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Optimistic in the Face of Ongoing Tragedy: Progress toward a World Free of Human Rabies

Posted on by Emily Pieracci
Emily Pieracci
Emily Pieracci

Rabies is a fatal disease that kills an estimated 59,000 people each year, almost half of whom are children. The majority of deaths occur in Africa and Asia. All of these deaths are vaccine-preventable with timely administration of post-exposure prophylaxis (PEP), the shots needed to prevent rabies from developing in bite victims.

So why is rabies still a threat to people? Why do so many people die needlessly every year? How do we stop this horrible virus from taking another human life?

I think about these questions as I travel around the world working with countries to eliminate rabies. The easy answer is to vaccinate 70% of dogs in a country. That is all it takes to eliminate canine rabies in a country, which is the cause of almost all human rabies deaths. But when we begin to look at why countries haven’t been able to do this, we begin to see that this is a very complicated issue with no quick or easy answers.

First, many of the affected countries don’t have sufficient infrastructure to run annual mass dog vaccination campaigns, which is the most effective ways to rapidly reach the necessary vaccination coverage among dogs. Without good roadways or reliable electricity, getting vaccines into remote communities becomes a very challenging task.

During her presentation at 2017 PARACON meeting on how to plan and budget for a mass dog vaccination campaign, Emily Pieracci asked who was committed to ending rabies.
During her presentation at 2017 PARACON meeting on how to plan and budget for a mass dog vaccination campaign, Emily Pieracci asked who was committed to ending rabies. Photo: Andre Coetzer

Second, many countries don’t know how many dogs they have. If the size of the dog population is not known, planning a vaccination campaign becomes difficult because health officials don’t know how many vaccines and other supplies to purchase. In an absence of reliable dog numbers, most countries end up falling far short of their target of vaccinating 70% of dogs.

Finally, many countries don’t have a large enough veterinary workforce to vaccinate enough dogs throughout the country. Veterinarians are critical advocates in the elimination of canine rabies: they organize and run vaccination clinics, they train animal technicians and community volunteers, and they educate communities about the risk of rabies and the benefits of vaccination.

It can feel like a bleak and insurmountable challenge. Yet, working to eliminate rabies over this past year has been one of the most inspiring experiences of my life. In every country I have visited, I have met incredible, dedicated people who have seen the devastating effects of this disease and are passionate about putting a stop to it.

In Africa

Vaccinating 70% of dogs can stop rabies from killing them
Vaccinating 70% of dogs can stop rabies from killing them

The Pan-African Rabies Control Network (PARACON), a global community of 46 sub-Saharan African countries and multiple international partners that works together to identify solutions to eliminate canine rabies across Africa , comes together every year to address deficiencies in rabies elimination programs. PARACON is dedicated to improving data collection within countries because having accurate data is essential for governments to secure the financial resources necessary to eliminate canine rabies. The country delegates support each other by sharing stories of success, as well as frustrations from setbacks, but regardless of the circumstances, they remain committed to the fight against rabies.

During the last year, I traveled again to Ethiopia to continue training animal health professionals in handling and vaccinating dogs, while my colleagues continue assisting with building laboratory capacity, vaccine availability, and community awareness, together helping to develop a national rabies elimination strategy. Ethiopia is a great example of the progress that can be achieved when animal and human health agencies work together to develop and implement effective prevention and control programs for diseases that affect both animals and people. I’m hopeful that we will soon see the real impact of this One Health approach.

In Asia

World Rabies Day is September 28
World Rabies Day is September 28

Recently, I visited Eastern Malaysia to provide assistance with an outbreak of rabies in Sarawak. Rabies has not been present in Eastern Malaysia for more than 10 years and the recent deaths of five Malaysians from rabies was a shock to the country. Veterinarians and doctors have been working non-stop for 2 months to identify bite victims, deliver PEP, and vaccinate animals. The dedication that the Malaysian government has shown to its people has been truly inspirational. The Ministries of Health and Agriculture have joined forces working together to fight the outbreak and demonstrated the true value of a One Health approach in addressing zoonotic diseases such as rabies.

In Cambodia, the government with assistance from WHO, Institute Pasteur, and CDC has started a pilot project to identify bite victims and ensure they receive proper medical treatment and PEP. The pilot strongly focuses on community education and timely reporting and medical care of bite victims. By ensuring bite victims receive PEP, we can stop people from dying from this horrible disease. I’m eager to see how this project will grow over the next year.

These are just a couple of examples that come to mind when I think of all the exciting work that is being done worldwide to eliminate canine rabies.

September 28 is World Rabies Day. It’s the day we pause to recognize that rabies is a deadly, yet preventable, disease that needlessly kills one person every nine minutes. It’s the day we celebrate the efforts of the incredible people who are working to eliminate this disease from within their countries not just on World Rabies Day, but every day of the year. It’s the day we acknowledge that we are a global community that must be united in this fight.

Let’s not wait another 364 days before we think of rabies again. Let’s commit to #EndRabiesNow.


