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What is Rabies?

Categories: rabies

3 dogs

Healthy Animals, Healthy People

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ryan M. Wallace, US Centers for Disease Control and Prevention

Ryan M. Wallace, US Centers for Disease Control and Prevention

Most people in the United States know rabies as a rare and terrifying disease, ending in almost certain death. However, it’s not usually something they think about, except when the reminder card arrives from their veterinarian that their pet needs its rabies vaccine booster. Even then, they probably are not considering how important that shot is to not only keep their pet safe, but also as a barrier from exposure to rabid wildlife. In addition, that single shot is a critical tool in an international battle to prevent the tens of thousands of human deaths from this disease every year.

I occasionally hear stories from friends and family members who worry about rabies. I once talked to a woman who didn’t give rabies a second thought until she was deployed to Senegal as part of the Peace Corps. Her biggest fear was getting bitten by a stray dog and contracting a disease she might not be able to recover from.

Or consider the young professional who told me a story about traveling abroad and getting bitten by a stray dog on a beach. He panicked and didn’t know if that bite was his death sentence. Thanks to decades of public health interventions, canine rabies has been eliminated in the United States. However, what most people do not realize is that approximately three quarters of the world’s population currently lives in a country where rabies is an ever-present threat.

As the Veterinary Medical Officer for the CDC Rabies team, I’ve seen the toll rabies has taken on families around the world. In Taiwan, I had the difficult task of assessing a young puppy that was attacked by a wild ferret badger during a rabies outbreak. While there were no visible wounds, we could not rule out that the puppy had been exposed to rabies. The unfortunate recommendation was to either euthanize the puppy or quarantine it for six months. The family was poor, subsiding on a small farming plot; the cost for quarantine was seemingly out of reach. Yet the family scraped together the funds and paid for the quarantine. Unfortunately, four weeks later the puppy developed signs of rabies and was euthanized. The compassion this family showed for their puppy was amazing, but in the absence of qualified rabies control officials, the consequences could have been dire if the dog had remained at home.

CDC Veterinary Epidemiologist, Ryan Wallace, trains veterinarians at a spay/neuter clinic in Ethiopia. In many parts of the world standard veterinary services, an integral component of rabies control, are not present. CDC is collaborating with the Ethiopian government, Gondar University, and Ohio State University to help improve veterinary infrastructure to keep animals healthier, and prevent rabies.

CDC Veterinary Epidemiologist, Ryan Wallace, trains veterinarians at a spay/neuter clinic in Ethiopia. In many parts of the world standard veterinary services, an integral component of rabies control, are not present. CDC is collaborating with the Ethiopian government, Gondar University, and Ohio State University to help improve veterinary infrastructure to keep animals healthier, and prevent rabies.
Photo by Ally Sterman, OC Hubert Fellow, Ohio State University School of Veterinary Medicine

Earlier this year I was in Haiti helping the local government train veterinary staff on humane euthanasia of suspected rabid animals. During the training, a veterinarian received a call from a young man who was bitten by his dog. Like many dogs in Haiti, this family pet was allowed to roam freely around the community. Three months prior to the call, the pet came home with a bite wound to his back leg. The family thought nothing of it; dog fights are common, especially among young male dogs in the neighborhood. It was now three months later and the dog was in a full rage. When the young man opened his door on this particular morning his dog lunged at him, leaving two deep bite wounds in his hand. The family was trapped inside their house for several hours until we arrived to safely euthanize the animal. Even though this animal was obviously ill, and had bitten two people, the family was still distraught by the thought of losing their beloved pet.

In Ethiopia, while assisting with a rabies vaccination clinic for dogs, we saw that people had walked for hours to get their dogs vaccinated. In particular, two boys waited more than six hours to have their dogs protected from this deadly disease. In all of the places I have traveled, I have witnessed the same truth: the human-animal bond is deep and universal, but dog-transmitted rabies is a far too familiar story for those of us who work in this field.

