Why Latin America is nearer elimination of rabies than Africa

 
 Copyright: CC, Global Alliance for Rabies Control 

Rabies: a contagious and fatal viral disease of dogs and other mammals, transmissible through the saliva to humans and causing madness and convulsions.                                            

Latin America is doing far better at managing, controlling and ultimately eliminating rabies from the region. Africa is failing to make the same gains and a rethink is required: can the lessons learned in Latin America be  applied or adapted to Africa?

At RSTMH meeting “Challenges in Disease Elimination” held in Cambridge [September 12-16th, 2016], Dr Katie Hampson described the Pan American Health Organisation (PAHO)'s surveillance & management framework operating in Mexico and Brazil, devised to support the elimination of rabies in 25 PAHO countries, which could be adapted.  Tanzanian researchers have developed a targeted surveillance system to improve case detection for the African setting where resources are constrained.

Current situation of rabies control in Latin America vs Africa

The short answer is that in Latin America, PAHO, which exists to “strengthen national and local health systems and improve the health of the peoples of the Americas”, has concentrated on vaccinating the dog population against rabies and interrupting transmission. African countries have no similar regional support structure for their health ministries and rely on post-exposure prophylaxis (PEP)  of humans bitten by dogs, to achieve a form of control of rabies. PEP vaccination only saves lives if the bitten person has timely access to a well-stocked clinic, and the money to pay for the shots. In remote and rural areas, this can lead to grim choices: which child do you treat if you only have money for one? We heard at the RSTMH of an African mother with several children bitten by the “family dog”, who having travelled a great distance to reach the vaccine, was then faced with that very choice.

World Rabies Day is September 28th and  so this month's Global Health Knowledge Base e-newsletter will focus on  Rabies.

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