By: Pharm Sylvester Segbaya

(Johns Hopkins University Center for Communication Programs)

Rabies is a zoonotic viral infection transmitted in saliva through bites and scratches of infected mammals such as dogs, cats, monkeys, sheep, goats, and bats. Dogs are however the leading source of the rabies virus, making up 94% of all rabies cases reported between 2014 and 2022 in the country. There is a global agenda to eliminate rabies by 2030, but many African countries including Ghana will require concerted multisectoral effort to make this vision a reality.  The Ministry of Health identifies rabies as an epidemic-prone disease in Ghana and a key priority zoonotic disease.

The rabies virus attacks the central nervous system targeting the brain and the spinal cord [1, 2, 3], and once signs and symptoms begin to appear, the victim is likely to die. Surveillance data show increasing trends in rabies cases in Ghana, however poor reporting and surveillance have led to significant underestimations of cases and mortality.

Rabies cases occur in almost all the regions of the country, but the Ashanti Region (160 cases), Greater Accra Region (GAR) (132 cases), and the Upper East Region (UER) (83) have the highest number of reported cases, with almost all of these being canine rabies. The Disease Surveillance Department of the Ghana Health Service reported 97,366 dog bite cases between 2017-2022 [2], with the highest case prevalence in GAR (19,241; 19.76%). Data also show that in 2022, there were 16,907 cases of dog bites in humans, with the GAR accounting for the highest prevalence of 20.23%. In addition, a minimum of 1,000 cases of dog bites were recorded per month in 2022, with the month of May recording the highest number of cases in people (1,533). Children are especially vulnerable to rabies, with four out of every ten rabies-related deaths in Africa occurring in children under the age of 15 [4, 5].

Mode of transmission: Rabies is spread from the saliva of an infected warm-blooded animals such as dogs and cats, through bites or scratches or other forms of contact. The rabies virus in the saliva enters a break in the skin like a wound or scratch and infects the central nervous system of the animal or person, ultimately causing disease in the brain and eventual death. The virus can also enter a person’s body through the mucosa of the mouth, eyes, or nose. This can happen when a rabid animal licks a person’s face or broken skin surface. There is no evidence that rabies spreads from person to person, but saliva from an infected person may transmit the virus.

Signs and symptoms of rabies in humans: The signs and symptoms of rabies in humans include fever, headache, pain or a tingling sensation around the bite site, hyperactivity, irritability, nervousness, confusion, hallucinations.

 Signs and symptoms of rabies in animals: The rabies virus causes an acute encephalitis in all warm-blooded hosts and the outcome is almost always fatal. The first symptoms of rabies may be nonspecific and include lethargy, fever, vomiting, and anorexia. Signs progress within days to cerebral dysfunction, cranial nerve dysfunction, ataxia, weakness, paralysis, seizures, difficulty breathing, difficulty swallowing, excessive salivation, abnormal behavior, aggression, and/or self-mutilation.

What you must do when bitten or scratched by an animal: Any animal bite or scratch including those that seem mild and harmless must be treated immediately to prevent infection including rabies and other health complications. Immediately wash the part of your body that has been bitten or scratched by a dog or any animal continuously with soap under running water for 15 minutes and then seek medical attention at the nearest health facility. Community pharmacist must refer all bite victims to a health facility for a thorough assessment and administration of post-exposure prophylaxis (PEP) to prevent the development of signs and symptoms of rabies. Rabies risk assessment for bite victims often involves quarantining of the incriminated animal for observation for a period and laboratory examination of spinal or brain tissue by the veterinary services to confirm rabies infection. Ghana’s treatment protocol recommends the administration of 5 doses of post exposure prophylaxis (Day 0, 3, 7, 14 and 28) to the bite victim when rabies is confirmed in the biting animal. Note that initiation of PEP must not await the results of laboratory diagnosis. PEP is not contraindicated in pregnancy and infants. (WHO).

