Thousands of Yemenis exposed to rabies due to stray dogs [Archives:2007/1114/Health]

Hamed Thabet
Five thousand people in Yemen received rabies through being bitten by stray dogs this year, said experts.

Ahmed Al-Wared, director of the National Program for the Eradication of Rabies, confirmed that “the number of deaths every year are 30, and it is increasing.” He noted that there are about a million dogs in Yemen, and only 10-20% of these are owned, while the rest are stray dogs.

Dr. Ahmed Al-Muthna, coordinator for the rabies disease program, noted, “All of the 965 rabies patients that we have in Ibb are men.” He added, “Rabies has spread in many governorates, like Ibb, Jibla, Yarim and Al-Qaed'a. The reason behind this is that dogs are attracted to the trash found near butcher shops in these governorates, which are not often hygienic.”

To date, only 2,000 dogs out of one million have been caught and destroyed. According to Al-Muthna, “There is a program in order to destroy these dogs. And the most important part of the program was a campaign in these areas to distribute vaccines for rabies.”

The Ministry of Health provides 100 doses for the center every month, but in fact, Al-Muthna stated, “100 doses are not enough, as the center provides more than 240 doses and the price of each dose is $15.”

In the current year there were 4 deaths due to rabies in Al-Faqer governorate. Consequently, the Ministry of Health immediately asked to form a special anti-rabies committee there.

Dr. Abud Al-Kahim Al-Kohlani, the Director General of contagious diseases and epidemical observation, stated to the press that “there must be cooperation between the Ministry of Health and the Ministry of Agriculture in order to limit the numbers of dogs which are causing death for hundreds of residents.” He also explained that there should be a special plan for the eradication of rabies and the annihilation of all stray dogs in Yemen.

Patients should theoretically receive five free injection doses over the course of seven to 28 days. “However, we only give patients three of the five injections because the hospital isn't able to treat all of the cases, which sometimes come to us from other governorates. In this case, patients must buy the two extra injections, which costs a lot,” confirmed Dr. Abdul Jabar Al-Muhia of the Yemeni-Swedish Hospital's anti-rabies unit in Taiz.

There were also reports of rabies cases in the governorate of Taiz. However, these numbers, based on medical sources at anti-rabies units, may not reflect actual statistics, as many patients living in remote areas aren't able to reach such units to receive medication.

In case treatment cannot be obtained, Al-Muhia explained first- aid measures that can be taken: “The wound should be treated by cleansing with hot water, an antiseptic solution like iodine and a sterile dressing.” However, he insisted that “the patient must be given the daily vaccine injection course according to a doctor's schedule, as rabies is always fatal if the vaccine isn't administered.”

Rabies is a virus that is usually transmitted by a bite from a wild infected animal, such as a bat, raccoon, skunk, or fox. If a rabid animal bite goes untreated, an infection can develop and lead to brain damage or even death.

An infected animal carries the rabies virus in its saliva and can transmit it to a person through biting. In rarer cases, an animal can spread the virus when its saliva comes in contact with a person's mucous membranes (moist skin surfaces, like the mouth or inner eyelids) or broken skin such as a cut, scratch, bruise, or open wound. After a bite, the rabies virus can spread into the person's surrounding muscle, and then travel up a nearby nerve to the brain. Once the virus infects the brain, it can cause severe, possibly permanent injury.

Dr. Al-Muhia described rabies symptoms, noting that, “There also may be a tingling or twitching sensation around the area of the animal bite, which is one of the most specific rabies symptoms at this stage of infection.”

After this initial period, a second stage begins with symptoms similar to those of encephalitis (inflammation of the brain). There may be fever as high as 40.6 degrees Celsius (105 degrees Fahrenheit) with any of the following symptoms: irritability, aggressiveness, confusion, hallucinations, bizarre or abnormal thoughts, excessive movement or agitation, muscle spasms, abnormal posture, seizure (convulsions), weakness or paralysis (the person can't move some part of the body), extreme sensitivity to bright light, sound or touch and increased tears or saliva production.

Patients are extremely thirsty but experience spasms of the larynx when water is presented or even mentioned, hence the disease's original name, hydrophobia [Greek hydro = water, phobos = fear]. There also may be an inability to speak as the vocal cords become paralyzed.

The individual infected with rabies can slip into a coma and stop breathing. Without life support measures, death usually follows within four to 20 days after the onset of symptoms.
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