So what is rabies? To people in the United States, it may be something that is rarely considered. To most of the world, it is likely something they have intimately experienced. In the public health world, rabies is defined as a neglected tropical disease (NTD). Why is this? How does it happen? Some NTDs don’t cause enough deaths to be a priority to many. Some NTDs are found only in poor parts of the world, where other public health issues take priority. Some NTDs, for various reasons, do not attract international attention. Those of us working on preventing NTDs often spend more time advocating for elimination of the disease than we do actually fighting it.

What is often frustrating for those of us who are passionate about preventing NTDs like rabies is that, unlike many NTDs, rabies is vaccine-preventable. In fact, there are over 20 different approved rabies vaccines for more than six animal species (and people too!). In addition to those vaccines, there are also step-by-step recommendations developed by world experts that have been proven, when followed, to successfully eliminate canine rabies. Yet despite the existence of effective vaccines and proven successful interventions, more than 55,000 people die each year from an easily preventable disease. 95% of these deaths can be attributed to a bite from a rabid dog. All of these deaths at the jaws of rabid dogs, even though in most parts of the world it costs less than one U.S. dollar to protect a dog against rabies.

World Rabies Day was created in 2007 as a way to raise awareness for this NTD. As a veterinarian working in the public health field, I cannot imagine a more rewarding NTD to fight against and advocate for prevention. I am fortunate enough to have the opportunity to travel the world, not only to save human lives, but also to advocate for healthier, happier animals. In my travels, I am reminded of how important and loved animals are to the families with whom they share homes.

So this Word Rabies Day please take a moment to thank all of the hard-working people who spend every day to prevent you and your pets from catching this fatal disease. Thank your veterinarian for keeping your pets healthy. Thank your local animal control officer, who just tussled with that rabid fox in your backyard. Thank that doctor who reminded you to get those rabies shots before your vacation to any one of the 150 rabies-endemic countries. Hug your dogs if they are vaccinated, and get them vaccinated if they are not! (Then hug them.)

Finally, in honor of World Rabies Day, I’d like to highlight some of the many great stories about how the rabies work of CDC and our collaborators impacts the lives of families around the world:

 

What it’s REALLY like fighting Ebola in Liberia

Categories: Ebola, global health security, infectious disease

 

This blog was originally posted on the ONE.org on September 11, 2014.

 

A Médecins Sans Frontières/Doctors Without Borders (MSF) staff member ties the face mask of Dr. Jordan Tappero, CDC, before Dr. Tappero enters the Ebola treatment unit (ETU), ELWA 3. MSF operates the ELWA 3 ETU, which opened on August 17.

A Médecins Sans Frontières/Doctors Without Borders (MSF) staff member ties the face mask of Dr. Jordan Tappero, CDC, before Dr. Tappero enters the Ebola treatment unit (ETU), ELWA 3. MSF operates the ELWA 3 ETU, which opened on August 17.

Jordan W. Tappero, MD, MPH

Jordan W. Tappero, MD, MPH

During my time in Liberia, I have tried not to provide much detail to my family about the day-to-day work we are doing.

I don’t want to cause alarm or propagate fear; conditions in Monrovia can at times be deeply troubling.

I have spent the past month working to help control the Ebola outbreak in Liberia as part of the United States Government’s Disaster Assistance Response Team, or DART.

Our work here has been nonstop and it doesn’t appear that the end of the epidemic will be anytime soon. There are days when there is palpable tension in the air, especially when a new community experiences Ebola virus transmission for the first time, or experiences a second or third wave of disease.

I have seen what needs to be done to stop Ebola from spreading – find patients quickly, isolate and treat them, identify their contacts and safely bury those that die. But the scale of this Ebola outbreak is unprecedented.

The systems currently in place to identify, refer, isolate and treat Ebola cases are overwhelmed. Knowledge of how the disease is spread varies from community to community, and unsafe burial practices continue to take place far and wide.

In addition, the international response has not been enough. This is in part due to fear that is fostered by ongoing transmission of infection among health care workers with inadequate supplies of personal protective equipment, soap and clean water, and incomplete understanding of required infection control practices, or both.

