World Rabies Day, which takes place each year on September 28, celebrates the anniversary of the death of Louis Pasteur, who oversaw the development of the first rabies vaccine, injected in 1885. One hundred and thirty years later, we wish to draw the public’s attention to rabies prevention in Cambodia, where the virus remains a major public health problem, killing hundreds of Cambodians every year.
Rabies mainly infects dogs, but can also infect cats, monkeys, cows and other domestic or wild animals. The virus is transmitted to humans through the saliva of a rabid animal following a bite, a lick on damaged skin, or a scratch. There is no cure for rabies once it has developed and symptomatic rabies is 100 percent lethal. However, infection by the rabies virus is preventable through timely and adequate vaccination before or after a bite.
Rabies is a lethal but underestimated public health burden in many developing countries. According to the World Health Organization, rabies is present in more than 150 countries but Cambodians are at particularly high risk of rabies.
Using a mathematical modeling approach on 2007 data, epidemiologists from Institut Pasteur du Cambodge (IPC) estimated that there were about 800 human rabies deaths per year in Cambodia. This would translate to Cambodia suffering an estimated 1.3 percent of estimated rabies deaths worldwide annually, for a population of approximately 15 million, which is 0.4 percent of the exposed population. After a potentially infective dog bite, most Cambodians face staggering financial and/or geographical challenges in accessing timely and adequate post exposure prophylaxis (PEP).
On the other hand, rabies is 100 percent preventable through vaccination. In 2014, the Rabies Prevention Center at IPC provided PEP to 21,782 people. The same year, rabies infections were confirmed in more than 130 dogs at IPC’s virology laboratory, the reference laboratory for rabies diagnosis in Cambodia. These animals that were confirmed to have rabies had bitten 198 people. All the victims received PEP and no deaths were observed after careful follow-up at six months.
Many developed or developing countries around the world—including in Asia—have reduced the risk of rabies in humans by vaccinating their dogs. This can also be achieved in Cambodia, which, like other countries that are part of Asean, has pledged to eradicate canine rabies by 2020. The Ministry of Health and Ministry of Agriculture, Forestry and Fisheries are implementing a National Rabies Plan that will set up a network of rabies prevention centers across the country so people throughout Cambodia can access timely, affordable and adequate vaccinations and treatment.
While we work to implement this plan, one way to save lives without waiting until 2020 is to educate and communicate on simple measures to avoid being bitten. Children should be taught basic safety tips and review them regularly.
They should not approach an unfamiliar dog or scream and run away from a dog. They should remain motionless when approached by an unfamiliar dog, and if knocked over by a dog, roll into a ball, knees toward the head, protecting the face. Ways to avoid such confrontations are to avoid eye contact with a dog, to not disturb a dog that is sleeping, eating, or caring for puppies and to not pet a dog without allowing it to see and sniff you first.
If bitten, children should not hide even a tiny wound, and immediately report the bite to an adult. In any case, children as well as adults must wash the wound abundantly and thoroughly for 15 minutes with soapy water. If soap is unavailable, use only water. Apply antiseptics such as povidone if available, and go to a competent vaccination center as soon as possible and preferably within two days of a bite.
If you decide to have a dog in your home, vaccinate it against rabies and spay or neuter the dog to reduce aggressive tendencies. Never leave infants or young children alone with a dog, don’t play aggressive games with your dog such as wrestling, properly socialize and train any dog entering your household and immediately seek advice from veterinarians or trainers if the dog develops aggressive or undesirable behaviors.
Arnaud Tarantola is head of the epidemiology unit of Institut Pasteur du Cambodge. Didier Fontenille is the director of Institut Pasteur du Cambodge. Ly Sovann is the director of the Ministry of Health’s communicable disease control department.