Wednesday, November 2, 2016
Cambodia - Deadly Rabies Virus Gets Overdue Attention
It kills more Cambodians every year than malaria. More than dengue fever. It’s 100 percent preventable, but very little has been done to eradicate it.
This year, Cambodia is finally taking on rabies—a killer virus most often transmitted to people through the saliva of biting dogs.
A pilot program, in an effort to vaccinate the country’s 5 million dogs for rabies and reduce the estimated 800 annual rabies deaths, was launched on Monday with small-scale field work in Phnom Penh and Kandal province.
Figures from the Pasteur Institute, which runs Cambodia’s primary rabies vaccination center, suggest there are more than 600,000 severe dog bites a year—one for every 25 people—and far more deaths than in neighboring countries.
“It’s a scandal to have so many deaths,” said Didier Fontenille, director of the institute in Phnom Penh.
Efforts to eradicate rabies have been successful in many countries, including Indonesia and Thailand, where just four deaths were reported in 2012. Fewer than 100 rabies deaths are recorded annually in Vietnam.
Rabies treatments also are reaching only a tiny fraction of those bitten by dogs, the institute estimated. “And it’s many children, because children are closest to the dogs,” Dr. Fontenille said.
The number of rabies deaths far outpaces several widely feared diseases, including malaria, which now kills about 10 people a year in Cambodia, or dengue, which killed 12 in 2014. The estimates are calculated by extrapolating data from rural surveys as well as cases received by the institute, which treats about 300 dog-bite patients daily.
On Monday, the pilot program to begin training and gathering data in both rural and urban settings was launched at locations in Phnom Penh and Kandal province. During the monthlong trial, 50 animal health officers will be armed with 50,000 doses of vaccine to administer to dogs, effective for at least a year, according to the Pasteur Institute and the Ministry of Agriculture, which is implementing the program.
“It’s the beginning of something,” Dr. Fontenille said. “At the end of the day, if we want to eliminate rabies in Cambodia, we have to vaccinate dogs. It’s not an easy task.”
Nevertheless, rabies eradication could follow Cambodia’s successes in combating HIV and malaria, he said. “We have to be optimistic because it has been done. It has been achieved in other countries, including in Southeast Asia. It’s possible to do the same in Cambodia.”
Tum Sothyra, director of the National Veterinary Research Institute’s department of animal health and production, said the pilot program was the country’s biggest rabies vaccination campaign.
“There’s high risk in Kandal and Phnom Penh,” Mr. Sothyra said. “Most dogs’ heads that have tested positive for rabies have come from Phnom Penh and Kandal.”
Vaccinated dogs would not be marked—as they are in some countries—because “their owners wouldn’t be happy,” he added, but owners would receive a receipt confirming the treatment.
Mary Gordoncillo, science coordinator at the World Organization for Animal Health, which provided the vaccines and $30,000 to fund the campaign, said she hoped to build momentum for a nationwide eradication program.
“At the very least, the initial capacity and experience from this project can serve as a helpful starting point for their future work,” Ms. Gordoncillo said. “The efforts and costs attached to a nationwide rabies campaign will be enormous.”
In Phnom Penh’s Chroy Changva district, dog owners welcomed the rollout of the campaign ahead of vaccinators’ visits.
Ly Buntha, 60, said he had vaccinated his three dogs for rabies at a private clinic, but was concerned about other dogs carrying the virus.
“If the dogs get rabies, they’ll bite us too,” Mr. Buntha said. “I’m really, really worried about other dogs.”
Ream Reach, 17, a monk at a nearby pagoda, said the temple’s 20 dogs were divided into two packs that often fought each other, and he didn’t want any of the monks to get caught in the fray. “If there’s a campaign, I’ll get them vaccinated,” he said.
The complement to vaccinating dogs is to expand medical access for people who have been bitten. If not caught in time, rabies is almost always fatal, and causes symptoms including hallucinations, agitation and hypersalivation.
Dr. Fontenille said one of the main challenges for fighting rabies was coordinating health providers working with both animals and humans.
“Rabies is what’s known as zoonosis: an animal disease which kills humans,” he said. “It’s a problem because who’s responsible over zoonosis? Health? Environment? Forestry? Agriculture?”
“The virus belongs to nobody,” he said. “We need to have several ministries all working together, and …every time you have several ministries it’s a bit more complicated.”