By Kim Krisberg
Just a few days ago, an event in the small town of Lilburn, Georgia, may have saved the life of someone living half a world away. It wasn't a black-tie gala or a celebrity telethon. It wasn't even about a disease that most of us here in the United States think much about. In fact, it was as easy as doing what us animal lovers would do anyway: vaccinating our beloved Fido or Whiskers against rabies.
In honor of World Rabies Day, which takes place Sept. 28, Lilburn's Banfield Pet Hospital held a rabies vaccination clinic, half of the proceeds from which were donated to the Global Alliance for Rabies Control to help prevent the spread of the fatal disease in developing nations. Genine Ervin, an associate veterinarian at the Banfield Pet Hospital, said she got the idea for the clinic after reading an article about World Rabies Day and that she hopes it represents the beginning of a long relationship.
"The idea of raising awareness within our community as well as about what we can do overseas really struck me," Ervin told me. "I hope that we can keep the partnership going with World Rabies Day and that this can be the start of something we do yearly."
The Lilburn event is one of hundreds being held around the globe in honor of World Rabies Day, which began in 2007. Since its inception, word of the awareness-raising day and its related events have become quite the cat's meow (sorry, I couldn't resist), with 74 countries reporting events during the first year and more than 150 countries expected to participate by the end of this year's observance, according to Peter Costa, global communications director at the Global Alliance for Rabies Control, which organizes World Rabies Day. Rabies is a zoonotic disease -- in other words, it can be spread from animals to people. Rabies is transmitted through saliva or tissue from the brain or nervous system. Those who have been bitten by an animal with an unknown health record should seek out medical care and possible vaccination, as rabies is almost always fatal in humans once its symptoms appear.
In the United States, thanks to massive public health and animal health efforts to vaccinate pets, the threat of rabies may hardly raise an eyebrow among the general public. In fact, in 2007, the Centers for Disease Control and Prevention declared canine rabies eliminated in the United States. Today, more than 90 percent of animal rabies cases reported to CDC occur in wildlife, and human rabies cases have declined from more than 100 at the turn of the century to one or two human cases annually. Overseas, however, the picture is quite different. Despite being completely preventable, more 55,000 people die annually due to rabies, primarily from contact with rabid dogs and overwhelmingly in Africa and Asia.
"Vaccination and education are key," Costa told me. "In the U.S., it's largely about the vaccination of animals -- the single best way to protect yourself is to vaccinate your pets. But in other countries where vaccine isn't available or in countries where people don't believe in vaccinating pets, it's all about education."
Such educational efforts can include knowing how to avoid bites and what to do after getting bitten, such as thoroughly washing the wound, he said. Costa called rabies a "neglected" disease because of the severe lack of funding and data to address the problem. In many countries where rabies is a continuing threat, surveillance and laboratory capacity are nearly nonexistent, which creates a vicious cycle: no money because there's no data; no data because there's no money. Costa and his colleagues are hoping to change that this year with the launch of a notifiability study, which is a big focus of this year's World Rabies Day. The study will begin by assessing the state of rabies capacity, policy and compliance in different countries and eventually use the data to help officials strengthen rabies control and prevention.
"The way to break the cycle is to have surveillance and mandatory reporting of human rabies cases," Costa said. "Today, this isn't possible in many countries because they don't know how to identify a rabid animal, or it gets euthanized before diagnosis. But without this data, we have a really hard time talking about the global burden and mortality rates and the economic impact for policy change."
Rabies in America
Back in the United States, the threat of rabies may be small, but it's not nil. Catherine Brown, chair of the Compendium for Animal Rabies Control and Prevention Committee of the National Association of State Public Health Veterinarians said that while it's hard to say whether human encroachment into previously wild areas will increase the risk of rabies, "it's important to remember that (rabies is) a persistent risk."
The United States is home to numerous wild rabies strains, such as those that affect skunks, raccoons, foxes and bats, and these strains can be transmitted directly or through unvaccinated pets to humans. In fact, the more scientists look, they more they find, said Brown, who is also the state public health veterinarian at the Massachusetts Department of Public Health. For example, a few years ago, a new type of rabies strain was discovered in skunks in Arizona; bats infected the skunks, and the virus mutated to be able to circulate among skunks.
Brown said officials have had varying levels of success controlling the virus in wildlife using oral rabies vaccine baits, such as in Texas to combat rabies in foxes and coyotes or along the East Coast to prevent the spread of raccoon rabies further west. Still, the best protection is to vaccinate our pets, which can serve as the bridge between wildlife rabies and people, Brown said.
"Wherever you live in the United States, there is the potential that rabies can impact your life, the life of your family and your pets," Brown told me.
Rabies is a reminder that the connection between human health and animal health is very real; a reminder that our behavior toward ecosystems can impact human health. Costa at the Global Alliance for Rabies Control put it much better.
"Rabies really is the quintessential 'one health' disease," he said. "You're protecting humans by vaccinating animals."
For more on World Rabies Day or to find out how to take part, visit the event website.
Kim Krisberg is a freelance reporter living in Austin, Texas, and has been writing about public health for almost a decade. While her education is in journalism, her heart is in public health.
I'd just like to reiterate that this does apply wherever you live. My neighborhood has skunks and raccoons for certain, and probably bats, and there have been rabid raccoons reported within a couple of minutes' walk of my home, though not recently.
I live in Manhattan, better known for subways and skyscrapers.
When I was a kid in the Mid-Atlantic (states) there was a strict protocol for raccoons. If you saw one while playing in the woods 1)freeze, 2)look behind oyu for an escape route, 3)note where you were, 4) run like hell away from it and tell and adult immediately. Since raccoons are generally noctournal, if a kid saw one during the day it was probably sick, and rabies was quite common in the area.
And you only had to hear the story about the treatment for rabies (giant needles!) to want to avoid it at all costs.
Even my indoor-only city cat is vaccinated against rabies.
I lived in a small town that had a series of rabid fox incidents--they'd come out of the woods near a school and attack children on the playground. (Not packs of foxes, but often more than one incident per week, different foxes.)
Some hippie group objected to planned use of oral vaccine bait, probably related to the NorCal antivaccine rhetoric. I'm hoping Animal Control got around this, but right about then I was too busy on my thesis defense to follow the newspapers.