How to eradicate canine rabies: a perspective of historical efforts.

September 28, 2011 will mark the fifth annual celebration of World Rabies Day, a public education event declared by the Alliance for Rabies Control in 2007. This is of special concern to Asia because Asia has more confirmed rabies cases and human rabies deaths than all the rest of the world combined [1]. Formed in 2007, the Alliance for Rabies Control is a non-profit organization dedicated to the proposition that canine rabies, in particular, can be eradicated through the same sort of concentrated effort that eradicated smallpox in 1980, after a 22-year effort led by the World Health Organization [2, 3]. The World Health Organization has hoped for decades to eradicate rabies in the same manner as smallpox, but as an entity working closely with national governments, it has had constrained ability to do the advocacy work undertaken by the Alliance for Rabies Control, which primarily represents concerned individual scientists. The Alliance for Rabies Control hopes to encourage repetition of the international co peration and attention to targeted high-volume vaccination, which between 1975 and 1980, brought the international anti-smallpox campaign to a successful close in only six years, following 16 years of sporadic gains and losses. The occurrence and nature of these setbacks include lessons applicable to advancing the eradication of canine rabies. Though the numbers of human rabies cases are disputed, with estimates widely varying by source, India is generally recognized as leading the world in canine rabies cases and human rabies deaths, followed (not necessarily in order) by Bangladesh, China, Indonesia, and Pakistan. India was also historically the primary smallpox reservoir. Both, globally and in India, more smallpox cases occurred in 1974, the 16th year of the WHO-led smallpox eradication drive, than in any year since 1951. Appearing to be headed toward ignominious failure, WHO instead learned from mistakes, restructured the anti-smallpox campaign to better emphasize educating the public and local governmens about the need to vaccinate, and in 1975 achieved a reduction in smallpox cases of more than 90%, in India and worldwide.

How not to fight a rabies epidemic: a history in Bali.

Bali, an island, should never have been afflicted with canine rabies, but in 2008 a lack of surveillance allowed the import of an unvaccinated rabid dog from Flores, a distant island where canine rabies was similarly introduced in 1997 and has since become endemic. The initial rabies outbreak on Bali occurred in a remote village at the end of an isolated peninsula, but five months elapsed before the outbreak was officially recognized. Even then, rabies had yet to escape the peninsula. However, Bali officials relied on exterminating dogs as their primary control strategy. They did not vaccinate enough dogs on the neck of the peninsula to keep the outbreak confined, they prevented nongovernmental organizations and private citizens from vaccinating dogs until approximately a year after the outbreak started, they used unreliable indigenous vaccines of only short-term potency; killed vaccinated dogs, and they repeatedly disregarded the advice of visiting rabies control experts. Two years after the outbreak started, 44,000 people had received post-exposure vaccination after suffering bites from suspected rabid dogs. The number of human rabies deaths had doubled each six months since the first death occurred.