisons aren’t helpful. But just look at the numbers! Every year I am responsible for more than five times the number of deaths reported during the most recent Ebola outbreak and many of my victims are children younger than 15. Surely that deserves some proper recognition?

Like Zika and Ebola, I can jump from animals to humans. Yet somehow, I barely get a mention in the news. Rabies is one of many that the World Health Organization has referred to as Neglected Zoonotic Diseases.

Once I infect someone they die. End of story. The number of my victims that survive is almost always zero. My record is strongest in rural Africa and Asia where more than 95% of my victims live. I think of myself as a silent but smart killer.

My preferred partner in crime is the humble domestic dog. I turn man’s best friend into a ferocious, fearless foe.  Most of my human victims are either bitten or scratched by an infected dog. Many are unaware of the seriousness of the threat and, in any case, in less developed areas, they probably lack access to life-saving rabies vaccines.

Yes, there is an effective vaccine that can beat me — it’s actually been around for more than 100 years, thanks to Louis Pasteur. But it remains expensive and has yet to find its way onto the Global Alliance for Vaccine Initiative list of life-saving vaccines for children living in the world’s poorest countries. And without the vaccine I can easily travel through the body to the brain. That journey takes about a month, by which time most of my victims have long forgotten the original bite.

After poisoning my victims’ minds, I make my way to their salivary glands. I make my victims want to bite. I make them scream. I make them fear water so much that they panic and sometimes violently shake at the sight of liquid. It’s an awful way to go, and yet still I don’t provoke the same level of panic as other diseases.

To catch a killer

Of course the irony is that my relatively low profile on the global viral “most wanted” list is precisely what allows me to continue to be so devastating.

People know I use the domestic dog as a gateway to human infection and it’s comparatively cheap to vaccinate dogs against rabies. To halt the spread of the disease, only 70% of dogs in a given region need to be vaccinated.

In fact I am the poster child for diseases that are cheaper to control in animals than in humans. But nobody seems to be paying attention.

In Kenya for example, it costs less than a dollar to vaccinate a dog against rabies, but around a hundred dollars to vaccinate a single bite victim. Oh and the number of dogs in Kenya is approximately 5 million compared to a population of over 40 million people that are at risk.

Where there’s a will

But the truth is, I can’t afford to be complacent. Kenya is one of the many endemic countries that has committed to ending human deaths due to rabies by 2030. International bodies such as the World Health Organization, World Organization for Animal Health, Food and Agriculture Organization of the United Nations, and the Global Alliance for Rabies Control are also backing the target.

If more countries joined the movement and signed up to a Pan-African Rabies Control Network that is helping share experiences and coordinate efforts towards the elimination of rabies – well I’d be in serious trouble.

It could be done. Humans managed to eradicate small pox, and rinderpest in cattle. Now even the end of polio is in sight.  Nigeria has recently celebrated no new polio cases for two years, which leaves only two countries — Pakistan and Afghanistan — still afflicted by the transmission of wild poliovirus.

So on reflection, perhaps it is better for me that Zika and Ebola, and before them swine flu and bird flu, have hogged the spotlight. They are absorbing precious resources and attention that could otherwise be targeted at me.

Fame could be my downfall. Because rabies can be eliminated. But only if affected countries and the international health bodies choose to make it a priority.

This post originally appeared on the Huffpost website on 4th April, 2016 authored by Thumbi Mwangi. Available at: http://m.huffpost.com/us/entry/rabies-just-cant-get-any_b_9609168.html

Thumbi Mwangi teaches at Washington State University, is an Aspen New Voices Fellow and a Wellcome Trust Fellow leading research towards rabies elimination in Kenya.

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Vietnam responses to animal health and zoonoses

Vietnam responses to animal health and zoonoses

Vietnam responses to animal health and zoonoses

The government has approved the draft content of an agreement on establishing an ASEAN Coordinating Centre for Animal Health and Zoonoses (ACCAHZ) in Vietnam. A zoonosis is an infectious disease of an animal that can be transmitted to human beings.

