Rabies Virus Does Exist

We are seriously conflicted here as we do not want to provide a platform for those spreading disinformation through public word, but allowing falsities to lie out there may be detrimental to your health and the health of your companion pets. In this post, we will provide a snapshot, commentary, data, and comparison. 

Snapshot of Rabies Virus

Rabies has been proven to exist globally. 

Rabies is caused by a deadly Lyssa virus, that results in essentially 100% mortality. 

Dogs can contract rabies. In 2020, 37 dogs in the United States were confirmed to have rabies according to the Journal of American Veterinary Medicine.  

People can contract rabies. In 2021, five human rabies cases were confirmed in the United States and all died. Four occurred after direct contact with a bat and another was bitten by a dog in the Philippines.

Bats are considered the primary spreaders of rabies to humans (bat-mediated) in the United States, at this time. 

Before 1960, companion dogs were the primary source of rabies infection in humans in the United States. In other parts of the world, dog-mediated rabies is still occurring. Dog-mediated rabies simply means a dog spreads the rabies virus or is the conduit for a rabies infection in humans.  

Please follow the state and local laws regarding rabies vaccinations, medical exemptions, and leash control of dogs.   

Commentary

Frankly, we are appalled – albeit – infuriated that people are profiting by claiming that “rabies has not been proven to exist”. Rabies has been proven to exist and does exist. Rabies is a debilitating, deadly zoonotic virus that is easily transmissible between all mammals with high concentrations in wildlife like raccoons, skunks, bats, and foxes. Animals spread it through bites, scratches or saliva. It does not take much exposure to succumb to rabies infection and death from the virus. 

Do you think Dr. Jean Dodds would have voluntarily dedicated a better part of twenty years of her life to the Rabies Challenge Fund to extend the length of time between rabies vaccinations for companion dogs if she thought the virus was not real? She does not need to think rabies is real, she knows rabies is real and exists. She has witnessed and experienced it firsthand. 

Ultimately, she recognizes that the rabies vaccination laws for companion dogs have greatly reduced the number of rabies infections in countries that require it. 

Have these Western public health protocols been perfect and without some consequences? No, but they have been very effective. We have scientific evidence demonstrating that the vaccine does protect against infection and inflammation. 

Yes; Dr. Dodds believes that updated and safer vaccines against rabies need to be developed based on the latest vaccine technology. Yes; she knows adverse reactions to vaccines are documented and do occur. Yes; parents should seek a medical exemption if their companion pet is immunocompromised and if the state has a medical exemption law. Yes; she believes that the laws surrounding rabies and vaccinations need to revisited and updated in the United States. However, she knows the laws were put in place for the greater public health and the health of our beloved companion pets. 

Remember: there is the virus which causes disease and death; the vaccine;  and, the law. For some reason, the second anyone mentions the rabies or any other pathogenic virus, some others jump to adverse vaccine reactions without considering the morbidity and lethality of the virus. But, providing tips and encouragement to readers to break the law, as well as making and spreading unfounded claims that the virus does not exist is dangerous and deadly – much more so than the vaccine against rabies.  

The combination of pet vaccination, animal control programs, public health surveillance and testing, and availability of post-exposure prophylaxis (PEP) to suspected rabies cases in humans has led to a decline in the number of deaths and transmission in the United States and in several other countries. 

This post is not about the vaccine against rabies. This post is also not about adverse reactions to the vaccine. We provide links below that cover these issues. 

Dr. Karen Becker provides an excellent, descriptive account of how rabies spreads in the body and the horrifying final days that infected mammals experience. We urge you to read it and provide a link below as well. 

The Data

Our aim is to demonstrate the rabies outcomes due to preventative measures taken in the United States as compared to Ethiopia. We are not criticizing Ethiopia, as unfortunately, the country does not have the resources that more developed countries have. Plus, we have to consider the surveillance, cultural, economic, perceptional, vaccine availability, and social differences between these two countries. 

First, let’s consider rabies in humans in the United States. We have two groups: confirmed cases and suspected cases. Confirmed cases are verified using laboratory diagnostics. Rabies is a fast-moving disease; so much so that suspected cases need treatment on the day of exposure. Post-exposure prophylaxis measures are ineffective, if a patient waits too long to seek treatment. According to the Centers for Disease Control and Prevention (CDC), 60,000 Americans receive post-exposure prophylaxis each year to prevent rabies infection after being bitten or scratched by an infected or suspected infected animal. The most common source for human exposure in the United States is bats.

