World Rabies Day 2021: the impact of COVID-19 on the fight against rabies
To mark World Rabies Day (28 September) this year, we are lucky enough to share two extremely interesting case studies from those working on the frontline of the fight against rabies.
Tackling rabies in the Philippines during the pandemic
Born and raised in the Philippines, Mirava Yuson (pictured left) is a small animal veterinarian who also holds an MSc in Veterinary Epidemiology from the Royal Veterinary College in London.
She currently works at FETPAFI in the Philippines, as an Epidemiologist and Field Team Leader for the SPEEDIER project.
My colleague Duane and I were in the island province of Romblon, doing fieldwork for SPEEDIER, a rabies research project, when we received a dreaded message from our Principal Investigator: “Go home now. The Philippines will lock down in two days.”
We’d meant to stay longer to complete post-training evaluations for health workers who had undergone training for Integrated Bite Case Management, an approach to improve rabies surveillance. Our fieldwork entailed conducting surveys, assessing whether health workers were conducting risk assessments of bite patients correctly and determining whether animal health workers were being informed of these high-risk bites so they could investigate the potentially rabid biting animals.
Instead of finishing our assignment, we found ourselves scrambling for a way home. The last flight back to Manila was the next day, on an eighty-seater plane. Only I was able to get a ticket. Luckily, Duane booked a ferry leaving for a port that was bus ride away from his hometown.
We parted ways the next morning, 13 March 2020. We haven’t seen each other in person since.
Challenges of being away from the field
With the implementation of travel restrictions in mid-March, I became a field team leader who was unable to work in the field.
It was only one of the myriad of challenges that arose due to the nationwide lockdown – the biggest of which was maintaining contact with freshly-trained health workers.
Despite our successful animal rabies sample collection seminar for Municipal Agricultural Office staff the previous month, we couldn’t return for post-training evaluations.
Attempts to get in touch by phone or email yielded poor results. The few responses we got were largely the same: they were too busy with new COVID-related duties.
Our team struggled to answer the question: how can rabies remain relevant in the time of COVID? We were cut off from the two provinces we were supposed to monitor, while health workers became “frontliners”, now serving on COVID wards and distributing relief goods.
Our rabies research field staff visited health workers to supply them with PPE. But with the pandemic in full swing, they had little incentive to prioritise rabies or other infectious diseases.
This was until two suspect human rabies deaths were discovered in June 2020 at a location that local government had thought was rabies-free, raising the alarm that rabies should not be ignored. That wake-up call led to small changes that would eventually snowball: animal investigation reports began trickling in. Then, a dog tested positive for rabies in September, with more suspect human rabies cases turning up at around the same time.
We maintained an open channel of communication in the form of online Peer Support Groups, where rabies-related news was disseminated, and health workers could reach out to us (or to each other) seeking help.
Our desired One Health approach came to fruition with the increased cooperation between human and animal health workers in investigating suspicious animals. Field staff went so far as to help dig up a buried carcass and transport it to the closest diagnostic laboratory for testing.
One Health in action
From completing fewer than 20 animal investigations in 2020, we now average ten reports per province monthly, and track bite record data regularly from nine Animal Bite Treatment Centres.
Combined efforts led to the confirmation of eight rabid dogs in 2021, versus three throughout 2020; all positive samples were delivered to Manila for genomic sequencing.
Further lockdowns and quarantines loom as health workers remain busy, but these successful examples of One Health in action serve as a testament to their resilience and self-sufficiency.
Our hope is that as COVID-19 vaccinations rollout, we can make headway against rabies too, for elimination of this deadly virus is well within our reach.
Rabies: public health threat in Burkina Faso
Dr Madi Savadogo (pictured left) is a Veterinary Epidemiologist and PhD candidate at the University of Liege (Belgium) and the Université Cheikh Anta Diop (Senegal). He is currently working as a Public Health Researcher for the national Institut de Recherche en Sciences de la Santé (IRSS).
In Burkina Faso, laboratory diagnosis confirms rabies in more than 70% of biting dogs that are tested. Although dog vaccination is needed to eliminate the virus and prevent human deaths, vaccination coverage in dogs remains very low compared to recommendations of international public health agencies.
Almost 5,000 bites are recorded annually by the Rabies Treatment Center, located in Ouagadougou, the capital city of Burkina Faso. Timely post-exposure vaccination is the only guaranteed way to prevent the onset of fatal disease in people who are exposed, but throughout the country, just two public Rabies Treatment Centers provide these life-saving vaccines, one in Ouagadougou and the other in Bobo Dioulasso.
Private pharmacies are also involved in post-exposure vaccine distribution and this public-private combination usually helps avoid vaccine shortages.
Rabies Free Burkina Faso
Rabies Free Burkina Faso, of which I am the Head, is a civil society association that aims to strengthen rabies control in the country.
During the COVID-19 pandemic, the most serious effect we have experienced has been a breakdown in the supply chain for emergency post-exposure vaccines for rabies. On 2 January 2021 Rabies Free Burkina Faso was contacted by a community member after a rabid dog bit three children and one adult in a peri-urban area of Ouagadougou.
Unfortunately, no post-exposure vaccine was found at the Rabies Treatment Center, Ouagadougou, where these vaccines are subsidised and therefore more affordable (about 1.8 Euros per dose in the last few years).
Instead, vaccine was available only from private pharmacies, where they cost almost 10 times the price. In this situation Rabies Free Burkina Faso decided to support the family to cover their vaccine costs.
However, just over a month ago in August, the association was again alerted to a family struggling to find post-exposure vaccines for four exposed family members in Ouagadougou. On investigating the situation, we discovered a vaccine shortage since May in both private and public facilities.
A health worker in Bobo Dioulasso reported: “We don't know what explanation to give to our patients, it's been more than two months that we don't have any vaccine.”
Immediately, the association used social media channels to source post-exposure vaccines from across the country and beyond, and within a week managed to find vaccines from a private pharmacy in Ouahigouya, a city located at 180km from Ouagadougou, where the vaccine was required.
Although a short-term solution was found for that family, the risk continues and just a few days later another child was bitten by a suspect rabid dog in Ouagadougou. Post-exposure vaccination began, but the vaccine shortage made it difficult to complete the course. When vaccine was found in a pharmacy located at 15km from Ouagadougou, the family was unable to afford the cost at over 20 Euros for one dose. Reportedly the same dog bit two other children but we are still unable to obtain information on those cases.
No national control plan for rabies
Although rabies is listed among the top five priority zoonoses in the country, there is currently no national control plan for rabies in Burkina Faso.
Control efforts should focus on dog vaccination, community awareness and post-exposure vaccination, but are currently not enough, and we are facing a crisis.
Just last week a veterinary officer from Ouagadougou report told me that “this situation is deplorable, two people contacted me in the week. I have contacted the pharmacists, but currently there is not even a dose of vaccine in the country.”
As well as COVID-19, we must not forget other diseases that vaccines can prevent – this situation in Burkina Faso shows the importance of ensuring access to vaccines – both for bite victims, and for dog vaccination to ultimately eliminate the source of this horrific disease.