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A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Wed 11 Mar 2009
Source: ReliefWeb [edited]
One of the most severe rabies epidemics to hit Angola has claimed the
lives of at least 93 children within 3 months in the capital, Luanda.
"The 93 children were brought to our hospital and are the only ones
we know of, so the number could be higher," said Luis Bernardino,
head of the Hospital Pediatrico David Bernardino in Luanda, the
country's largest referral hospital. "The number of cases has,
however, started declining now." He said the hospital was unable to
save any of the children, as it had run out of doses of rabies
vaccine; in some instances, the children were brought in too late.
"It is a sad moment for us," said Bernardino.
Francois Meslin, the rabies expert at the World Health Organisation
(WHO) headquarters in Geneva, said in the last severe rabies
outbreak, from 1998 to 2003 in Indonesia's Flores Island, 100 people
had died within a year. "The high number of deaths in Luanda within
the short period of time is a cause for serious concern and calls for
a thorough investigation."
Rabies is an incurable viral disease transmitted by close contact
with saliva from infected animals, usually canines or rodents. It can
be prevented by vaccination, either pre-exposure or as part of
post-exposure treatment. However, once the symptoms of the disease
develop, it is fatal in both animals and humans.
Post-exposure treatment comprises 5 doses of the vaccine and has to
start "as soon as possible" to prevent the symptoms from developing,
Meslin said. The disease attacks the respiratory, gastrointestinal
and/or central nervous systems, leading to paralysis followed by coma
and death in all cases, usually due to respiratory failure.
Luanda's large stray dog population has been identified as causing
the spread of the disease. "We have had some sporadic cases in other
provincial capitals in the country; we think the virus was brought
into Luanda and then spread through the dogs; Angolans love dogs,"
said Bernardino.
The capital was built to accommodate around 400 000 people but now
has a population of more than 4.5 million, most of whom live in
unhygienic conditions in "musseques" or slums.
The outbreak has raised concerns over the slow reaction of the
Angolan authorities. "When the 1st 10 deaths were reported in
December 2008, we alerted the authorities, but we do not have
veterinary services in the city, no kennels [to keep and observe the
animals] and vaccinate them," said Bernardino. There were also not
enough vaccines available. "I think it was probably that no one was
prepared for such a high case load," he said. A vaccination campaign
is underway. "We now also have enough vaccines in stock. The cases
have started dropping now; we have 12 cases in one week, it dropped
to 4 cases, and this week, it is down to 3," Bernardino told IRIN.
Developing countries are often unable to afford rabies treatment,
which is prohibitively expensive, said Melvin. "One dose costs about
USD 10, and 5 of those have to be administered, which makes the total
cost of treatment USD 50, which is more than what a family can earn
in a month in most developing countries." Besides the vaccine, "in
instances where the person has been heavily exposed, with multiple
bites in the head," that person also has to be given rabies
immunoglobulin to prevent death, which can cost another USD 50. "The
treatment can be a huge drain on public health services, especially
in countries where the vaccines are given free."
Melvin said there was a global shortage of the vaccines. "As there
are few registered manufacturers who meet the WHO guidelines, the
supply cannot keep up with the demand." At least 55 000 people die
from rabies every year in Asia and Africa; most of the victims are children.
[This article does not necessarily reflect the views of the United
Nations or its agencies.]
Communicated by:
ProMED-mail Rapporteur Brent Barrett
[The number of child deaths in this rabies outbreak in Luanda, the
capital city of Angola, has risen from 63 on 18 Feb 2009 to at least
93 known child deaths on 10 Mar 2009. The number of adult deaths is
not reported. The outbreak is now thought to be in decline, as judged
by the number of children admitted to the main referral hospital per
week. Unfortunately, none of the children admitted to hospital has
been saved due to the lack of vaccine and immunoglobulin for
post-exposure treatment, in part due to the global shortage of
vaccine and its high cost. Control of the urban dog population
remains unresolved due to the absence of appropriate veterinary
services, although adequate supplies of canine vaccine are said to be
available. Until progress is achieved in control of the dog
population, it is unlikely that there will be an early end to this outbreak.
The HealthMap/ProMED-mail interactive map of Angola showing the
location of Luanda in the north of the country can be accessed at:
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