Human Rabies is a global public health concern for up to sixty thousand cases per year, of which the majority occur on the continent. Africa contributes to the greatest number of Rabies cases. Despite being vaccine-preventable, around 21,500 dog-mediated rabies deaths are reported from the continent each year. Rabies is one of the twenty neglected tropical diseases (NTD) prioritised by the World Health Organization (WHO) for elimination by 2030. It is caused by infection with the rabies virus (RABV) and other lyssa viruses causing progressive and fatal inflammation of the central nervous system. Clinically, 80% of the victims present with furious rabies where they exhibit hyperactivity, spasms, hydrophobia and die within a few days, while 20% present with paralytic rabies characterised by gradual paralysis of muscles followed by coma and death. The latter is often misdiagnosed. Rabies is a hundred percent fatal once symptoms develop however, if proper medical treatment (post-exposure prophylaxis, PEP) is received immediately after exposure to the bite or scratch of a rabid animal, rabies infection can be halted before symptoms of the disease are present, and the disease can be prevented. In Africa, like most other rabies endemic regions, the domestic dog is the principal reservoir host responsible for transmitting rabies to humans in 99% cases through bites or scratches. The Rabies Virus can infect a wide range of mammal species and bats. Rabies imposes a devastating human, social and economic burden predominantly among the most vulnerable and marginalised populations. Around 40% of cases are attributable to children under 15years of age. The Rwanda Biomedical Center (RBC) and the Rwanda Agriculture and Animal Resources Development Board are responsible for coordinating activities related to Rabies. Rwanda is described among the countries with no information in 2017 indicating that the data on the disease are less captured. Not much data on dog bites is available but Nyagatare District Hospital recorded 421 cases of dog bites from January 2017 to December 2019. A research study conducted in Nyagatare district in 2023 reported that dog bites require significant attention, with regular awareness campaigns on rabies epidemiology, prevention, infection routes, and post-exposure behaviours. Effective rabies management involves interdisciplinary teamwork among veterinarians, environmental experts, and public health professionals. Special focus should be given to rural areas where people often delay seeking post-exposure prophylaxis (PEP). Public health officers must ensure PEP availability and promote health insurance to facilitate timely medical consultation. Involving local leaders in raising awareness and encouraging timely payment of health insurance is crucial for improving access to health services after dog bites. Pre-exposure rabies immunisation is recommended for people in high-risk occupations, such as laboratory workers handling rabies viruses and animal disease control staff, as well as those in contact with potentially infected mammals like bats and carnivores. It is also advised for travellers to rabies-affected, remote areas who plan to engage in outdoor activities, as well as visitors and long-term travellers where access to rabies treatment is limited. Children in high-risk areas should also be immunised, as they may be more vulnerable to severe bites and less likely to report them. Post-exposure prophylaxis (PEP) is critical for preventing rabies after exposure, as it stops the virus from entering the central nervous system. PEP involves thorough wound washing for at least 15 minutes, a course of WHO-approved rabies vaccines, and rabies immunoglobulin (RIG) if needed. PEP is recommended based on the severity of contact with a suspected rabid animal, ranging from no treatment for minor contact to immediate vaccination and RIG for severe bites. Rabies risk increases if the animal is a known rabies carrier, the bite was unprovoked, or the animal’s vaccination status is unknown. Preventing rabies, though it is a vaccine-preventable disease, requires a multi-sectoral approach involving community awareness, collaboration, and responsible practices. Key prevention measures include regular veterinary visits to ensure up-to-date rabies vaccinations for all dogs and cats. Communities should keep their pets under control, preferably indoors, and supervise dogs when outdoors. It's important to report stray animals to veterinarians, police, or local leaders to reduce the risk of unvaccinated or ill animals. In case of a dog bite, the wound should be washed with soap and clean water for 15 minutes, followed by an immediate visit to the nearest health facility for vaccination and medical care. The incident should also be reported to a veterinarian for dog isolation to prevent further transmission.