As part of the DART, our goals are to help partners find people with the virus in the community, get them into Ebola treatment centers and improve infection control practices to prevent the spread of the virus to health care workers and burial teams.

I have worked with many Liberians, our CDC team, and partners in the field who are at the front of the response, and I’m amazed by their dedication in this challenging environment.

As just one example, Dr. Mohammed Sankoh, Director of the Ministry of Health and Social Welfare’s Redemption Hospital in Monrovia is now managing a primary care facility that is being overrun by suspected Ebola patients.

He has lost many of his staff (doctors, nurses, a physician assistant and a midwife) to Ebola. His remaining staff are fearful of coming to work, and his community is increasingly afraid of coming to the hospital, with many preferring to die at home.

In his own words “When we had our civil war, we knew who we were fighting, but with Ebola, the enemy is invisible, and it is taking us in increasing numbers.”

We simply need more people to step up to help supply, train and equip Liberian nationals to take on the epidemic.

The work is challenging, yet highly rewarding. The United States’ effort in Liberia is but one cog in a larger wheel of the response that is striving to save lives. However, I am certain that the epidemic would be even worse without our presence.

I am grateful to be able to contribute to the fight against this scourge.  And the Liberian people are thankful that the U.S. has not abandoned them.

We need others to join in the fight against Ebola. But let’s not stop there.

To prevent such public health events, all countries need to have the capability to prevent the spread of infectious disease threats quickly, detect them accurately, and respond to them effectively.

It is heartbreaking to see countries like Guinea, Sierra Leone and Liberia trying to tackle this epidemic with inadequate public health infrastructure and trained public health and medical workforce that could have averted it with modest investment.

It is a global health security imperative to contain Ebola in West Africa and to prevent its spread across the continent and beyond.

The High Stakes in Fighting Ebola: Leave One Burning Ember and the Epidemic Could Re-Ignite

Categories: Ebola, global disease detection, global health security, health systems strengthening, infectious disease

 

This blog was originally posted on the Huffington Post on August 7, 2014.

 

A banner encouraging people suffering from Ebola to go immediately to a health center for treatment is seen on a sidewalk in the city of Freetown, Sierra Leone, Thursday, Aug. 7, 2014. While the Ebola virus outbreak has now reached four countries, Liberia and Sierra Leone account for more than 60 percent of the deaths, according to the World Health Organization. The outbreak that emerged in March has claimed at least 932 lives. (AP Photo/Michael Duff)

(AP Photo/Michael Duff)

CDC and our partners are currently fighting the biggest and most complex outbreak of Ebola virus disease ever recorded.

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

There are hundreds of cases in West Africa and now a new cluster of cases in Nigeria is very concerning. The spread of Ebola shows what happens if we don’t have meticulous infection control, contact tracing, and proper isolation of those with symptoms of the disease.

There are two things that are very important to understand about how Ebola spreads.

The evidence suggests that Ebola only spreads from sick people—not from people who have been exposed to the disease but haven’t yet become sick from it. The illness has an average 8-10 day incubation period, although in rare instances the incubation period may be as short as two days or as long as 21 days, which is why we recommend monitoring for 21 days after any potential exposure.

World Cup serving as real-world test for new disease detection technology

Categories: global disease detection, global health security, health systems strengthening, infectious disease

 

World Cup soccer ball

 

With the World Cup underway in all its frenzied glory, you can be forgiven for missing another major effort currently underway in Brazil that represents the first large scale, real-life, real-world test of important new technology.

And no, it’s not the goal-line technology that’s being used for the first time at soccer’s biggest competition.

This technology uses computer tablets, sophisticated software designed by CDC and public health experts from Brazil’s Ministry of Health (MOH) trained in the Field Epidemiological Training Program (FETP) to provide the most complete, detailed and timely information about disease threats and other public health concerns.