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In recent years, the world has recorded several new dangerous zoonoses such as SARS, MERS-CoV, Ebola, H5N1 and H7N9 influenzas, which have caused serious impacts on human’s health, socio-economic development, as well as security and policy among countries globally.
At the national level, the Prime Minister has formed several bodies to prevent an avian influenza epidemic or other zoonoses outbreaks, including the emergency operations centre (EOC) with the participation of the Ministry of Health, the Ministry of Agriculture and Rural Development, and international organisations.
Vietnam with its role of a leading country in the ASEAN region has coordinated with member states to build the ASEAN Rabies Elimination Strategy, aiming to eradicate the deadly disease in regional countries by 2020.
The ACCAHZ was endorsed after the ASEAN Ministerial Statement, during the 33rd AMAF Meeting held in October 2011 in Jakarta, Indonesia.
The main objective of the ACCAHZ is to facilitate coordination and cooperation among ASEAN Member States and relevant national and international partners and stakeholders in prevention, control, and eradication of transboundary animal and zoonotic diseases in the region.

Thus article originally appeared on the Vietnam net website on 1st April, 2016. Available at: http://english.vietnamnet.vn/fms/environment/154345/vietnam-responses-to-animal-health-and-zoonoses.html

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Anthropological musings on animal-human interactions and zoonotic disease

Anthropological musings on animal-human interactions and zoonotic disease

Anthropological musings on animal-human interactions and zoonotic disease

Fruit bat in Ghana. Image: Kofi Amponsah Mensah

Fruit bat in Ghana. Image: Kofi Amponsah Mensah

I was really excited when, a few years ago now, an opportunity arose for me to work on an interdisciplinary project looking at bats and zoonotic disease(diseases that go from animal to humans).  The truth was that I was more excited about the bats than the zoonotic disease stuff.

I’ve always loved bats for their soft, velvet touch, tiny faces full of expression and translucent wings. I also love their mystique and their anthropological symbolism.

Anthropologically, bats are anomalous and liminal animals. They are not easy to categorise: they look like mice but fly like birds; they are social but occupy the night. I had one of the best times in my anthropological career when I was invited to spend a night catching and tagging bats in Ghana.

Working with an interdisciplinary team, I came to learn much more of the many diseases harboured by bats (perhaps I will never again have the opportunity to go bat catching and to handle bats with the same naked enthusiasm). In the social science research on bats and zoonotic diseases (as I did actually have to do some anthropology and wasn’t able to convert to a full-time bat catcher), we focused on bat-human interactions and the policy implications thereof.

Disease spillover

The interactions between humans, domestic animals and wildlife are, in my view, the critical nexus where the scope for disease spillover occurs and, potentially, where a solution might lie. In my conceptualisation of animal-human interactions I focused on immediate, physical interactions – moments when humans and bats came together (men hunting bushmeat; kids playing with bats; families living in close proximity with bats), and in times and spaces where humans came into contact with bats’ bodily fluids or faeces (cleaning bat droppings off the car, eating fruit previously bitten by a bat).

Cast forward a few years, and I’m lucky enough to be involved in another interdisciplinary zoonotic disease project. This time it’s in Tanzania and I am focusing on cattle and pastoralists.

Now cows aren’t bats. And I can’t say that I have always loved cows. But, they are beautiful and regal (and, in Tanzania, a little bit scary).

Masaai woman milking. Image: Tiziana Lembo

Maasai woman milking. Image: Tiziana Lembo

And like bats, cows have important anthropological significance: in Southern Africa, where I grew up, cows are used for bridewealth, for establishing and solidifying social relationships, for determining lineages and for livelihoods. Similarly in Tanzania, where Maasai cattle are critical for establishing marriage relations, they bring children into lineages and have religious significance.

Working in Tanzania, and thinking about zoonotic disease, has made me realise just how complex animal-human interactions can be. I have come to realise that my focus – my own inbuilt bias – emphasised live human beings interacting with either live or dead animals, or with the bodily products of those animals, in a kind of one-to-one relationship. In my head, all these people were villagers or ordinary people going about their normal lives (my anthropological bias coming to the fore). For me, for a zoonotic disease to occur, a human had to interact with an animal that was sick or with the bodily fluids of that animal.

Rethinking animal-human interactions

But attending a workshop in Tanzania, in which vets, geographers, epidemiologists, modellers and more came together to discuss zoonotic diseases forced me to reconceptualise human-animal interaction in relation to zoonoses. It led me to start thinking about the many different ways in which animals can get sick and how human behaviours – often unseen and apparently unconnected – can affect animals’ states of health and the potential for human infection.