In 2021, five human rabies cases were confirmed in the United States and all died. Four occurred after direct contact (Minnesota, Illinois, Idaho, and Texas) with a bat and another was bitten by a dog in the Philippines. Only one sought immediate care, but was immunocompromised so treatment was ineffective. 

During 2020, 87,895 animal samples were submitted for rabies testing in the United States. 85,483 had a conclusive (positive or negative) test result. Of these, 4,479 (5.2%) tested positive for rabies. Of the total reported rabid animals, 4,090 (91.3%) involved wildlife, with raccoons (n = 1,403 [31.3%]), bats (1,400 [31.3%]), skunks (846 [18.9%]), and foxes (338 [7.5%]) representing the primary hosts confirmed with rabies. Rabid cats (288 [6.4%]), cattle (43 [1.0%]), and dogs (37 [0.8%]) accounted for 95% of rabies cases involving domestic animals in 2020. 

This is a decrease in the number of submitted samples due to the COVID-19 pandemic. 

Comparison

Confirmatory testing of rabies infection and subsequent death requires examining brains of animals. Ethiopia has one rabies testing laboratory for both animals and people at the Ethiopian Public Health Institute (previously known as Ethiopian Health and Nutrition Research Institute) in Addis Ababa, which is the country’s capital. The laboratory also housed, observed and quarantined suspected live cases. Deressa et al. performed a retrospective analysis of the outcomes for the time between 2001 and 2009.

Table 1: Clinical observation and quarantine of animals suspected of rabies from Addis Ababa and surrounding areas between 2001 and 2009 (Deressa et al.)

Species Total # Under Clinical Observation and Quarantine Animals free from rabies after 10 days of quarantine No. ( %) Positive for rabies No. (%)
Dog 20,113 18,102 (90%) 2,011 (10%)
Cat 265 125 (47%) 140 (53%)
Others (donkey, monkey, horse, cattle) 36 16 (44%) 20 (55%)
Total 20,414 18,243 (89%) 2,171 (10.63%)

Table 2: The brains of animals examined for rabies from Addis Ababa and surrounding areas between 2001 and 2009 (Deressa et al.)

Year Dog Cat Other
Brain Examined Number (%) Positive Brain Examined Number (%) Positive Brain Examined Number (%) Positive
2001 379 274 (72%) 15 11 (73%) 1 0
2002 1,259 919 (73%) 20 17 (85%) 19 14 (73.68%)
2003 400 302 (75%) 12 10 (83%) 10 5 (50%)
2004 115 102 (88.7%) 9 5 (55%) 5 3 (60%)
2005 297 237 (79.8%) 17 12 (70%) 3 2 (66%)
2006 280 193 (68.9%) 11 5 (45%) 7 5 (71.43%)
2007 240 202 (84%) 15 10 (66%) 7 3 (42.8%)
2008 67 46 (68.65%) 12 10 (83%) 10 7 (70%)
2009 224 183 (81.7%) 15 11 (73%) 11 5 (45%)
Total 3,261 2,458 (75.37%) 126 91 (72%) 73 44 (60%)

Abdella et al. ran the numbers for the time period of 2016 – 2020. 1,216 dog brains were examined and 855 (70.3%) were rabies positive. A significant change did occur. It appears that dogs and other animals were no longer quarantined at the laboratory, but sent home to quarantine. Dog owners were supposed to report the outcomes, but follow-up was poor. 

Things really have not changed over the past 20 years except for the quarantine. This is still the only rabies testing facility in the entire Ethiopian country. As a point of reference, the United States has over 130 laboratories that test for rabies in animals. 

Due to lack of rabies laboratory facilities throughout Ethiopia, the majority of dogs tested were living or found in or around Addis Ababa,  and samples were sent to the laboratory. 

There does not seem to be a requirement to bring in all suspected dog cases within this area. So, the true number of actual dogs infected with rabies in Addis Ababa could be much higher. It is estimated that up to 50% of dogs in Addis Ababa are strays, which is also a challenge.

Additional challenges – such as lack of infrastructure and money – make it impossible to require all suspected cases to be brought to the national government laboratory. 80% of Ethiopia is rural, remote and agricultural. Oftentimes, they just kill the dog if they suspect a rabies infection in order to stop the spread. 