Polio Eradication, Microplanning and GIS

Categories: child health, immunization, polio

A Bugagi child travels by camel near Lake Chad in Borno State, Nigeria. Photo courtesy of Thomas Moran/WHO.

A Bugagi child travels by camel near Lake Chad in Borno State, Nigeria. Photo courtesy of Thomas Moran/WHO.

Victoria Gammino, PhD, MPH, Epidemiologist, CDC Global Immunization Division

Victoria Gammino, PhD, MPH, Epidemiologist, CDC Global Immunization Division

Geospatial data have been used in public health since John Snow mapped cholera cases around the Broad Street water pump during the London cholera epidemic of 1854.  And, while global positioning system technologies (GPS) are so ubiquitous in the United States that virtually all new smartphones, tablets and cars have this technology embedded, in many areas of the world, health care workers in the field are often without the most basic two-dimensional paper maps.

So what do maps and map literacy have to do with polio?  Polio is a crippling and potentially fatal infectious disease. There is no cure, but there are safe and effective vaccines. Therefore, the strategy to eradicate polio is based on preventing infection by immunizing every child to stop transmission of the virus that causes polio, and ultimately make the world polio free.   The four pillars of polio eradication all rely on “microplans”— detailed logistical blueprints that guide the planning and implementation of vaccination campaigns, routine immunization outreach, and surveillance for polio cases by providing critical data on the size and location of the target population in a given geographic area.  These target population numbers determine the amount of vaccine required, the number of health care workers and supervisors to deliver the vaccine, and the cost of transportation to get the vaccine and health care workers where they need to go.

CDC Staffers Take No Refuge From Helping Refugees Around the World

Categories: infectious disease, refugee health

A child plays with a kite in a tent camp after the earthquake, Port-au-Prince, Haiti, 2010.

A child plays with a kite in a tent camp after the earthquake, Port-au-Prince, Haiti, 2010.

For anybody wondering why CDC has a branch dedicated to helping refugees or why the United Nations has formally recognized World Refugee Day every year since it was created in 2001, the answer can be found in a single, stark statistic: In 2013, a person became a new refugee or internally displaced person every 4.1 seconds.

Michelle Dynes, PhD, MPH, MSN, CNM, RN, EIS Officer/Epidemiologist, CDC Emergency Response and Recovery Branch

Michelle Dynes, PhD, MPH, MSN, CNM, RN, EIS Officer/Epidemiologist, CDC Emergency Response and Recovery Branch

Cyrus Shahpar, MD, MBA, MPH, Medical Epidemiologist, CDC Emergency Response and Recovery Branch

Cyrus Shahpar, MD, MBA, MPH, Medical Epidemiologist, CDC Emergency Response and Recovery Branch

That translates to “a population of concern” of nearly 40 million refugees or internally displaced people worldwide every year, according to the United Nations.

It also translates to a lot of illnesses and suffering. And that’s the reason Cyrus Shahpar, Michelle Dynes and approximately 50 other staff in CDC’s Emergency Response and Recovery Branch (Division of Global Health Protection) have their bags packed and are constantly ready to deploy to the field.

Communication Matters in Global Health Deployments

Categories: global health security, infectious disease

During the simulation exercise, ECN trainees deployed to the site of a mock disaster in Avully, Switzerland.

During the simulation exercise, ECN trainees deployed to the site of a mock disaster in Avully, Switzerland.

Communication matters.

Gaya Gamhewage, MD, Coordinator, WHO Communication Capacity Building Team; Founder, WHO Emergency Communication Network

Gaya Gamhewage, MD, Coordinator, WHO Communication Capacity Building Team; Founder, WHO Emergency Communication Network

That’s not a new idea. Many of us have learned this the hard way. This concept is being applied in a new, more comprehensive way for a key purpose—to help the World Health Organization (WHO) communicate more effectively, with more clarity and purpose during humanitarian and public health emergencies.

The idea is to better integrate communications specialists from WHO, CDC, ministries of health and a wide array of other humanitarian and global health organizations into a cohesive, specially trained team that can be dispatched on short notice when public health or humanitarian emergencies occur.

