Rabies – another threat from the north

Dogs, and not wild animals, are now the main reservoirs of this deadly infectious disease.

By JUDY SIEGEL-ITZKOVICH
scary dog 311 (photo credit: (Frank Rivera/The Orlando Sentinel/MCT).)
scary dog 311
(photo credit: (Frank Rivera/The Orlando Sentinel/MCT).)
There have been no Israeli deaths from rabies in the past 40 years, except for three tragic cases in 1996 that included an IDF soldier who was bitten by some creature while asleep in his tent, but those in charge – apparently believing it to be a “harmless rodent” – did not get him vaccinated.
The incurable viral disease, which annually causes the horribly painful death of some 55,000 people in Asia and Africa, makes Israel’s health authorities nervous. (Only one American who was bitten by a rabid bat reportedly survived.) The Agriculture Ministry’s rabies detection lab at the Kimron Veterinary Institute in Beit Dagan is open round the clock, 365 days a year, to examine suspected animals for the virus and perform DNA testing to determine the strain. Since 1996, it has used light planes to drop bait infused with oral vaccine to prevent the spread of rabies among wild animals in the north. And the Health Ministry spends as much as NIS 6,500 per person to vaccinate those bitten or even just scratched by mammals suspected of being infected; in many cases, the animal was never found and tested. The five shots used to be injected painfully into the abdomen, but today only four are given into the upper arm.
The disease is endemic to this area, and especially difficult to cope with because borders that keep human infiltrators and tanks from crossing allow infected animals to pass through. In addition, Israel is not able to consult with the governments of Syria and Lebanon – the main initial sources of infected animals – on whether they have effective anti-rabies policies.
There is not much coordination even with Jordan, with which there is a peace agreement. The World Health Organization only publishes statistics from each country on the number of human and animal cases there are each year; it does not pass information between neighboring countries that are at war or do not have diplomatic relations.
BUT THERE have been changes in recent years, according to a report by Dr. Dan David, head of the rabies lab. Urban rabies was common here between 1930 and 1960. When vaccinating and licensing one’s dog became mandatory and jackals were widely poisoned in the Sixties, this disappeared. In the Seventies, the fox became the main vector for rabies.
But since 2004, the authorities have realized that while they had wiped out the virus in wild animals thanks to the bait, they were facing a new enemy – the V7 strain, which originates in Turkey and affects mostly dogs reaching northern Israel from neighboring countries. This form of the disease has not yet infected wild animals, David wrote. Thus, clearly, the oral vaccine in bait is not enough to prevent rabies among mammals in this country.
SINCE JANUARY 2010, 38 animals have been found to be rabid. Of these, 18 were dogs, and the rest jackals, cows, sheep and one cat, fox and wolf. Safed, the Golan Heights, Afula and Beit Shean were the most frequent locations, but the disease appears to be slowly moving southwards. Other animals found to be rabid in recent years include horses, badgers, mongooses, goats and martens.
Among the dogs, one was a pet whose owners had documents showing he had been vaccinated four times; either his immune system was not affected by the shots, the vaccine was outdated (as the Health Ministry suggests), or the dog had not really been vaccinated – the view of some private veterinarians.
A number of private vets The Jerusalem Post spoke to on condition of anonymity said they were not happy with the Agriculture Ministry’s vaccine distribution system. This “bureaucratic and monopolistic system,” they claimed, results in some animals falling between the chairs.
“We don’t believe a pet dog vaccinated four times will have no sign of anti-rabies antibodies in its blood because each time the vet used ‘outdated’ vaccine,” they argued. “Why should anyone have to use such outdated vaccine? If the system is set up in such a way that a vet does not have enough current vaccine, there is a problem in the system that led this dog to die and put humans at risk.”
The private vets argue that the law requires them to submit a paid dog license for each dose of vaccine they get from the municipality. “Theoretically, in large cities like Jerusalem, there is a form that can be paid at the post office and given to the vet; he takes a fee for giving the injection.”
Dogs have to be vaccinated annually from the age of three months. The municipality or local council requires prepayment of NIS 137.50 if the animal has not been neutered or spayed, and NIS 48 if it has.
There is also a fee for the one-time insertion of a computer chip under the animal’s skin whose data can be accessed via electronic readers in vets’ and government offices that serves as the dog’s ID, carrying its vaccination history for the rest of its life.
