On 12 September 2021, the Sri Lanka Veterinary Association (SLVA) conducted an online session on the topic of “Latest Updates on Rabies: One Health Approach” which was held as part of the SLVA’s Continuous Professional Development (CPD) webinar series.
The programme featured an eminent panel of industry professionals; University of Peradeniya Faculty of Veterinary Medicine and Animal Science, Department of Veterinary Clinical Sciences Professor in Veterinary Clinical Sciences, Prof. Nayana Wijayawardhane, Medical Research Institute (MRI) Consultant Virologist and Vaccinologist, Head – Department of Rabies and Vaccine QC, and NCL for Vaccines and Covid-19 Lab 3 Dr. Kanthi Nanayakkara, and Colombo Municipal Council Chief Municipal Veterinary Surgeon Dr. Mohamed Ijas.
Rabies is a zoonotic disease; a disease transmitted to humans from animals that causes acute encephalitis. It is caused by a virus and rabies infects both wild and domesticated animals, and is spread to people via infected saliva.
Patients develop malaise, headache, and fever as early symptoms of rabies and later develop violent movements, uncontrolled excitement, hydrophobia, and finally death due to respiratory failure. Dogs are most likely to infect people in Sri Lanka but Rabies infections from other mammals like cats, mongoose, jackals, and bandicoots also have occurred.
Prof. Wijayawardhane shared the most recent statistics on rabies infections, from the end of 2019, providing that there was a reported 30 human deaths from rabies and that in Sri Lanka 20 to 30 deaths occur annually due to rabies, mainly from exposure to infected dogs.
She provided that the main reasons for deaths in Sri Lanka are non-vaccination of dogs against rabies and not getting post-exposure treatment. If treated properly and immediately after an infected animal bite, she stated that it is 100% preventable and post-exposure vaccine and serum is freely available at government hospitals.
Sri Lankan rabies control authorities recommend annual rabies vaccination of all dogs above six weeks; considering how it has been reported that rabies control measures launched in Sri Lanka since 1975 have had a tremendous effect on the incidence of human rabies. With the number of human rabies deaths declining from 377 in 1973 to 19 in 2014.
The panellists pointed out that a primary concern is the unavailability of data, sharing that there is a grave disparity between the analytics and the real picture.
Dr. Ijas explained that “we are only getting the tip of the iceberg”, stating that the laboratories receive roughly about 1,500-1,800 samples and from these samples more than 88% of which are dog samples, however this does not give a clear picture about the disease.
Dr. Nanayakkara added that a major component of this lack of reliable and comprehensive data is because “we have a poor surveillance system” she said, adding that: “A major drawback can be seen in sample collection, and sample submission to the MRI because owners are reluctant to come and handover the samples.” She said that it is mostly due to logistical reasons like having to travel long distances to submit it.
She shared that the system may be able to remedy some of these concerns if they are able to establish a proper system for dog rabies disease control surveillance, proposing that at least a single laboratory be made available for each province to carry out diagnosis. Dr. Nanayakkara even proposed a more economical alternative: “There are commercially available lateral flow vaccines which we don’t currently use, but, instead of the anti-body carried out at the MRI’s, this testing is time consuming and laborious however by utilising these lateral flow tests, we can maybe have satellite laboratories that immediately address these tests.”
Sri Lanka was the first country in the World Health Organisation Southeast Asia region to develop a national strategy for elimination of dog-mediated rabies and is a key country sharing knowledge, expertise, and capacity-building in the region towards the global target of zero rabies deaths by 2030. However, for our country to attain its own goals of rabies elimination, more will need to be done to scale up dog vaccination, enforce responsible dog ownership, strengthen surveillance for animals and humans, and conduct mass awareness programmes.