Posted on by Emily PieracciLeave a comment

CDC Global Rapid Response Team Pilots Workshop for Senegal and Burkina Faso

Global Rapid Response Team

Participants to the Rapid Response Team Management workshop, Dakar, Senegal, August 7-11 The 2014-2016 Ebola epidemic clearly demonstrated the need for trained scientists who can deploy quickly to confront health threats and ensure global health security. While we often think about the emergency response itself, we typically don’t think about the work that happens behind Read More >

Posted on by Global Rapid Response TeamLeave a comment

Making some noise about noncommunicable diseases in Rwanda

We weren’t sure what to expect when the Rwanda Biomedical Center requested a training for their noncommunicable disease (NCD) program managers. We had never delivered this particular curriculum before, but after three months of preparation, our journey from Atlanta began. After landing in the capital Kigali, we faced a bumpy three-hour drive into the mountains Read More >

Posted on by Kristy Joseph, MA, CDC Global NCD BranchLeave a comment

Parasitologist for the People

LT Knipes chats with school children who have been enrolled and are waiting to be tested for lymphatic filariasis and malaria in Nord Est Department, Haiti.

Global health emergencies are a constant in today’s world. In recent years, we have seen the impact of natural disasters, mass migrations, famines, conflicts, and more. When there are large population movements, we see rapid spread of infectious disease. When there is famine, those affected have a compromised immune system, allowing them to contract illnesses easier. For these reasons it is vital that public health staff from the Centers for Disease Control and Prevention (CDC) is on the scene. Read More >

Posted on by Adrienne Lefevre, MPH, CHESLeave a commentTags , , , ,

Are Ebola response investments making an impact? CDC Epidemiologist reflects on West Africa then and now

The first time I deployed to West Africa was in September 2014, at the height of the Ebola epidemic in Sierra Leone. I have witnessed many disease outbreaks in my public health career, but this one was more devastating than I could ever have imagined. It eventually took more than 11,000 lives. What was happening Read More >

Posted on by John T, Redd, MD, MPH, FACP, CAPT, US Public Health Services, CDCLeave a commentTags , , , ,

Vaccination remains the most cost-effective strategy to get on track with hepatitis B elimination in resource-limited settings

Midwife providing the 5-in-1 pentavalent vaccine (diphtheria-tetanus-pertussis [DTP], hepatitis B, and Haemophilus influenzae type b) during a routine vaccination session in Myanmar In the 1990s, the Western Pacific Region had one of the highest prevalence rates of chronic hepatitis B infection in the world (>8%). As a result, in 2005, it was the first World Read More >

Posted on by Dr. Rania Tohme, Team Lead, Global Immunization DivisionLeave a commentTags , , , ,

Training the Future Public Health Workforce in Malawi: Field Epidemiology Training Program (FETP)

8. Malawi FETP-Frontline Cohort 2 trainees with mentors and guests during graduation ceremony: Photo courtesy: Kiran Bhurtyal, CDC

At 4:00 PM on July 12, 2016, I received an urgent email from the CDC Malawi office asking if I had any information on a typhoid outbreak in Malosa in southern Malawi. The U.S. Embassy in Malawi was planning a visit to Malosa by the Second Lady of the United States, and they had received reports of an unusually high number of typhoid cases there. Fortunately for me, one of our trainees from the Field Epidemiology Training Program (FETP) had presented on the same outbreak earlier that day during the FETP graduation ceremony.  Read More >

Posted on by Kiran Bhurtyal, CDC MalawiLeave a commentTags ,

Polio Eradication and Beyond: What the Polio Endgame Means for Public Health

Melisachew Adane

The end of polio is in sight, with fewer cases of wild polio virus being reported yearly. Today, polio is on the cusp of eradication, with cases in only a few high-risk areas of three countries—Afghanistan, Nigeria, and Pakistan. This brings the eradication effort to its final chapter, otherwise known as the polio endgame. The Read More >

Posted on by Manish Patel, MD (CAPT, USPHS)Leave a commentTags , , ,

CDC Protects People from Disease Threats and Outbreaks in the U.S. and Around the World

This blog was originally published on Global Health Council’s The Collective Voice on June 16, 2017. Opinion polls show that the Centers for Disease Control and Prevention (CDC) is one of the federal government’s most admired and trusted agencies. Since its founding in 1946, CDC’s history as America’s premier public health agency has been tightly intertwined Read More >

Posted on by Carmen Villar, MSW, Center for Global Health Deputy Director for Policy and CommunicationsLeave a comment

Keeping Kids Healthy in Sierra Leone

Even before the recent Ebola outbreak, the lack of quality healthcare was a major challenge in Sierra Leone, leading to the country suffering some of the highest maternal and child mortality rates in the world. When a major outbreak strikes, overburdened health systems struggle to take care of other critical health issues, like making sure Read More >

Posted on by Regan Rickert-Hartman and Tushar Singh1 Comment