Shooting the dog may sound inhumane. However, people know the dogs will die soon and painfully if they are truly rabid. Plus, the majority of Ethiopians have working dogs that hunt, or protect property or livestock instead of having them as companions. Livestock can be infected too with the virus, which can cause an economic hardship. In fact, 90% of dog owners in Addis Ababa are stated to have dogs specifically as guardians to protect their property. 

A study by Beyene et al. provided data on animal bite victims in three distinct districts to account for variation in lifestyle and setting in Ethiopia: Bishoftu, Lemuna-bilbilo and Yabelo. They collected data from not only the health centers in these districts, but also tracked down unregistered victims. The results from September 2013 to August 2014 found a total of 655 animal bite cases. 96.5% were from dogs and 73.6% of the dogs were suspected to be rabid.  

An estimated 2,700 humans die annually from rabies in Ethiopia. We would not be surprised if this is a conservative estimate because of the lack of reporting, surveillance, laboratories, vaccinations, infrastructure, post-exposure prophylaxis, and animal vaccinations.

Speaking of rabies vaccinations, it is estimated that only 0.5% of Ethiopian dogs are actually vaccinated in the country. The goal for achieving herd immunity is 70% vaccinations; very much higher than current reality. 

Vaccinating dogs faces additional challenges there. For context, Reta et al. looked at demographic data from the laboratory such as dog sex, ownership status, age, and vaccination status between 2008 and 2011. 50% (8/16) of vaccinated dogs that were presented tested positive for rabies infection. 73.43% (310/428) unvaccinated dogs tested positive for rabies infection. Reta and colleagues did check the vaccination records of the dogs. However, they did not note the length of time between vaccinations or the name of manufacturer. 

Why did the vaccines fail? Remember at the end of 2020, mRNA vaccines against SARS-CoV-2 (COVID-19) from Pfizer and Moderna had to be stored in very cold freezers. One of the challenges was that many pharmacies did not have them.

Reta and colleagues surmised similar problems with the rabies vaccinations in Ethiopia. The country experienced frequent power disruptions, lack of cold chain during transportation of vaccines, and lack of storage facilities in the country. Basically, vaccine mishandling and inadequate storage were the problems. They also mentioned Lagos bat virus in dogs as another reason for the occurrence of rabies in vaccinated dogs, as the current vaccines are not protective against this genotype of rabies.

Our readers also may be interested in a more natural medicine approach. In Ethiopia, practitioners are referred to as traditional healers and many Ethiopians seek their services for animal bites in lieu of conventional medicine, which is also oftentimes not easily accessible. Of course, a bite does not mean the animal is rabid. Deressa et al. noted that the highest number of fatal human cases from rabies recorded by the Ethiopian Public Health Institute were associated with herbal remedies where the majority of human rabies cases were treated by traditional healers. Additionally, some healers advised not to cross rivers and travel to health facilities in search of medical care before 40 days. According to the healers, if there is no clinical sign during this period that the dog bite cases are free of rabies, which is considered the incubation time of the virus. 

Our opinion? The treatment options for rabies provided by traditional healers first need to be scientifically proven as effective. 

Finally, Ethiopians have known that dogs are reservoirs of the rabies virus in their country and have called it “Mad Dog Disease” for hundreds of years. We do not think they are discriminating against dogs by giving the disease this label. The limited data to date has shown that rabies is uncontrolled in Ethiopia and that dogs are reservoirs. Dogs were once reservoirs in the United States as well. Now, bats, skunks and raccoons are the problem in North America. 

Links

Infectious Diseases and Vaccines; Hemopet Index Part II.

Infectious Diseases and Vaccines; Hemopet Index Part I. 

Rabies Vaccinations During the Coronavirus SARS-CoV-2 Pandemic”, Hemopet, April 6, 2020.

What Every Pet Parent Needs to Know About Rabies”, Dr. Karen Becker. 

Reta T, Teshale S, Deresa A, Ali A, Mengistu F, Sifer D, Freuling CM. Rabies in animals and humans in and around Addis Ababa, the capital city of Ethiopia: A retrospective and questionnaire based study. J Vet Med. 2014;6(6):178–186. doi: 10.5897/JVMAH2013.0256.

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