Around the corner from the large, open pediatric hospital ward in Queen Elizabeth Central Hospital, there is a sign announcing entry into the Paediatric Research Ward, the place where I work. When I walk to the hospital, before entering the Ward itself, there is a locked storeroom. Until recently, every few years everything inside the storeroom was moved out into the hall for a few days. A hospital bed, a bench, and a mattress were moved into the room. A child was being admitted with a universally fatal disease. It was rabies. In 2015, Queen Elizabeth Central Hospital had more rabies cases than any other hospital in Africa. Though the storeroom has been pleasantly undisturbed for a couple of years, rabies came up in my life twice this week. It got me thinking about vaccine preventable illnesses and the links between veterinary and human health.
I walk to work. It takes about 25 minutes from the front door of my house to the entrance of the Paediatric Research Ward. During my commute to and from work, I listen to podcasts. When choosing what to listen to, I try to select subjects I know little about. This week one of the episodes I listened to was about rabies, specifically the Milwaukee Protocol to treat it.
As many people know, rabies is a viral infection transmitted to humans by the bite of an infected animal. During the bite, virus is inoculated into the skin. The virus migrates into nerves, slowly climbing up the nervous system to reach the brain. Until the Milwaukee Protocol, once a human developed symptoms of rabies (and there are 59,000 cases every year) they died, a 100% case fatality rate. In 2004, a 14 year old girl was admitted to a hospital in Milwaukee with rabies. Her doctors decided to try to save her. They put her on a ventilator and gave her heavy sedation. The idea was to sustain her body until it could mount an immune response to the virus, killing it off. She was in coma for several weeks but eventually the sedation and the ventilator were stopped. Several days later she began to move. Over months she mostly recovered. The case fatality rate decreased to 99.9995%. Since then, two other people have survived rabies after being treated with the Milwaukee Protocol or a variation.
Mission Rabies’ website states that if 70% of domestic animals are vaccinated in highly endemic areas, human rabies will disappear.
Though treating a disease is nice, preventing it is better yet. One of my good friends in Blantyre, Dr. Jordana Burdon Bailey, is a veterinarian. Dr. Burdon Bailey works for Mission Rabies, an NGO whose focus is animal vaccination. The organization’s aim is to eradicate human rabies by 2030. To get there, they need to vaccinate a lot of domestic animals, mainly dogs and cats. (Of course, rabies can be transmitted to humans by bites of wild animals, such as bats. But humans have much more contact with domestic animals than wild animals, thus the focus on vaccinating dogs and cats.) Jo travels through Africa (recently to Ghana and Mozambique), organizing vaccination campaigns using local personnel and volunteers. The places where she travels are often remote and her accommodation is, at times, challenging.
Saturday night, Jo and her partner had Norwegian Vets and me over to eat dinner. When they asked me to join them I, of course, wondered why she was feeding two veterans of the Norwegian Army. But no, they were veterinarians here on Mission Rabies business. The visitor who sat next to me had degrees in both human medicine (like me) and animal medicine (a vet). The conversation around the dinner table strayed in many directions but we discussed the Milwaukee Protocol, vaccines, and other possible treatment and prevention strategies for rabies. It was super interesting.
All fatal illness is terrible. But death from a vaccine preventable illness is worse. It is amazing that the world has an effective vaccine to prevent a (almost) universally fatal disease and yet deaths continue. To stop human rabies, the vaccine needs to get into the bodies that need it, domestic animals. Mission Rabies’ website states that if 70% of domestic animals are vaccinated in highly endemic areas, human rabies will disappear. I do not understand the epidemiology, but will need to trust them on that statistic.
One of the joys of living and working in Blantyre are that people here are a self-selected group. We are here because we want to be, despite it sometimes being a more challenging place to live and work than in Europe or the USA. We find our work meaningful and hopefully impactful. So, hats off to Dr. Jordana Burdon Bailey and Mission Rabies. I have renewed respect for my friend and the cause to which she is devoted.
