19th December 1999

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Even pups can get rabies

Dr. Harischandra said that even very young puppies could get rabies. But present veterinary practice is to administer the anti-rabies at three-four months of age.

"We have had reports of rabies in six week pups. I firmly believe that the first vaccination given to a puppy must be the anti-rabies. The Parvo and DHL can follow.

"Rabies is a killed vaccine and the danger to the animal is very little," he said.

Puppy rabies is serious because most people ignore a pup bite or scratch. It can infect children much more easily.

The booster vaccination should be given in three months and thereon every year, Dr. Harischandra said.

A dogging problem

Despite efforts to eliminate rabies the number of human deaths has increased

By Tharuka Dissanaike

Despite a long running control programme, the incidence of rabies in the country is still high.

From a relative low of 79 human deaths last year, this year's figure hovers in the region of 100. These are just the reported cases. Experts agree that there may be more rabies deaths in the provinces unaccounted for and unrecorded.

A staggering Rs. 75 million a year is spent on procuring the tissue-culture vaccine for human use. The number of doses has increased from 253,000 in 1995 to 400,000 in 1998 and is likely to keep escalating. In addition to the tissue culture vaccine, the anti-rabies serum for human use also has to be bought abroad at a cost averaging some Rs. 15 million annually. Due to the exchange difference of the dollar against the rupee, the price paid for the vaccination increases even further.

This tremendous cost in protecting humans against the fatal disease has shown very marginal results. In recent years the highest incidence of human rabies was in 1973 where records show 377 deaths. Ever since it has hovered in the 100-150 range, dipping below that average in 1993 with 93 deaths and then again in 1997. Over 40 per cent of the victims are children.

An ever-increasing stray dog population appears to be the main problem. Of an estimated dog population of 2.2 million almost half are stray or semi-stray dogs that live in marketplaces, institutions and places of worship.

With urbanisation and the proliferation of shops, markets and garbage, the control of strays has become virtually impossible. The Colombo Municipal Council spends huge amounts of money in attempting to eliminate strays from the streets and public places, but has found little support or success in the venture.

"You can take away all the stray dogs in a marketplace and within a week there will be a new population," said Dr. Harischandra, Director of the Health Ministry's Rabies Control Programme.

The Programme distributes 600,000 doses of anti-rabies vaccine for dogs and destroys 100,000 rabid or rabies-suspected canines every year. While the Health Ministry spends some Rs. 13-14 million in procuring the vaccine and a similar cost is borne by the provincial health ministries in dispensing it, the vaccine hardly covers one third of the estimated canine population.

"This is a serious drawback," Dr. Harischandra admits. "Despite almost Rs. 30 million spent, a majority of domestic dogs are not vaccinated during the yearly campaigns."

Dr. Harischandra has developed a master plan for rabies control, setting himself an unenviable task of eradicating rabies by 2010. But serious impediments lie in the way.

Lack of staff and dedication by the provincial health authorities is styming efforts made by the national campaign. A sour point when it comes to devolving health services appears to be the difficulty in coordinating Health Ministry-based campaigns with each province's health authorities, all of which have different budget priorities.

Each district has teams numbering 10-12 on the control programme. Eight people make up the vaccination team that goes down to community level with the vaccine every year. The entire Uva province, covering a large land area has just eight people to conduct vaccination campaigns. Due to the impossible logistics, the vaccine is distributed once in two years in the Uva and Sabaragamuwa Provinces.

"Provincial Councils still have to realize the importance of controlling rabies, to allocate more staff and resources to the control programme," Dr.Harischandra said.

A bigger impediment is that the programme has never successfully been able to immunize strays.

"Stray dogs are the real reservoir for the disease. We have developed several methods of vaccinating strays, but they are yet at experimental stage," said Dr. Harischandra.

One such method is the anti-rabies biscuit. The biscuit is used in place of the vaccination. Although not as effective- as it depends on how much of the biscuit is consumed- it provides some protection for dogs that have not been immunized. Strays and animals that are not brought for the vaccination campaigns are the main target market for the biscuit.

The auto plunger, an auto vaccinator that can be operated from a distance, is now being tested out on community-held animals like those in temple premises and market places. This instrument was developed by a Sri Lankan inventor to be used on larger domestic animals like cattle or buffalo, but on Dr. Harischandra's request the plunger has been modified to immunize dogs.

"I hope to vaccinate dogs hanging around in temples and schools all over the country by end next year," he said.

Dr. Harischandra said that cleaner cities would naturally discourage strays for lack of forage. People must be aware of the dangers of harbouring and encouraging strays in public places, eg. feeding them.

On average ten dogs' heads are brought to the Medical Research Institute at Borella for rabies testing daily. This is the only specialised institute in the entire country that can carry out testing for disease.

For years Dr. Omala Wimalarathne, Consultant Virologist and Head of the Department for Rabies Diagnosis and Research at the MRI has tried to encourage decentralised rabies testing.

"We do not get samples from faraway provinces. Which means that most cases of dog or human rabies in the North, East and North Central Provinces go unrecorded."

Again, setting up rabies labs at provincial level has not elicited much enthusiasm from the health authorities of each area. "Rabies testing is very specialised and cannot be done in an ordinary lab because of its highly infectious nature.

"We have trained people from the major outstation hospitals, but there has to be some commitment by the authorities to set up testing facilities," said Dr. Wimalarathne.

Meanwhile to cut down on the enormous cost of the anti-rabies vaccine and serum for human use, the MRI has introduced the 'intradermal schedule' in 22 hospitals across the country. With this method each vial of the vaccine can be used on many patients rather than the single dose administration used earlier.

"Because we introduced the intradermal schedule, there has been no shortage of serum or vaccine at the National Hospital and the Lady Ridgeway Hospital last year," he said. Despite the increase in the numbers seeking rabies treatment, largely attributed to media publicity and better awareness on how to avoid the fatal disease, the number of human deaths has not considerably declined.

"Many of Sri Lanka's health indices compare favourably with those in developed Western countries. But where rabies deaths are concerned we are still far behind," Dr. Harischandra lamented.

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