Rabies sounds like a disease from other times, like the plague or leprosy. However, in Spain every owner of a dog, cat or ferret is required to have them vaccinated against rabies. It’s really necessary? The News of five cases of canine rabies in Melilla in the interval of a few months can give us some clues to answer this question.
A lethal but preventable viral zoonosis
Rabies is a viral infectious disease that causes around 60,000 deaths each year. In the vast majority of cases, the dog is the animal that transmits it to us. Once the symptoms appear, there is no possibility of effective treatment, and death is an inevitable outcome. The good news is that human-to-human transmission of rabies has never been proven.
Fortunately, both treatment with vaccine and gamma globulin in the days following exposure to the infected animal – post-exposure prophylaxis – and preventive vaccination – pre-exposure prophylaxis – prevent infection with total and absolute effectiveness.
However, being a zoonosis, the only option to control it is to vaccinate our pets. By protecting them, we protect ourselves. After all, human, animal and environmental health are one health.
How can it be then that a disease for which we have had an effective vaccine for 136 years kills 60,000 people annually? Well, because most of its victims live in rural areas of economically disadvantaged countries and do not have access to treatment. That is why rabies is included in the WHO list of neglected tropical diseases.
The problem of imported rabies
At the beginning of the 20th century, all of Europe was endemic for canine rabies. Thanks to the population control of stray dogs and the vaccination of pets, it was gradually eliminated from the entire continent, in what is a great public health epic.
Spain did so in 1965, although in 1975 an outbreak was declared in the province of Malaga that could not be quelled until 1978. Since then we have been free of canine rabies.
Most of its victims live in rural areas of economically disadvantaged countries and do not have access to treatment.
However, in the 1940s, an epizootic (epidemic in animals) in foxes began in the east of the continent and spread like an oil slick until it reached the south of France. Successful campaigns with oral vaccines arranged in baits have achieved that vulpine rabies is today practically eliminated from the European Union, although it remains highly endemic in the eastern border countries. Vulpine rabies never reached Spain, thanks to the efforts of our neighbors.
The situation is quite different in the south, since all of North Africa is highly endemic. Ceuta and Melilla have land borders with Morocco and it is very difficult, if not impossible, to prevent the passage of infected dogs, which are detected from time to time by the surveillance system.
Rabies vaccination, which is subsidized in both cities, and the exhaustive control of dogs without owners prevent imported cases from leading to epizootic outbreaks and allow these cities to remain rabies-free territories.
We also have evidence of the passage through our maritime borders of several infected dogs, which were picked up by tourists in Morocco and hidden in customs, to cross the peninsula by car and end up in France, where they developed symptoms causing epidemiological alerts.
In June 2013, a dog with an unusually aggressive behavior bit several people in the city of Toledo, causing serious injury to a child.
The analyzes revealed that the animal was infected with the rabies virus and the subsequent investigation concluded that the owners, residents of Spain, had traveled with the dog to Morocco months before without meeting all the required requirements, resulting in infection during the stay.
Upon their return, they managed to hide it and introduce it illegally, causing the first case of rabies in the peninsula in 35 years and an alarm that lasted for six months, causing serious economic loss. The existing vaccination coverage in the affected territory and the rapid surveillance and control measures implemented meant that no other animal cases were declared nor that we had to mourn human victims.
Border controls and other lines of defense
Maintaining a good border control system is essential to protect us from the risk of reintroduction of rabies. However, it cannot be foolproof and we must establish additional lines of defense. This implies having an efficient surveillance and epidemiological control system. But also a good level of immunity in our pets obtained through universal vaccination, which prevents an imported case from spreading in an uncontrolled manner.
In that scenario (an imported case of rabies), the first victims would be the dogs that came into contact with the imported case and we would come after. Vaccinating them is the only way to protect them and ourselves from an absolutely lethal disease that we were only able to get rid of after decades of fighting, but that we continue to have at our doors.
However, the definitive solution to this problem will only be able to come from the new United Against Rabies international forum, which brings together WHO, OIE and FAO under the aim that there will be no cases of human rabies transmitted by dogs in 2030.
The control of infectious diseases can only be understood globally and achieved through cooperative policies. Does this sound like something to you?
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