Reuters AlertNet - ANGOLA: Record rabies outbreak kills 93 children

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Reuters AlertNet - ANGOLA: Record rabies outbreak kills 93 children

ANGOLA: Record rabies outbreak kills 93 children

11 Mar 2009 19:37:28 GMT
Source: IRIN
Reuters and AlertNet are not responsible for the content of this article or for any external internet sites. The views expressed are the author's alone.
JOHANNESBURG, 11 March 2009 (IRIN) -

One of the most severe rabies epidemics to hit Angola has claimed the lives of at least 93 children within three months in the capital, Luanda.


"The 93 children were brought to our hospital and are the only ones we know of, so the number could be higher," said Luis Bernardino, head of the Hospital Pedi?trico David Bernardino in Luanda, the country's biggest referral hospital.

"The number of cases has, however, started declining now."

He said the hospital was unable to save any of the children, as it had run out of doses of rabies vaccine; in some instances the children were brought in too late. "It is a sad moment for us," said Bernardino.

Francois Meslin, the rabies expert at the World Health Organisation (WHO) headquarters in Geneva, said in the last severe rabies outbreak, from 1998 to 2003 in Indonesia's Flores Island, 100 people had died within a year. "The high number of deaths in Luanda within the short period of time is a cause for serious concern and calls for a thorough investigation."

Rabies is an incurable viral disease transmitted by close contact with saliva from infected animals, usually canines or rodents. It can be prevented by vaccination, either pre-exposure or as part of post-exposure treatment. However, once the symptoms of the disease develop it is fatal in both animals and humans.

Post-exposure treatment comprises five doses of the vaccine and has to start "as soon as possible" to prevent the symptoms from developing, Meslin said.

The disease attacks the respiratory, gastrointestinal and or central nervous systems, leading to paralysis followed by coma and death in all cases, usually due to respiratory failure.

Slow reaction
Luanda's large stray dog population has been identified as causing the spread of the disease. "We have had some sporadic cases in other provincial capitals in the country; we think the virus was brought into Luanda and then spread through the dogs - Angolans love dogs," said Bernardino.

The capital was built to accommodate around 400,000 people but now has a population of more than 4.5 million, most of whom live in unhygienic conditions in "musseques" or slums.

The outbreak has raised concerns over the slow reaction of the Angolan authorities. "When the first 10 deaths were reported in December 2008 we alerted the authorities, but we do not have veterinary services in the city, no kennels [to keep and observe the animals] and vaccinate them," said Bernardino.

There were also not enough vaccines available. "I think it was probably that no one was prepared for such a high case load," he said. A vaccination campaign is underway.

"We now also have enough vaccines in stock. The cases have started dropping now - we have 12 cases in one week, it dropped to four cases, and this week it is down to three," Bernardino told IRIN.

Costs and shortages
Developing countries are often unable to afford rabies treatment, which is prohibitively expensive, said Melvin. "One dose costs about US$10 and five of those have to be administered, which makes the total cost of treatment $50, which is more than what a family can earn in a month in most developing countries."

Besides the vaccine, "in instances where the person has been heavily exposed - with multiple bites in the head," that person also has to be given rabies immunoglobulin to prevent death, which can cost another $50. "The treatment can be a huge drain on public health services, especially in countries where the vaccines are given free."

Melvin said there was a global shortage of the vaccines, "As there are few registered manufacturers who meet the WHO guidelines, the supply cannot keep up with the demand." At least 55,000 people die from rabies every year in Asia and Africa; most of the victims are children.

Polio outbreak
Besides the rabies outbreak, polio has also gripped densely populated Luanda and Benguela provinces. Sona Bari, a WHO spokeswoman, confirmed that 28 cases had been recorded in 2008 and another 1 so far this year.Angola last experienced a polio outbreak in 1999, when more than 1,000 cases were recorded, but the number of cases had dropped to just 55 in 2000.

Bari noted that "If Angola were to fully implement the polio immunization campaign and pull out all stops, the disease can be eradicated in the country."

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<cite cite="http://www.alertnet.org/thenews/newsdesk/IRIN/9e5ea9e9c00743651e3b680296010952.htm">Reuters AlertNet - ANGOLA: Record rabies outbreak kills 93 children</cite>

[Giuseppe]

Re: Reuters AlertNet - ANGOLA: Record rabies outbreak kills 93 children

Reuters AlertNet - WHO takes aim at rabies with new project

WHO takes aim at rabies with new project

16 Mar 2009 15:27:38 GMT
Source: Reuters
* WHO to test vaccinating dogs
* Focus on Philippines, Tanzania, South Africa
* Culling strays not the solution

By Michael Kahn
LONDON, March 16 (Reuters) -

Immunising dogs rather than producing more vaccines to treat people with rabies is the best way to tackle the disease that kills a person every 10 minutes, mainly in the developing world, experts say.


A new program backed by the World Health Organisation and the Bill and Melinda Gates Foundation will test whether this approach helps eliminate the deadly virus in the Philippines, South Africa and Tanzania, said WHO researcher Francois Meslin.

Researchers will work with public health officials and local veterinarians to round up strays and vaccinate them against rabies over five years. The goal is to vaccinate about 70 percent of the dog population, both strays and domestic pets.

"The simple and most cost-effective way is immunising dogs, which are responsible for almost all cases of human rabies," Meslin told Reuters in a telephone interview.

"It is far less expensive than to keep on providing for human vaccines for all people exposed to dog bites in countries where dog rabies exist."

Rabies is a highly infectious and almost invariably fatal virus that can attack all mammals. Once symptoms start there is no cure, although one complex approach called the Wisconisin protocol did save the life of a 15-year-old girl in 2004.

According to the World Health Organisation, more than 55,000 people die of rabies each year, mainly in countries in Asia and Africa that have large populations of stray dogs.

Drug makers like Sanofi-Aventis <sasy.pa> and Novartis <novn.vx> make vaccines for people but there is a shortage of this vaccine. Plenty is available for dogs, Meslin said.

An outbreak in Angola in recent months has killed at least 93 people, mostly children, despite efforts to round up and kill stray dogs.

Meslin said culling dogs was not a good solution because the animal population would eventually rebuild. "It costs more to destroy a dog and deal with its carcass than to immunise a dog," he said.

"One of the biggest challenges is to maintain the vaccination coverage in dog populations that are often increasing in number and not often controlled very well.

"The Philippines, South Africa and Tanzania were chosen because health officials there have shown a willingness to work with others to attack the problem, Meslin said.

"You cannot do it everywhere. You need to do it where the public health and veterinary sector are willing to work together," he said.

Findings from a Canadian research team published last week in the Public Library of Science Journal PLoS Biology bolstered the idea that focusing on pet dogs was the right approach.

Jonathan Dushoff of McMaster University and colleagues ran a computer model based on data from outbreaks in two districts in Tanzania that showed a surprisingly low level of transmission from dog to dog.

This suggests concerted efforts focused on immunising even just pets could theoretically wipe out the disease, they said.

"With sustained, international commitment, global elimination of rabies from domestic dog populations is a realistic goal," they wrote.

(Reporting by Michael Kahn, Editing by Maggie Fox)
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<cite cite="http://www.alertnet.org/thenews/newsdesk/LG441882.htm">Reuters AlertNet - WHO takes aim at rabies with new project</cite>