Effective surveillence of rabies imperative

Pakistan, a rabies-endemic country, needs to develop an effective surveillance network to assess the magnitude of the disease, health experts say.

"Every day there are about 25 to 30 new cases of dog-bites treated by the doctors at the civil hospital of Karachi [one of the city's biggest public hospitals]," Dr Naseem Salahuddin of the Infectious Diseases Society of Pakistan (IDSP) told IRIN from Pakistan's largest city of Karachi, capital of Sindh province, noting, however, nobody really knew how many cases of rabies were reported.

Among human infections rabies is believed to be the tenth most common cause of death in the world and according to the World Health Organization (WHO), once clinical symptoms have occurred, the disease is almost invariably fatal.

Asia sees the highest rabies prevalence, with about 30,000 rabies deaths annually in India alone. In Pakistan, in the absence of any accurate number of rabies deaths, a projected estimate by the IDSP working to raise awareness about infectious diseases, suggests around 2,000 to 5,000 rabies deaths per year, the world health body said.

"Dog-bites - as everyone knows here - are widely prevalent all over the country in the cities, towns and in countryside, but we do not know the exact statistics - as we don't have such a reporting mechanism. Nevertheless, it is highly prevalent in this region. We need to know the extent of the disease in our country before we can make any preventive or control programme," Salahuddin said.

According to a study by the country's National Rabies Control programme, Punjab, Sindh and the North West Frontier Province (NWFP), as well as a few districts of Naseerabad, Pishin and Jaffarabad in Balochistan, are categorised as the high-risk areas for the disease, while the occurrence of dog-bites and rabies in the federally administered northern areas (FANA),is extremely low.

The country lacks proper rabies diagnostic facilities, according to heath experts. "Besides developing such centres, we also need to train our physicians and paramedics on how to administer rabies vaccine properly," said Salahuddin, a member of WHO's international rabies experts committee for the next four years.

Although all age groups are susceptible, rabies is most common amongst children between 5-15 years. According to IDSP, since many of these exposures are never reported, it is likely that there is a high proportion of young children dying from undiagnosed rabies.

Human deaths from rabies can effectively be prevented by vaccination. However, the widely used anti-rabies nerve-tissue vaccine, produced in the country's National Institute of Health (NIH), has long been discredited by the WHO for having a high rate of adverse effects.

"We are trying to shift to WHO-approved cell-derived vaccines, for which we still need technology and infrastructure, but we hope we'll start to produce that shortly," Dr Shahid Akhtar, joint executive director at the NIH told IRIN in the capital, Islamabad.

Health experts maintain that rabies vaccines of nerve tissue origin may induce serious neurological complications. In addition, these vaccines require more injections because of inferior protective potency per dose.

Meanwhile in some areas of the country, rabies among animals has also been recorded. "Rabies has also been reported in livestock like cows, buffalos and donkeys - but as we don't have a proper veterinary system, they generally die untreated," Dr Janbaz Afridi of the Pakistan Rabies Eradication Scientific Society (PRESS) told IRIN from the northwestern city of Peshawar.

According to infectious diseases experts, besides a comprehensive surveillance network, a nationwide public awareness campaign was also needed.

"Another pressing side of the issue is the advocacy - to stop producing nerve-tissue vaccine and promote use of modern, safe and efficacious tissue-culture vaccines," Salahuddin maintained.