The recent death of a six-year-old boy named Gabriel from rabies complications after a dog bite in Sakwa village, Siaya County, could have been avoided.
The dog that bit the boy would not have gone wild had it been vaccinated against rabies. Additionally, the lack of life-saving vaccines at the primary health centres is a daily stark reminder of the virulent nature of this neglected disease.
The boy could have been protected from getting the incurable clinical disease had he received the full dose of the recommended five post-exposure vaccines.
Rabies is caused by a virus that is nearly always transmitted to humans through bites and scratches from rabid animals. Without appropriate intervention to prevent the development of clinical disease, rabies is 100 per cent fatal. From the first day of the dog bite, the anti-rabies injections are normally given on the first, third, seventh, 14th and 28th day after exposure.
The most effective way to prevent human rabies is by vaccinating domestic dogs. However, when bitten by a rabid animal, one should immediately wash the wound with clean running water for at least 15 minutes. An immediate visit to a health facility is highly recommended.
With about 2,000 Kenyans dying annually from rabies, in 2014 Kenya adopted a strategic plan for the elimination of human rabies, in line with the global target of eliminating dog-mediated human rabies by 2030. Unfortunately, rabies is a neglected zoonotic tropical disease whose burden and risk disproportionately affect poor rural communities, particularly children under 15 years like young Gabriel.
Primary health facilities
In Kenya, human vaccines are not included in the routine and essential vaccines at the primary health facilities where dog bites are first reported.
As an expensive on-demand vaccine, it is uneconomical and impractical to stock it in all health facilities. Access can also be an obstacle if health facilities that stock the vaccine are not optimally placed and patients are forced to travel long distances to access them.
Mass dog vaccinations covering 70 per cent of the dog population is a cost-effective way to break dog-to-dog rabies transmission, in addition to human inoculation.
Low dog vaccination coverage often results from lack of information on the proportion of dogs inoculated during mass vaccination campaigns and logistical challenges. Poor knowledge on disease transmission and prevention however remains the main challenge.
Communities need to be educated on rabies and capacity enhanced for health workers with regard to rabies exposure assessment, diagnosis, administration and judicious use of the rabies vaccines. Veterinarians need to tighten surveillance, risk assessment and reporting compliance for data availability.
The county and national government should enforce laws and allocate resources for a multidisciplinary and holistic approach of to the war on rabies. Rabies programmes should also have specific and measurable outcomes for tracking progress and providing evidence for rabies elimination.
Mumbua is a Rabies researcher at the University of Nairobi’s Institute of Tropical and Infectious Diseases and the Kenya Medical Research Institute.