CAMBODIA : has the highest rate of rabies deaths per capita in the world, with an estimated 850 people killed every year by the virus. Although rabies is preventable if treated quickly, there are few treatment centers, and almost none of the country’s roughly four million dogs are vaccinated against the virus. As a result, a Cambodian is as likely to be killed by rabies as a citizen of Western Europe is to be killed in a traffic accident.
The ASEAN Rabies Elimination Strategy, which has been endorsed by Cambodia, aims to wipe out the disease by 2030. The Ministry of Health and Ministry of Agriculture are drafting a strategic plan to eliminate the disease, but the head of the epidemiology department and the rabies prevention clinic at the Pasteur Institute, Dr. Arnaud Tarantola, said it could take decades to eliminate canine rabies from the country.
“If you want to eliminate canine rabies, you have to vaccinate all the dogs,” he said. “And it will probably take two decades before all the dogs are routinely and regularly vaccinated in Cambodia.”
No Money, No Vaccine
Dr. Ly Sovann, head of the communicable diseases control department of the Ministry of Health, said the disproportionate number of rabies cases in Cambodia has a simple explanation: the country has too many dogs. He estimated there are roughly four million dogs in the country – one for every three humans.
The dogs are usually domesticated, not strays. More than 98 percent of Cambodians who went to the Pasteur Institute for rabies prevention after a bite for treatment for rabies said they were bitten by their dog, or a neighbor’s. If they become rabid they will often bite multiple people before they can be put down.
Despite the risk, people are often reluctant to pay to vaccinate their dogs against rabies. “People are loath to vaccinate their animals in general, and their dogs especially,” said Dr. Tarantola.
Though other countries such as the United States have laws requiring people to vaccinate dogs against rabies, Cambodia has no such law. And with little funding for vaccinations, the government cannot afford to provide free canine vaccinations.
A Race Against the Virus
With the goal of vaccinating the country’s dogs out of reach for now, attention remains focused on vaccinating people who are bitten. If treated quickly, infection by the virus is completely curable. But if left untreated, rabies is one of the most lethal infectious diseases in the world, killing within a few hours 100 percent of people who develop neurological symptoms.
There are currently just two treatment centers for rabies in the entire country, both of them in Phnom Penh. Most healthcare centers outside of Phnom Penh do not store rabies vaccines because of the high cost, and because the vaccines are rarely used. While some private medical practitioners have the vaccine, it may often be counterfeit, ill-stored, or expired.
The lack of nearby rabies treatment proved fatal for Ms. Vann, a Battambang resident, whose first name was withheld for privacy reasons. After she was nipped on the hand by her dog in late May, she went to the local doctor for treatment. The doctor was out of rabies medication, however, so she didn’t receive treatment. The bite healed quickly, and she did not return for a rabies shot.
One morning two months later, her son said she was terrified of getting in the shower. She had one of the classic symptoms of late-stage rabies – fear of water, or hydrophobia. She was transported to a Phnom Penh hospital, but it was too late: she couldn’t be treated, and died two days later.
The tragedy spurred action. After Ms. Vann’s death, her neighbors in Battambang all decided to vaccinate their dogs. “People, when they know someone who died, will tend to get vaccinated or vaccinate their dogs,” said Dr. Tarantola. “But when they don’t know someone who died [of rabies] in their immediate surroundings – and most people don’t – then the only thing you can place your hope in is a good information campaign and a change to the law.”
The government’s new strategic plan for dealing with rabies aims to prevent tragic cases like Ms. Vann’s by introducing new rules for animal vaccinations and creating more rabies treatment centers outside the capital. “We are in the final stage of drafting [the plan],” said Dr. Sovann, “and have already started implementing parts.”
Still, it may take years for the new treatment centers to be completed. Meanwhile, the government is also using an informational TV, newspaper, and radio campaign to inform citizens about the disease.
Long a neglected disease, rabies needs to be brought into the spotlight, said Dr. Sovann. “As the number of HIV-AIDs and tuberculosis cases are down, there should be more attention to neglected diseases, such as rabies,” he said. “People need to work together to eliminate the disease in animals and humans.”