World Rabies Day raises awareness about education, vaccination

International Report

-- Every year, more than 30,000 people in the United States are exposed to rabies. Worldwide, about 55,000 people die from the virus, equaling about one totally preventable human death every 10 minutes.

Many cases originate from contact with animals carrying the deadly virus, so veterinarians and other animal care workers are especially at risk.

Photo by Allison Alchemy

A puppy is examined at a World Rabies Day 2007 vaccination clinic at St. Georges University in Grenada.

Staying up-to-date on vaccinations and educating the public about the risks associated with rabies and how infection can be prevented are key elements to keeping the spread of rabies at bay. The initiation of World Rabies Day last year was a combined effort by numerous animal and human health organizations to spread the word about rabies, and that effort is continuing this year with the second annual World Rabies Day observation on Sunday (Sept. 28).

World Rabies Day, a global rabies awareness campaign, is spearheaded by the United Kingdom charity Alliance for Rabies Control (ARC) and the U.S. Centers for Disease Control and Prevention.

Last year, at least 74 countries participated in World Rabies Day events, which included vaccination clinics, lectures and education programs, parades, festivals, and dog walks. World Rabies Day organizers had hoped to have about 55,000 involved in the first year's events on Sept. 8 last year, but the group says its data indicates that more than 393,000 took part in World Rabies Day programs. Media efforts help spread the word about rabies prevention to millions of people worldwide, and more than 600,000 vaccines were administered.

"Vaccination prior to possible exposure is a crucial part of health management of domestic animals, and is the single most important factor in rabies prevention," says Peter Costa, global communications coordinator for ARC.

But where to start?

Rabies is considered one of the world's oldest viral problems, with the first written record of the infection in dogs dating back to 1930 B.C. It was virtually eradicated in the United Kingdom through strict wandering animal and vaccination regulations in the 20th century, but raccoons have increased the spread of the disease in the United States, and recent pet booms have increased the incidence of infection in East Asia. Beijing in China has instituted a one-dog per person policy to help control the spread of the disease, while India reports the highest incidence of human rabies anywhere in the world.

So, while the human rabies vaccine first was developed by Louis Pasteur -- who died on Sept. 28, 1895 -- and Emile Roux more than 120 years ago, the world is still grappling with the spread of the virus. Why does this continue, and why have world leaders decided only now to embark on large-scale education efforts about rabies?

A lot has been discovered in the last century about the disease, and Dr. Charles Rupprecht of the CDC says it has come to a point where researchers know just about all they will ever learn about the disease. So the focus, he says, needs to become combating the disease rather than trying to understand it.

"It was the synthesis of the scientific process that led all of us to the eureka moment that it's not going to be someone else who says this is the moment. It has to be self discovery and self enlightment to create a movement," Rupprecht says. "You reach a certain point where previously in your career, you've always been mentored. Then you wake up and realize you are the generation that needs to make it happen."

The creation of a worldwide event to spread information about rabies is something Rupprecht says he and members of the World Health Organization have discussed for years. But now that the human-animal bond is increasing, and domestic animals are in greater contact with wildlife as they move into suburban areas, there is even more concern. People need to be reminded constantly to vaccinate their pets and the simple message of "if you can touch it, don't" for people who find it hard to resist the urge to welcome wild animals with open arms.

Photo courtesy of WorldRabiesDay.org

An onlooker cringes as a puppy gets its rabies shot at a World Rabies Day 2007 event in North Carolina.

The three overlapping messages Rupprecht and the other World Rabies Day originators came up with are simple: human rabies can be prevented; canine rabies can be eliminated, not just controlled; and there needs to be a greater focus on offering oral vaccinations to free-range animal populations.

Efforts meet obstacles

Despite the best intentions, there still are obstacles to preventing rabies.

Cost is one major factor. Many developing countries that live in close contact with both domestic and animal populations can't afford regular veterinary care like vaccinations. The annual estimated cost of rabies prevention in the U.S. alone is more than $300 million, and that cost is primarily for the vaccination of dogs, according to the CDC.

Global warming may also pose problems for controlling the spread of the virus, as wildlife is forced into more limited areas, resulting in more contact between different species, Rupprecht says. Animal populations are shifting areas along with climate change, too, and bringing new diseases like rabies into new areas that might be naïve to their effects.

Perhaps one of the largest obstacles, however, is a shortage of human vaccine supplies. On Sept. 4, Novartis announced it would no longer ship supplies of its human rabies vaccine, so that doses could be retained for emergency use by state and local public health authorities.

The human vaccine supply problem began in June 2007, when Sanofi Pasteur renovated its vaccine production facility in France to comply with new French and U.S. Food and Drug Administration regulations. The renovations will be complete sometime in 2009, but only a limited amount of the vaccine is available until then. In the meantime, vaccines made by other companies, like Novartis, are being stretched thin.

While supplies of rabies pre- and post-exposure vaccines are "much less than ideal," Rupprecht says he has been meeting with a vaccine committee in Washington, D.C. to address the shortage and discuss the creation of a national stockpile of rabies vaccines.

"The inability to supply vaccine to all exposed individuals should not occur," Rupprecht says.

Where there doesn't seem to be any fear of a shortage is in oral vaccines for wildlife populations. Merial alone has produced more than 100 million doses of its oral vaccine that was approved for the immunization of raccoons and coyotes. It also has produced more than 400 million doses of another vaccine approved for use in six different species and more than 12 million feline rabies vaccines.

To continue its progress, Merial also launched a contest last year with the Student American Veterinary Medical Association among 26 veterinary colleges to host rabies awareness events and education programs. The winning school, Tuskegee University, will get to host an on-site rabies symposium sponsored by Merial Oct. 18.

Spreading the word

World Rabies Day allows organizations from all over the world to come together to offer education and free vaccination clinics. It will be celebrated Sept. 28 this year with a major symposium at the CDC. But World Rabies Day will not be a one-stop event. Events are planned throughout the year all over the world as authorities aim to re-educate each continent about the disease and what impact it could have if not addressed.

Photo by Dr. Perfecto Buyamba Kabanshi

Zambian villagers gather their dogs for a free vaccination clinic in 2007 in honor of World Rabies Day.

In the United States alone, more than 30 events were scheduled in observation of World Rabies Day.

In Africa, a national event took place in Angola in July involving a door-to-door vaccination plan. Other events scheduled in Africa include mass vaccinations and festivals in the Congo, Ghana, Kenya, Nigeria, Sierra Leone, South Africa, Sudan, Swaziland and the United Republic of Tanzania.

In the Americas, Brazil hosted a number of events, as well as Canada. Grenada, Colombia, Mexico and Puerto Rico followed suit.

In Asia, China, several regions of India, Japan, the Republic of Korea, Nepal, the Philippines, Sri Lanka, and Thailand all scheduled events for World Rabies Day. Other participants world-wide include the Netherlands, the Syrian Arab Republic, Saint Kitts and Nevis.

For more information about World Rabies Day or to find an event near you, click here.