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Author: Rida Belgawi – Although canine rabies has been eradicated in many countries, especially in Western Europe, in Tunisia, after significant progress at the end of the last century and no rabies deaths in 2009, this deadly disease has made a comeback in recent years, causing many deaths and instilling fear in the entire population, especially at the beginning of the school year.
So far, nine people have died from attacks by rabid animals. The last case was recorded on August 15. The case involved a 19-year-old youth from Enfidha district who was scratched by a cat.
In response to the situation, a ministerial meeting was held on the 19th of this month, which decided to activate the crisis unit of the Ministry of Health and strengthen the national rabies control program. An extensive national campaign has been launched to raise awareness of the dangers of rabies, while emphasizing preventive measures and calling on cat and dog owners to vaccinate their animals. The Ministry of Agriculture has set up 190 centers to carry out a free national vaccination campaign covering the entire country.
National Rabies Control Strategy
In 1982, Tunisia launched the National Anti-Rabies Program (PNLAR), which was established by the Ministry of Health. A national committee was charged with oversight and developing control strategies. This involved three ministries, each with their own responsibilities, namely the Ministry of Health, the Ministry of Agriculture, and the Ministry of the Interior. The program has three main components:
I/ Prevention through annual vaccination campaigns,
two/ Caring for a person suspected of animal contamination
three/ Control the dog population by culling stray dogs.
This action is carried out by the municipalities. The ultimate goal of PNLAR is to preserve the health of citizens and eradicate the disease in the long term.
The Rabies Laboratory of the Pasteur Institute of Tunisia is the national reference laboratory responsible for centralizing rabies data and providing care for people who have had contact with suspected animals. Many governorates have rabies prevention and control units whose mission is to carry out vaccinations and, if necessary, provide assistance to rabies patients. The last one started a few days ago at the Kassab Hospital (La Manouba).
Despite the massive resources invested in the program, some fifty years later, rabies has not been eradicated; instead, we are witnessing a serious and dangerous increase in rabies episodes and deaths.
Control strategy gap
The current catastrophic increase in rabies deaths can be attributed to two main reasons:
1/ Relaxation and setbacks in vaccination campaign
This relaxation seems to be related to the revolution of 2011, since no cases of rabies were recorded in 2009, and the number of cases has continued to increase since then. It must be recognized that since 2011, the entire country has experienced a general relaxation of all sectors, a deterioration of all services (health, transport, education, administration, etc.), a deterioration of long-standing sectors and mechanisms, especially in cleaning and garbage removal. There are even indications that a stock of 300,000 doses of rabies vaccine was not used in 2020 and was destroyed after it expired. However, it should be remembered that 2020 was the year of the Covid-19 pandemic and we had to implement restrictions to prevent the spread of the Covid virus, which disrupted the progress of the rabies vaccination campaign.
In Tunisia, vaccination campaigns mainly affect owned animals. In fact, the Ministry of Agriculture’s services and its numerous regional representatives vaccinate cats and dogs brought in by their owners free of charge. They also visit villages and towns to vaccinate dogs.
Stray dogs are not taken care of and the only solution suggested by PNLAR is for municipalities or the National Guard to kill them. Unfortunately, these stray dogs are the main reservoir of rabies and the biggest danger to citizens. There is a 50% chance that stray dogs will be infected with rabies and the number of these dogs is increasing.
2/ The increase in the number of stray animals can be attributed to:
• Stop killing stray dogs under pressure from associations and civil society
• Dogs are abandoned by their owners, or young from new litters are placed on the streets, and the owners are unable to care for them
• Garbage is piling up and is poorly managed, with municipal services not emptying bins, which are perfect reservoirs for stray animals
• Some citizens who think they are doing the right thing provide food and water to street animals, thus encouraging them to reproduce.
It should be noted that after the revolution, people feared for their safety and started keeping dogs. This led to an increase in dog breeding, trade and even dog theft (dogs were stolen and then sold). Later, many dogs were abandoned by their owners either because they could not take care of them or because of various nuisances (barking, dirty, etc.). The development of remote monitoring and surveillance cameras, which are cheap and very practical, encouraged owners to stop keeping watchdogs. Finally, it was discovered that after a rabies campaign involving dogs, many owners tended to abandon their pets to avoid problems and trouble, thus making the situation worse.
