Philip M. Kitala 1 and Stella Kiambi 2 1 University of Nairobi Dept Public Health, Pharm and Toxi 2 Ministry of Livestock Development Zoonoses Disease Unit (ZDU)

History of rabies  Rabies, an ancient disease, is well known in Kenya  1 st confirmed rabies case was in 1912 in a dog in the outskirts of Nairobi  1 st documented human rabies case was in 1928 in a woman from South Nyanza  Records kept by the Vet Dept shows that Kenya experienced rabies epidemics in early 1930s, late 1940s, and early 1950s

 Widespread deployment of an egg-adapted life virus vaccine in the 1950s and 1960s, effectively controlled rabies so that by 1973, the disease was virtually eliminated from the country  However, following an outbreak in late 1974 in Taita/Taveta, the rabies situation changed dramatically  By 1979,the disease had spread along the densely populated coastal strip and along the Tanzania border to Trans Mara, South Nyanza, and Western Kenya

 By end of 1982, rabies had spread throughout Nyanza, Western Province, Central Rift Valley, Nairobi and adjacent areas  To date rabies is more widespread and prevalent in Kenya than at any time in its history  By 1992, only 4 districts of the then 41 (10%), had no confirmed rabies cases

Epidemiology of rabies in Kenya… Figure 1: Distribution of confirmed animal rabies cases in Kenya, 2002 – March, 2013

Distribution of rabies cases by species  The domestic dog remains the principal reservoir and transmitter of rabies to both man and his other domestic animals in Kenya  From 1912 to end of May 1991, a total of 2931 animal specimens were confirmed positive with dogs accounting for 64.2% (1881)  Between , domestic dogs accounted for 63% of the 2149 animal rabies cases confirmed

 By contrast, of the 1034 animal specimens confirmed positive for rabies in the last ten years (2002-March 2013), dogs accounted for 46% of the positives and cattle 37%.  We believe this apparent decline in dog rabies prevalence is a reflection of weaknesses of the surveillance of rabies in recent years – suspected rabies in the more economically important dairy cattle are more likely to be reported by their owners relative to suspected dog rabies cases.

 Due to defective surveillance of rabies in the country these figures should only be taken as an indication of the rabies trend in the country and not a reflection of the true incidence of the disease and therefore rabies burden

Confirmed rabies cases by species in Kenya, 2002-March 2013

Rabies trend in Kenya, 2002-March 2013

 Role of wildlife in the epidemiology of rabies in Kenya remains unclear  The disease has been confirmed in the following wildlife species: Jackals Fox Mongoose (white-tailed) Hyena Genet cat Leopard Squirrel Monkey Honey badger Bat (Lagos bat virus, Shimoni bat virus)  The few wildlife rabies virus isolates so far typed have been found to be of the canid type (Africa 1b) – indicating transmission from dogs to wildlife

Human cases of animal bites  Over the last three years, a total of cases of animal-bites were documented countrywide:  Assuming a human population of 40 million people, the crude estimate of animal-bite incidence for the three years: bites / population bites / population (3.4 times) bites / population (1.1 times)  Compare with incidence estimated for Machakos 1992/1993 of 234/ population (97% by dogs) and for Tanzania in 2010 of 140/ population

Human rabies cases  Information on numbers of confirmed human rabies cases in Kenya is scanty  True incidence of human rabies deaths in Kenya is grossly underestimated  Reasons for this are many in Africa: 1) Rabies victims are often too ill to travel to hospital or die before arrival; 2) Families recognize the futility of medical treatment for rabies

3) Patients are considered to be the victims of bewitchment rather disease; 4) Clinically recognized cases at hospitals may go unreported to central authorities 5) Misdiagnosis is not uncommon

Spatial distribution of human rabies cases in Kenya, 2002-March 2013

Conclusions  The rabies burden in Kenya is likely to be substantial but its size and extent remains unknown  The domestic dog remains the principal reservoir and vector of rabies in the country  Past rabies control efforts have been ineffective  Rabies occurs over large parts of the country mainly due to a large, poorly supervised, and inadequately protected dog population by vaccination

What is lacking?  Better reporting of both rabies cases and dog bites in the country  Better communication between the veterinary and medical communities in terms of:  Outbreak reporting  Information flow  Joint vaccination programs  Budgets

 Scaled-up approach across wide regions rather than a one-off exercise Big scale interventions over long periods of time, with annual vaccination of dogs Centralized management  Commitment to a sustained budget  CAN IT BE DONE?

Vaccinated dogs (Millions)

 THANK YOU!