I came to realise that I hadn’t really considered how chains of interactions could occur between humans and animals, and nor had I considered the ways in which human-animal interactions could involve a microbial dimension or, if you will, microbial-animal–human interactions.

My work with others on fruit bats had already alerted me to the ways in which in Bangladesh, Australia and elsewhere bats roosting or eating fruit above domestic animals (horses in Australia, pigs in Bangladesh) can cause illness in these animals which can, in turn, infect humans. In some instances, perhaps exemplified in peri-urban environments (i.e. those at the interface between town and country) where wild and domestic animals are often in close proximity, people may not always be aware of the animal-to-animal-to-human interactions that are occurring.

Exactly which animals are interacting with other animals also affects the disease dynamics and which pathogens are involved. For example, fruit bats carry Henipaviruses which can be transmitted to pigs, horses (and humans) but other bats do not; similarly, foot and mouth disease affects ruminant wildlife and livestock, but not carnivores. Brucellosis affects many different animals – buffalo, cattle, pigs, sheep – and there are many different species of Brucella, with goats being associated with the most pathogenic of these species.

Movement and social networks

Cattle market in Tanzania. Image: Mary Ryan

Cattle market in Tanzania. Image: Mary Ryan

Movement and transportation offer further scope for understanding interactions and affect the possibility of infection. Transporting animals (sick and healthy) is significant as it can allow diseases to ‘jump’ across time and space, and markets play a key role. Here the length of time the animals are together is significant: for bovine tuberculosis short contacts at markets are not important, but foot and mouth is highly contagious even over brief contact periods.

The effect of movement is also influenced by the social networks of the livestock owners, both in terms of who these owners come into contact with and in terms of who they exchange animals with. And some livestock owners may act as ‘super spreaders’ by having a large number of networks and frequent interactions with many different people.

Thus, indirect human-to-human interactions completely removed from the animals themselves can shape how human-animal interactions take place.

The microbial dimension

Another dimension, although surely not the last, occurs at the level of microbial-animal-human ‘interactions’ and food-borne zoonotic diseases such as non-typhodial Salmonella and Campylobacter. Here, abattoirs, slaughter practices and cooking habits are particularly relevant as these diarrhoea-causing bacteria live on the skin and in the guts of animals.

Factors such as how an animal is slaughtered come into play: does, for example, raw meat come into direct contact with skin or faeces when a knife penetrates the intestines? But these bacteria could equally well live independently of animals – on knives, cutting surfaces, in the vehicles used to transport meat, on human hands – and can in this way infect both humans and animals. So microbial-human ‘interactions’ have a role to play too in considering zoonotic disease infection.

Now microscopic bugs are not cute, aren’t regal and don’t have an important symbolic role in anthropological literature. But isn’t it fascinating how many different kinds of interactions shape whether or not zoonotic disease infection occurs?

Having to think well beyond immediate face-to-face, physical interactions between humans and animals opens new horizons on how we conceptualise Livestock, Livelihoods and Health and in terms of how we respond to zoonotic diseases. Which reminds me: my role in this interdisciplinary project is to focus on policy understandings of zoonotic disease. I wonder what conceptualisations of animal-human interaction underlie current zoonoses-relevant policies in Tanzania?

Dr Linda Waldman is a Research Fellow at the STEPS Centre (Institute of Development Studies/University of Sussex).

Article originally appeared on the Livestock, livelihood and Health website on 30th March, 2016 authored by Dr Linda Waldman. Available at: http://livestocklivelihoodsandhealth.org/blog/musings/

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The Philippines Rabies vaccination campaign: a One Health success story

The Philippines Rabies vaccination campaign: a One Health success story

The Philippines Rabies vaccination campaign: a One Health success story

Philipines Rabies vaccinationRabies still causes the death of tens of thousands of people every year. Knowing that dog bites are responsible for more than 95% of all human rabies cases, the eradication of canine rabies is the only way to end the disease’s animal-human transmission cycle. It is estimated that vaccinating 70% of dogs in zones where rabies is present can dramatically reduce human cases.

