Way back in my early medical career, between my two stints in Africa, I worked in a small New England town where a young girl was brought into our office with a bat bite.

It seems that she opened the back door to the barn, and a bat fell down, then promptly flew up and bit her on the finger before flying away.
Now, this is not exactly normal behavior in bats, and indeed a call to the local infectious disease expert said the bat was probably rabid, and we needed to start the immunizations immediately.

Back then, high risk patients got immune globulin followed by 20 shots into the skin…and after the eighth or ninth shot, the poor girl started getting local reactions (hard knots where the shots were given) and by the time we finished giving them, she was being treated for hives and completely misearable, but since rabies was (and still is) 100% fatal, we continued to give the shots, along with medicine to keep the pain and itching down.

The final part of the story is that our office had bought the vaccine with the county’s approval, but later found that the cost of the vaccine plus office visit cost the same as half a year of that small county’s public health budget.

Rabies is a BAAD DISEASE. It is 100 percent fatal (although there are reports that one or two people who had developed it after getting the vaccine survived), and you die miserably.

Nowadays, you only need four shots (one immune serum and three vaccination shots) to prevent from getting the disease if you have been bitten.

I got a series when one of our puppies who used to root in the garbage outside got sick and bit me. We called the vet to euthanize and check the brain, but one of our farmers heard we were planning to kill a dog, and decided on his own to help us. He killed the dog and threw it in the river before the vet arrived…

No dog, no brain, so I got the shots. Cost? One hundred dollars for the vaccine, then sixty dollars for each shot. Usually, however, people just get the first shot, and don’t bother with the follow up if the dog is known and doesn’t die. The cost of vaccinating our dogs is about three dollars each by private vet.

Rabies is rare in the US, but still a few people die of it each year in the US. But worldwide, about 55 000 people die each year, mostly from dog bites, but sometimes from cats, cows, raccoons, bats, and even from an organ transplant at a Texas hospital.Olivia Judson at the NYTimes has a nice article that summarizes the disease and problem of finding treatment in rural Africa.

However, her claim that rabies can be eliminated is true, but not quite: Like any other disease it is an ongoing problem, not a one shot deal. And when rabies deaths go down, money goes to other priorities, until the next outbreak. You see, there just isn’t a lot of money, and when thousands of people are dying of malaria and dysentary and HIV and TB, a couple hundred deaths from rabies just isn’t important enough to spend the money.

But to put it into perspective: $1.50 per shot per dog per year. Ms. Judson estimates $6 million for Tanzania to vaccinate 70% of it’s 5 million dogs.

But the problem is not just the cost of the shot, but the logistics: getting the dogs their shots, trapping feral dogs to get shots, training people to give the shots, carrying the shots to the villages (petrol and landrovers cost money), using an incentive to get people to bring in their dogs, and finally, making sure someone doesn’t steal the vaccine and sell it on the black market for profit.
When I worked in rural Africa, the government would send in teams of vets to vaccinate dogs. People would have their dogs vaccinated, and food was put out to catch and vaccinate semi feral dogs. After the vaccinations were given, the dogs were painted with red paint that would last a month or so. Then came the hard part: The sharpshooters would place meat around, and shoot any dog they saw that wasn’t painted.
But all this costs money, and one African country (I think Tanzania but I can’t find the reference) had a huge outbreak of rabies back in the 1970’s because it couldn’t afford the price of vaccine, to pay vets to give it, or to buy bullets for the sharpshooters.

Whether to kill feral dogs is a big debate in the rabies control community, and only part of the argument is because animal lovers loathe such actions. But ironically, except as an incentive to force pet owners to get their pets vaccinated (or else risk getting them killed) and except the importance of shooting animals with strange or aggressive behavior (who might be infected) just going in and shooting every feral dog just isn’t practical, especially in towns.
You see, even in our town here in the rural Philippines, there are a lot of vacant lots full of garbage that attract animals (when the vacant lot here stinks too much, we burn it with gasoline or complain to the mayor to start making the trash men pick up the trash).

There are always feral dogs, but if you kill all the feral dogs, rats and feral cats and racoons and jackals and monkeys and whatever will move in. And these animals can carry rabies and other diseases.

One study in Zimbabwe suggests that vaccinating dogs will help stop the cycle in other animals that seem to catch rabies from the dogs. This is partly because feral animals don’t usually come into contact with humans, so are less likely to bite them, and party because they tend to die off before spreading the disease, so often are infected from infected (healthier) pets.

So the way to control the disease still comes down to shooting the animals: When in doubt shoot: With vaccine, and in the case of feral animals with aggressive behavior, with bullets.

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Nancy Reyes is a retired physician living in the rural Philippines. Her webpage is Finest Kind Clinic and Fishmarket, and she writes medical essays at HeyDoc Xanga Blog

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