How to protect yourself, your family and your community from rabies: The risk of rabies may appear to be low, but people who interact with animals frequently have a higher risk of contracting rabies. There are simple actions we can all take to mitigate the risk of animal bites and spread of rabies: Vaccinate your pets against rabies each year to protect them from rabies, and hence protect yourself, your family and other animals. Rabies vaccines for animals are available at Government Veterinary Service offices and Private Veterinary Service providers’ facilities. Keep your pets in your yard or in an enclosed area. Dogs that roam freely are more likely to meet rabid dogs and other animals and can spread the disease to other animals and people. Feed your dog regularly to avoid having them roam the neighbourhood for food. Take your pets for regular veterinary care. Avoid letting your pet lick your face or any breaks in the skin such as cuts, scratches, or sores. Always wash your hands and arms with soap under running water immediately after any contact with an animal, even if it looks healthy.

Bite prevention: Since rabid animals may not immediately show any signs and symptoms, it is important to guard against being bitten or scratched by animals. Dogs and other animals may bite for many reasons. For instance, they may bite when they are afraid or trying to protect something that is theirs, where they live, their young ones, their food, or their owner. Avoid disturbing dogs or any other animal, especially when they are sleeping, eating, or with their young ones. Dogs may bite when they are surprised, or scared, so exercise caution when passing or entering a place where a dog lives. Many people keep dogs to protect themselves and their homes. Taking your time when passing by or entering an area where a dog lives can help a dog know you are not a threat. Avoid playing with, touching, or getting close to stray dogs and animals, even if they look friendly. If a dog comes close to you, stand still, and remain quiet. Stay away from any dog and other animals that is acting strangely or that looks sick. A dog that is acting strange or looks sick might have rabies or some other disease and is more likely to bite if you go near it.

Any animal that has bitten someone or another animal must be examined by a Veterinary Officer and kept away from other animals and people for 10-14 days for observation for the signs and symptoms of rabies. If an animal shows signs and symptoms of rabies or is acting strangely, avoid the animal and contact a Veterinary Officer for advice on what to do next. Let your family and neighbours know whenever you see any strange behaviour in a dog so that they take precautions.

If you find any bites on your animals or they are showing any strange behaviour, separate them from other animals and people. Immediately inform a Veterinary Officer for assistance.

The role of Pharmacists in rabies prevention: Community pharmacies remain the first point of call for most people seeking some form of medical attention or assistance, so it is important for pharmacists to update their knowledge on rabies and its prevention and provide relevant education to their staff and clients. Victims of animal bites must be educated and referred to the nearest health facility by the pharmacist for proper assessment and treatment. Hospital pharmacists have a duty to ensure their facilities stock up rabies immunoglobulins and always maintain the cold chain. Pharmacists must provide timely and accurate advice on dosage regimen for pre- and post-exposure prophylaxis to clinicians whenever required. Community pharmacists must identify and have the contact number of the nearest veterinary service in their community to strengthen collaboration in rabies prevention.

References

  1. Danso, F. and Eshun, E (2023). Rabies in Ghana: The Animal Health Perspective. 2018-2022. Presentation Veterinary Services, Epidemiology Unit. Ghana.
  2. Abdul-Tawab, A. (2023). Rabies Situation in Ghana – The Human Health Perspective. Presentation: 19 January 2023, Disease Surveillance Department, Ghana Health Service, Ghana.
  3. Diwakar, R., Diwakar, R. K., Yadav, V. and Singh, S. P. (2017). Rabies: A Zoonotic Disease. International Journal of Agriculture Innovations and Research, 5(4), 2319-1473.
  4. Knobel, D., Coleman, P., Fèvre, E., Meltzer, M., Miranda, M., Shaw, A., Zinsstag, J. and Meslin, F. (2005). Re-evaluating the burden of rabies in Africa and Asia. Bulletin of the World Health Organization, 83(5), 360-8. Switzerland: Geneva.
  5. Butler R.A. and Bingham J. (2000). Demography and human-dog relationships of the dog population in Zimbabwean communal lands. The Veterinary Record, 2000. 147, 442-446