Sharon is a brave nine-year-old Japanese spitz due for her annual rabies vaccination. Dr Joseph Mugachia administers the precautionary injection on her—a shot that is not only lifesaving for Sharon but one that also holds the key to elimination of rabies, a neglected disease responsible for about 2,000 deaths annually. Nonetheless, the number of Kenyans dying yearly from rabies could be under-reported.
Responsible dog ownership is not widely practised in Kenya, courting spread of rabies to humans through scratches and bites.
Ironically, despite being an animal specialist and enthusiast, Dr Mugachia has not been spared dog bites. Not once, not twice, but thrice he has been bitten during his two-decade long line of duty, with the most recent bite having happened last April.
“During a campaign in Meru, I was vaccinating one of the loosely handled dogs when it became irritated by the injection and charged at me. It reached for my hand and held onto it firmly between its canines.”
Dr Mugachia recalls not only the excruciating pain but also the fact that the dog exposed him to deadly rabies.
Aware of this, his colleagues immediately administered first aid on him, after which he was given post-exposure treatment to prevent the transmission of rabies.
Mugachia acknowledges that veterinarians are often exposed to body fluids from dogs like saliva that could also contain infections detrimental to a person’s health.
“All people handling animals should have updated records of vaccination, especially against rabies,” he says.
So what triggered his interests in the field? Growing up in a farm in Murang’a decades ago, Mugachia always knew he wanted to take care of animals.
Discreetly and from the safe confines of their homestead littered with cows, goats, sheep, cats, dogs and other domestic animals, young Mugachia would keenly watch the veterinary doctor treat the animals whenever their vaccines were due or illness set in.
Today, he is a veterinary doctor— passionate about the health of animals and therefore keen to create awareness on responsible dog ownership. But he has not been spared the risks that come with a job that involves interacting with animals both in the field and at Garden Veterinary Clinic situated along Kiambu Road.
On this chilly day, the doctor is taking care of Jack, Titan, Alpha, Foxy, Spot and Milley — all dogs admitted for treatment and care at his clinic. In case of a dog bite or scratch, Mugachia reiterates the importance of immediate first aid, which involves wound cleansing and vaccination within a few hours after contact with an animal suspected to have rabies.
“Running water and soap to clean the bite is the first step to keeping rabies at bay before getting the required anti-exposure treatment,” Dr Mugachia says.
Dr Thumbi Mwangi of Washington State University echoes these sentiments. He says responsible dog ownership is key—owners must vaccinate their dogs and educate their children who are fond of dogs.
He said the launch of the National Rabies Elimination Coordination team last Friday would kick off a national discussion on rabies elimination.
And with an estimated dog population of about five million dogs in Kenya, the implementation of the national rabies strategy can be achieved by reaching only 70 per cent of the dog population (3.5 million) annually for three years to stop rabies in dogs altogether, and consequently keep the disease away from people.
“Rabies death is cruel, devastating to family members but preventable,” says Dr Mwangi, who is also a Wellcome Trust Fellow at the Kenya Medical Research Centre and a 2016 Aspen New Voices Fellow.
According to Mugachia, tips to prevent dog bites include keeping children and adults away from unsupervised dogs and treating dogs with respect.
He acknowledges that the greatest burden of this neglected disease is found in rural areas.
He is quick to add that animals can act unpredictably and bites are not always provoked. However, an animal is more likely to bite if it is disturbed, feels threatened or gets overexcited.
The World Health Organisation (WHO) says that treatment after exposure to suspected rabies exposure is an emergency and should not be delayed or deferred.
The global health body also indicates that wounds should be washed or flushed and disinfected immediately. The initiation of post-exposure treatment should not await the results of laboratory diagnosis or be delayed by dog observation when rabies is suspected.
Pre-exposure vaccination should be given to groups of persons at high risk of exposure to the live rabies virus. These include laboratory staff, veterinarians, animal handlers and wildlife officers. Children in highly endemic areas may be considered if vaccine quantities are adequate.
The key is vaccinating enough dogs to shut down the spread of the virus since 99 per cent of human rabies infections are from dog bites. Awareness on prevention of rabies needs to be fast-tracked, especially in rural areas in order to reduce incidences of people (mostly children) bitten by dogs.
The first rabies outbreak in Kenya was in a dog in 1912 in the outskirts of Nairobi, and the first case of human rabies was documented in a woman from the Lake Victoria basin in 1928.
But what exactly is rabies? According to Dr Mwangi, rabies is a viral disease transmitted from animal to humans.
It is known to cause death in persons who develop the symptoms, with the virus contracted through wounds arising from scratches or bites from an infected animal.
Once inside the body, the virus travels to the nerves and finds its way to the brain while multiplying in numbers, where it inflames the brain and spinal cord, at which time the clinical signs become visible before death.
WHO rates rabies as a preventable disease mostly affecting children, with four out of every 10 deaths by rabies being a child under the age of 15. Globally, only one person has survived rabies through miraculous medical procedures that included inducing a coma, with the victim having to relearn everything — from talking to walking.
The condition virtually kills all its victims who get the clinical disease, making it a dangerous disease that remains largely misunderstood. The general public loosely refers to it as the ‘mad dog’ disease due to the aggression portrayed in infected dogs.
Mugachia counts himself lucky to have survived; but the lives of Kenyans every year are at stake if the national rabies elimination strategies are not taken seriously, Mwangi warns.