The World Organisation for Animal Health Director-General, Dr Monique Eloit, explains the work of the OIE carried out regarding the One Health concept, with a particular focus on the success story of the Philippines Rabies vaccination campaign, where 1,701,150 doses of rabies vaccines have been delivered between January and February 2016. These recent deliveries raise the number of doses purchased by a beneficiary country in collaboration with WHO through the OIE rabies vaccine bank to almost 8 million.

The OIE thanks the WHO Pandemics and Epidemics Diseases Department for authorizing the use of the interview’s footage recorded in December 2015.

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View the recording below

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Researchers offer new insights into animal-to-human disease transmission

Researchers offer new insights into animal-to-human disease transmission

Researchers offer new insights into animal-to-human disease transmission

Key findings on who gets sick and why from the Dynamic Drivers of Disease in Africa Consortium are being shared at One Health for the Real World: zoonoses, ecosystems and wellbeing, a high-level international symposium taking place at the Zoological Society of London this week.

Jeremy Farrar, Director, Wellcome Trust

Jeremy Farrar, Director, Wellcome Trust

Resilient global health systems, strong civil society and leadership for those health systems and broad research agendas from disparate fields are the three essentials to face the challenges of 21st century equity and health, according to Professor Jeremy Farrar, Director of the Wellcome Trust.

Speaking at  the One Health for the Real World: zoonoses, ecosystems and wellbeing symposium, co-organised by the STEPS-led Dynamic Drivers of Disease in Africa Consortium and the Zoological Society of London, with support from the Royal Society, Professor Farrar stressed that people were not passive observers in history and could bring about these changes.

However he said a move to individualised medicine would act against public access, equity and a holisitic approach to health.

Key findings from the Drivers of Disease consortium are being shared with high-level policymakers, practitioners and academics at the two-day symposium, which is taking place at the Zoological Society of London. They include representatives of the World Health Organization, the UK Department for International Development, the UN Food and Agricultural Organization and EcoHealth Alliance.

The Consortium has been researching the relationships between diseases transmitted from animals to people (zoonoses), ecosystems and wellbeing for the past four years. In particular it has explored henipavirus infection in Ghana, Rift Valley fever in Kenya, Lassa fever in Sierra Leone, and trypanosomiasis (sleeping sickness) in Zambia and Zimbabwe.

One Health

Importantly, it took a One Health approach to its research. One Health recognises the interconnectedness of human and animal health with environmental health. It seeks to promote the collaborative effort of multiple disciplines, working locally, nationally and globally to attain optimal health for people, animals and the environment.

The Drivers of Disease Consortium involved 20 partners in Africa, Europe and America. It saw social scientists from STEPS (IDS/University of Sussex) working together with ecologists, epidemiologists, virologists and other natural scientists – with the integration of multiple disciplines and research approaches proving essential to learn how diseases transmit from animals to people.

Local and participatory

The research has underlined the value of taking a ‘local’ approach. First, understanding the local circumstances in which diseases pass from animals to people was shown to be essential for disease preparedness and prevention.

Second, participatory research undertaken by the Consortium showed the importance of considering local people’s various perspectives to open up new lines of inquiry and reveal links otherwise missed.

Policy and practice

Professor Melissa Leach, Director of the Institute of Development Studies (IDS) and lead researcher for the Consortium, said: “This work has many implications for policy and practice. It suggests opportunities for new integrated interventions involving collaboration between vets, medics, environmental planners, agricultural technicians, social development practitioners and more.

“Such interventions need to be adapted to diverse local settings and contexts yet also have the potential to scale up and out. Identifying and taking these opportunities forward is what doing ‘One Health for the real world’ means.”

Silos and hierarchies

She added that the work was just beginning: “Unfortunately, there are forces that make the One Health approach difficult. These include the tendency for sectoral and disciplinary silos and the dominance of old hierarchies, interests and perspectives. Findings ways to overcome these forces is the key challenge now.”

The research has been funded by the Ecosystem Services for Poverty Alleviation (ESPA) programme. ESPA spokesperson Rob Bruce said: “We are a proud partner in this project. The work of the team has been phenomenal, delivering real game-changing science that could genuinely save and improve lives. This is what ESPA is all about: helping nature to help people in an effort to make the world a better place for both.”

This originally appeared on the Institute for Development Studies website on 17th March, 2016 authored by Naomi Marks. Available at: http://www.ids.ac.uk/news/researchers-offer-new-insights-into-animal-to-human-disease-transmission

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