One Health approach to eradicate rabies

Canine rabies is one of the world’s deadliest and most terrifying diseases and still poses a substantial public health problem in many parts of the world, particularly Asia and Africa, where tens of thousands of people die from dog-mediated rabies every year.

Yet rabies is also a disease that is highly amenable to prevention, control and elimination, with scientific interest and policy successes in rabies control and elimination going back many decades.

Rabies is one of the zoonotic diseases that are infections that spread between people and animals. These infections are caused by germs, such as viruses, bacteria, parasites and fungi. Some can be severe and life-threatening and others may be milder and get better on their own.

Human rabies is 100 per cent preventable through two complementary measures. Firstly, post-exposure prophylaxis (PEP) involves the administration of rabies immunoglobulin and a multi-dose course of rabies vaccination to people bitten by suspected rabid animals.

Secondly, mass vaccination of animal reservoirs (primarily domestic dogs, the reservoir in the vast majority of human cases) reduces human exposure risk and can ultimately result in rabies virus (RABV) elimination.

There are about 1.7 million dogs in Bangladesh and most roam freely in the streets. They are the main transmitter of rabies, which still is endemic in the country. Infections impose a heavy burden on the affected communities, despite being 100 per cent preventable.

Under the circumstances, mass vaccination is the most effective way to eradicate rabies in Bangladesh. Through that, over the past few years, the country has managed to reduce the number of rabies cases by more than 50 per cent.

This success has been possible due to the collaborative efforts of the Health and Family Welfare Ministry, Fisheries and Livestock Ministry, LGRD Ministry, and the Education Ministry. Jointly, they implemented rigorous mass dog vaccination programmes, provided PEP for bite victims and raised awareness throughout the country.

Unifying approach

Collaboration between the different sectors is the key to working towards the global goal of eliminating dog-mediated human rabies deaths by 2030 and is a prime example of what a One Health approach can achieve.

“One Health” is an integrated and unifying approach to balance and optimise the health of people, animals and the environment. It is particularly important to prevent, predict, detect, and respond to global health threats.

In addition to preventing rabies at the source, Bangladesh established more than 300 modern Animal Bite Management Centres at the national, district and upazila levels. It is crucial to ensure that remote communities have the opportunity to seek medical care. Travel time and available transportation options greatly influence the decision to visit one of the centres for the treatment of bites.

They are now ensuring an uninterrupted human rabies vaccine and immunoglobulin supply to provide PEP to over 400,000 bite victims every year. In addition to that, Bangladesh now organises a weeklong mass vaccination programme annually to ensure the mass vaccination of all street dogs. This year it was held between November 30 and December 5.

Before 2010, rabies approximately caused more than 2,000 human deaths in Bangladesh. However, implementing human and animal vaccination and educating communities about treatment options instead of relying on traditional medicines helped reduce the disease burden. As a result, only 40 rabies cases were registered in 2021.

Despite difficulties and setbacks during the Covid-19 pandemic, Bangladesh is continuing their collaboration with different stakeholders and using a One Health approach to get closer to eliminating all human rabies deaths.

M Rubaiyat Adnan Turjo has completed BSc in Veterinary Science and Animal Husbandry and is currently a postgraduate student at the Microbiology and Parasitology Department at Sher-e-Bangla Agricultural University