Poor management of stray animal populations
In Tunisia, stray or street animals, cats and dogs, are so numerous that they are everywhere in town, especially near the garbage cans, that we have become accustomed to them. These abandoned animals have become part of our landscape, and no street is immune.
Citizens have even started offering food and drink to these creatures, especially during the summer months and heatwaves. Unfortunately, some people, in an effort to get rid of their own animals, which have caused them problems, or are new litter that they cannot take care of, abandon them near trash cans and garbage containers in order to have a clear conscience. Other owners dump sick animals on the street because they cannot afford veterinary bills, which in some cases are very expensive. This reprehensible and irresponsible behavior creates a serious animal cruelty problem and can have public health consequences due to an increase in diseases such as rabies.
Abandoned, abused, chased, hungry, thirsty and tired stray dogs are bound to become aggressive and suspicious of humans. Moreover, recent studies have shown a link between high temperatures and aggression in dogs (like most mammals). Heat causes stress, leading to increased heart rate, blood pressure, sweating and breathing difficulties. Heat waves also lead to increased testosterone production, which can increase aggression in stray dogs. No wonder the number of dog attacks is higher in the summer. With global warming and heat waves, the situation is likely to get worse.
To combat rabies, PNLAR has only provided for the culling of stray dogs. Apart from its barbaric and inhumane aspects, this solution has proven to be completely ineffective and a waste of time and resources. It has been increasingly condemned by civil society and large sections of the population.
The TNVR method (trap, neuter, vaccinate and release) consists of capturing stray dogs, sterilizing them, vaccinating them and releasing them (preferably at the place where they were captured, to reclaim the original territory) and has achieved good results in: However, this solution requires qualified personnel, especially those who capture and handle the animals, as well as significant material and financial resources (transportation as well as premises to treat, care for and house the animals). Certain municipalities and associations interested in animal welfare have chosen this solution. However, it still affects only a very small number of dogs. It is strongly recommended to be promoted nationwide.
Spaying and neutering a dog is a surgical procedure performed under general anesthesia by a qualified veterinarian. It is expensive, time-consuming, and can be a significant limitation to the TNVR procedure. To reduce costs, you can:
• If only males were sterilized (castrated), the presence of these sterile males in the population would necessarily limit the birth rate
• Other castration methods are used, such as chemical castration, which is performed by placing an implant under the skin. The implant can be renewed after one year when the same animal has been vaccinated.
• It is much cheaper to use castration techniques used in domestic breeding (pigs, cattle and sheep), such as crushing the testicular cord with castration forceps or using elastic bands, which subsequently cause the testicles to fall out.
The fight against rabies concerns us all
Eradicating rabies is a tedious, expensive and time-consuming task. Vaccinating animals is the only way to protect themselves. It is estimated that at least 70% of the dog population must be vaccinated to slow down the spread and eliminate it later. The control strategy adopted in Tunisia is to vaccinate animals with known owners, while stray and abandoned animals represent a danger and the main reservoir of the disease.
The fight against rabies concerns all of us and requires good management of stray dogs. Governments, administrations, local authorities, civil society and associations must mobilize to manage the stray animal population correctly and humanely. Citizens also have obligations and must refrain from putting their own animals on the street, not give food to stray animals (but can adopt them or take them to a veterinarian for treatment and sterilization) and respect good practices in household waste disposal. Owning a dog is a big responsibility and you must be aware of this before taking the risk. Getting a dog must be a well-thought-out and not impulsive decision. You must think carefully and ask yourself if you have the necessary means and time to care for the animal and meet its needs during its existence (food, veterinary care, space, etc.).
Finally, we want to use the opportunity of the start of school to educate young people about rabies, how to deal with a pack of stray dogs, and first aid measures and treatments after a rabies bite. This kind of awareness and information campaign can save lives. Fighting rabies has a price, but human life is priceless.
Rida Belgawi
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