Rabies in the Democratic Republic of Congo

A study has recently been published on the extent and nature of rabies cases in the town of Kananga, in the Democratic Republic of Congo. The author, Dr. M. Nday Mwenze, is a veterinarian based in the town, and is also responsible for the NGO "Animal pour la Santé" (Animals for Health). The study provides interesting data on the nature of rabies cases in an area where the disease is endemic, yet no systematic controls are in place.

In the town of Kananga, the last campaign to vaccinate dogs against rabies took place over 16 years ago, and there are now regular human and animal cases of rabies. During the two year study, 3 human rabies cases were reported in 2008 and the number of deaths rose to 7 in 2009. The study was conducted at the SEVYMED dispensary in Kananga. It is a mixed agro-veterinary / human health dispensary, and the only one of the town's 27 health establishments responsible for the management of rabies cases. It sells rabies immune globulin and vaccine and follows up the administration of vaccine through the local hospitals. The study gathered data on both human bite victims and the animals that had bitten them. The information included the breed of animal, where it came from, whether it had bitten more than one person and what had happened to it subsequently. Data collected from human bite victims included age, sex, geographical location, details of the bite, the season when the victim was bitten, how long it took for them to receive treatment and the number of vaccine doses they received.

The results showed that men (60.3% of 146 bite cases analysed) were more likely to be bitten than women because they have less fear of dogs, and are more involved in local trade in dogs and cats for meat. Children and young people were particularly affected by bites, with 22.6% of victims aged 1-10, and 21.2% 11-20 years old. These figures corresponded to other studies, and the author of the survey attributed this to the fact that children were less aware of the risks.

An alarming 50.7% of human bite victims received no specific rabies prevention treatment, and four out of the eight people bitten by a dog who died of suspected rabies received no treatment. Only a very small proportion of people (13.7%) sought treatment immediately after they were bitten, and only around 40% sought treatment within the first week. Some bite victims only sought treatment after clinical signs of rabies appeared, and this is attributed in part to the cost of vaccine and the lack of treatment centres. Even when there was a strong suspicion that the animal that had bitten them was rabid, people were reluctant to seek treatment because of the cost of vaccine. Of the 146 bite cases analysed in the study, only 33.5% received an adequate course of vaccine. The author is convinced that a lack of awareness, education and understanding about the risks is also a major cause of bites. In summary, the study attributed the increasing or continuing? number of rabies exposures in the DR Congo to the lack of a strategic prevention programme, the lack of treatment centres, the high cost of vaccine and a lack of awareness and education among the population.

The author considers the lack of government intervention to be a serious public health risk, and has called for a national, interministerial programme of surveillance and prevention, to include the Ministry of Health (to vaccinate bite victims), the Ministry of Agriculture (to arrange preventative animal vaccination campaigns) and the Ministry of the Interior (to manage stray animals). The author also calls for a surveillance programmes to be under the responsibility of regional governments.

Contributed by Dr Nday Mwenze Clairvoyance (pictured). The article was summarised by Jane Coutts, African Outreach Officer for GARC, from an article published in September 2011 in the journal CERDAF, based in Bukavu in the DR Congo.