The logic is based on the idea that communications is part and parcel of emergency health response. Communicating in a crisis not only provides the public and policy maker clear and critical information, it also can help the technical side of the response. It connects those affected with those willing to help and can make sure that resources are aligned to the most important needs.

Voices from the Central African Republic: FELTP residents remain committed to strengthening disease surveillance and outbreak response in CAR

Categories: child health, immunization, infectious disease, refugee health

CAR refugees forced from their homes by rebels

CAR refugees forced from their homes by rebels

Dr. Els Mathieu, Resident Advisor, CAR- FELTP

Dr. Els Mathieu, Resident Advisor, CAR- FELTP

The Central African Republic (CAR) is a landlocked country in Central Africa, bordered by Chad in the north, Sudan in the northeast, South Sudan in the east, the Democratic Republic of the Congo and the Republic of the Congo in the south and Cameroon in the west.  CAR is one of the world’s least developed nations and has experienced several periods of political instability, as well as deadly attacks and violence by rebels that have forced nearly 1 million people from their homes in search of refuge.  With so many civilians fleeing to refugee camps in the capital, Bangui, and the provinces, there is an increased need to strengthen disease surveillance and response.

CDC Protects Families: My favorite stories

Categories: child health, malaria, tuberculosis (TB), women's/maternal health

Terri Still-LeMelle

Terri Still-LeMelle

As we celebrate families on Mother’s Day, May 11, and the International Day of Families, May 15, I am especially proud to work in CDC’s Center for Global Health.  As one of the Center’s  health communication specialists, I have the privilege to write or edit many stories about how CDC’s programs impact the lives of families around the world.  In honor of this season, I’d like to highlight a few of my favorite accounts about brave mothers, determined families, and CDC’s global health programs.

 
 
 
 

Mozambique FELTP fellows evaluate impact of malaria bed net campaign

Categories: health systems strengthening, malaria

One thing is to read a protocol, and quite another to write a protocol, do the field work, and see it through to the end" - Geraldo Chambe, FELTP resident

One thing is to read a protocol, and quite another to write a protocol, do the field work, and see it through to the end" - Geraldo Chambe, FELTP resident

Four Mozambican epidemiologists-in-training spent a month walking up to ten kilometers a day to make sure that one of the most effective malaria control interventions was reaching the poorest Mozambicans. Malaria is the leading cause of death in Mozambique, and insecticide-treated bed nets are one of the key malaria control measures. Since 2007, the U.S. President’s Malaria Initiative (PMI) has supported the Mozambican Ministry of Health and the National Malaria Control Program (NMCP) in efforts to reduce the burden of malaria in the country, not only through distribution of bed nets, but other key components as well: indoor residual spraying, diagnostic testing and treatment with effective antimalarials, and intermittent preventive therapy for pregnant women.

Mateusz Plucinski, PhD, MPH, Epidemic Intelligence Service Officer, Division of Parasitic Diseases and Malaria, Malaria Branch

Mateusz Plucinski, PhD, MPH, Epidemic Intelligence Service Officer, Division of Parasitic Diseases and Malaria, Malaria Branch

In 2013, with PMI support, the NMCP launched a universal bed net distribution campaign in six districts in Nampula Province, located in the northern region of Mozambique. The goal was to provide access to a bed net to the entire population living in the 250,000 households within the target area. The definition of “universal” varies somewhat by country; in Mozambique it means one bed net for every sleeping space. Mass distribution campaigns meant to achieve universal coverage are ambitious, complex, multi-step activities. They involve visiting all households in the distribution area to perform a census, determining how many bed nets to distribute per household, and organizing the logistics of delivering hundreds of thousands of bed nets to remote areas. It is therefore important to evaluate their performance and determine how successful they were in achieving their goal so that lessons learned can inform planning for the next campaign. And for the NMCP, it is important to document how increased bed net ownership and use made possible by campaigns affect malaria transmission.

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