The tales of veterinarian in dealing with rabies – a silent killer

Dr Mutesasira

By Dr Jesse Mukisa Mutesasira

Rabies is a zoonotic viral disease that affects warm-blooded animals (dogs,cats, cattle, goats among others) humans inclusive. The disease has two cycles the wild (sylvatic) which happens within wildlife animal reservoirs and susceptible hosts. These include foxes, racoons, wild dogs and other members of the canine family. Then the domestic cycle which comes into play after a wild reservoir or susceptible animal interacts with a susceptible domesticated animal usually dogs to cause transmission of the disease following contact of the rabies virus (contained in the saliva of the wild animal) through a broken skin by bite/scratch. The disease is 100 % fatal in humans’ the moment clinical signs are manifested. It has an incubation period that varies from a few weeks to several years (7) depending on what the disease agent-host interactions. It remains listed as a neglected tropical disease (NTD) mainly in Africa and Asia with thousands of lives lost yearly. NTD is a humble term used to mean diseases of the poor as the disease is 100 percent preventable and many countries such as Malta, Spain, Finland among others through practicing massive rabies vaccination campaigns and practicing responsible dog ownership practices.

Dog bites and children as the most at-risk population.

The first aid to a dog bite or scratch is washing the wound with plenty of running water and soap for 15 -20 minutes then seeking professional medical help.

Dog bites/scratches account for more than 99% of human rabies cases. Although any age group is susceptible to bites, most of the victims of dog bites and human rabies are children aged below 15 years as these are most times involved with naturally loving dogs and also inability to assess the potential dangers of an attacking rabid dog.

Recently an innocent Ugandan child, aged 9 years whose future was yet to be determined was robbed of their young life, in Kabale district. The child, a primary 2 pupil at Kibuga Primary school, was reported to have previously been attacked and bitten by a stray dog weeks ago on their way to their grand parent’s home. The child’s peasant parents not being well informed on what to do never gave the necessary attention this incidence deserved and only took the child to the hospital having the health status of the child worsen and a few days after which the child was pronounced dead.

This led to preventable loss of a young life due to rabies. This incident only came to limelight because of media coverage of the scenario. This makes me wonder how many such cases go unnoticed and why should we normalise these preventable deaths? This clearly proves Dr. Ian Clarke’s argument highlighted in the April 10th, 2022, Sunday Vision article, “Why do Ugandans die young?”  where he highlighted lack of proper investing in the necessary infrastructures key to saving Ugandan lives.

Personal encounter with a suspected rabies case.

I first had a chance to interface with a suspected rabies case in 2022 when a farmer gave me a call in the night and reported how one of his puppies had become aggressive and bitten the sibling, they shared a kennel with. I asked him whether they were still locked up and he said yes. This gave me a breather and I kindly requested him not to open up for them since it was late night, and he was 20km plus away from me. I explained to him the suspected disease was rabies and that I was to go there the next day to collect samples for laboratory submission and confirmation.

The next day I had to struggle with the cold chain facilities to ensure the sample remained viable, got on the motorcycle and used the locally available resources to try to get the brain sample from the dog. With God’s grace I succeeded however during the process I got an accidental exposure to the brain tissue and fluids. You should have seen the looks on me knowing alone the risk I had got into regardless the only option I had was to remain composed. I requested some soap and water to flush my eyes where the spill had happened and then got my cool box dropped in the sample and rushed to prepare my self to deliver it to National Animal Disease Diagnostic and Epidemiology Centre (NADDEC) in Entebbe a team I communicated to and patiently awaited for me as I explained to them I was coming from far and I was to use public transport..

Knowing I had been exposed and fully understood what a common Ugandan goes through to get the post-exposure prophylaxis for rabies (PEP), when I got to  Kampala I quickly visited Kirudu hospital rabies unit which was said to have available PEP for persons at risk of rabies.  At Kirudu hospital, the only thing I received was the PEP prophylaxis form and recommended to go purchase the PEP from private facilities.  I proceeded to NADDEC where I was received despite having got there at past 5pm, the technician ran the rapid diagnostic test it came out positive for rabies and a more specific test was to be run on the sample the technician assured me but it was to take some more days to get the results.

With this evidence in a jiffy, I felt the rabies signs all in me in an instant.  I quickly rushed to Entebbe grade B hospital. I arrived at Entebbe Grade B hospital at around 6:45 pm where I was told the unit handling rabies had closed and it runs 7am -12:00 pm so, I had to return the next day.

By 7a.m of the next day, I was at the hospital, and I was told the government-supplied PEP was out of stock as doses are usually limited versus the patients the hospital receives. So, I had to be treated via the private wing and religiously I took all my 5 shots in the one-month window. During my third visit, I was able to meet an actual rabies victim who had come to the hospital and during my interaction with him, he said he had been bitten by a stray dog while he was standing in a certain trading centre in Mityana a month ago however he only treated the wound. This gentleman was sweating, complaining of stomach pain, laboured breathing, hypersalivation. The pain was much in that they had even tied a piece of cloth around his waist. The hospital was trying to keep him on intravenous fluids and working on his referral to Mulago hospital for further management.

It is such a pain to see lives being lost to preventable diseases. World Rabies Day is commemorated every year on the 28th of September in memory of the great scientist Louis Pasteur who discovered the rabies vaccine in 1885, this year the national event was held in Kasese district under the leadership of the Ministry of Agriculture, Animal Industries and Fisheries (MAAIF) with a theme “Breaking Rabies Boundaries.” The World has a global target of eliminating dog-mediated rabies by 2030 and as a country, the National Rabies Elimination Strategy is in place however the implementation faces various gaps financial commitment to implement the strategy being a major challenge. With only a few years left to the 2030 target, it is imperative that resources be availed by One health stakeholders (in Animal, Wildlife, Human and Environment health) to support the rabies elimination agenda.

I end by appealing to all pet owners (dogs/cats) owners to annually vaccinate their pets against rabies by engaging a qualified and licensed veterinarian who has access to efficacious vaccines. The government’s commitment to eliminating rabies will see many young Ugandans live to their full potential. Every life is precious and should be protected.

My final appeal is to call on all practising veterinarian to ensure that they immediately get vaccinated against rabies when the exposure happens. The consequences of neglect will beonly felt by you and your loved ones.

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Jesse Mukisa Mutesasira

Email: [email protected]

 

 

 

 

 

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