“In reality, most municipalities do not have the post-office collection system in place, and a privatepractice vet must serve as a tax collector before he can vaccinate or he will not be able to obtain vaccine for future use,” the private vets maintain. Even in the capital, they argue, most dog owners do not pay at the post office first.
“Young dogs receiving their first vaccine do not have any form from the municipality, since the city had no reason to send them a renewal form,” the private vets said.
“Therefore, we provide the form, must collect the fee, pay it for the dog’s owner at the post office and send them the license if we want to obtain another dose of vaccine from the municipality. Making the license fee a prerequisite to vaccinate minimizes the number of animals vaccinated. It also often creates a situation whereby vets will not have sufficient vaccine.” They suggest that the governmental authorities fear losing some revenue by working as they do, but in doing so “they are putting the populace at risk.”
As each municipality provides vaccine for dogs in its area (pet cats do not have to be licensed, but some municipalities encourage owners to vaccinate their felines), a vet operating in Jerusalem, for example, will likely have to go to as many as 10 municipalities to cover all the areas from which customers come and make an appointment with the city vet to obtain vaccines. These localities can include Efrat, Gush Etzion, Mateh Yehuda (Ora and Aminadav), Mevasseret Zion, Mateh Binyamin (Adam and Kochav Ya’acov), Ma’aleh Adumim, Betar, Kiryat Arba or the Jordan Valley.
THE RED TAPE clearly restricts vets from doing what they should be doing – preventing disease, the animal doctors argue, and can lead to some animals being left unvaccinated even though they are registered as having gotten their shots. If the Agriculture Ministry were to allow vets to obtain vaccine privately from any any licensed distributor, as they do with all other veterinary biologics, the process would be much more efficient, they concluded. This is the system used in the US and other Western countries, where it seems to work well.
Competition also reduces the price of vaccination to the animal-owning public, and therefore maximizes the number of animals vaccinated.
But Dr. Deganit Ben Dov, the Agriculture Ministry official in charge of enforcing the Cruelty to Animal Law who was the person chosen to respond to The Post’s queries on rabies, said she was “unaware of any bureaucratic problem or difficulty in the private vets getting the vaccine they need. We do not have a shortage; we have reserves. If they are willing to file complaints, I will look into them. We chose the system of municipalities providing the vaccine to promote our supervision and to encourage dog owners to license their pets,” she said.
Ben Dov, a trained veterinarian, said rabies cases among mammals “come in waves. Sometimes the number rises, and sometimes it falls. We were successful using oral vaccines in bait to eliminate rabies in wild animals – and we will not stop. As for wandering dogs, we are working to fight this problem as well. The fact that there is a new strain doesn’t concern us, as our vaccine is good against all the strains.” But the only way to combat the current strain, whose reservoir is dogs – which the oral vaccine does not reach – is to vaccinate the maximum number of canines. Making the license fee a prerequisite for vaccination results in too many dogs not being vaccinated, the private vets insist.
The Agriculture Ministry official noted that rabies is found almost everywhere, “except for islands like Britain or near islands like Italy. It was even mentioned in the Babylonian Talmud. We have to keep our finger on the pulse.” Over 400,000 pet dogs are registered with the municipalities, but 180,000 are vaccinated each year, Ben Dov reported. “We don’t know how many of these have died. Some municipalities don’t have the funding or manpower to keep track of dogs they previously licensed. But we do believe most pet dogs are vaccinated annually.” If her ministry had an unlimited budget for dealing with rabies, she said, “I would do more education of the public.”
PROF. ITAMAR GROTTO, the Health Ministry’s chief of public health, told The Post that dogs are today the main reservoir for rabies in the north. “We are concerned about the higher numbers. We fear that some people who are exposed to rabid animals might not go to the nearest district health office in time for examination and, if necessary, vaccination,” he said.
Neither the Health nor Agriculture Ministries has placed public service announcements on TV or radio.
“We don’t have the budget,” he explained. “We send lecturers to schools in the north to explain the danger of rabies and warn children not to touch unfamiliar animals. Soldiers also hear about rabies,” Grotto said.
But he conceded that more could be done, especially due to the fact that people from around the country – and foreign tourists – visit the north and may not be informed about the danger.
“The Agriculture Ministry deals with the animals, while we handle people who have been exposed.
Officials meet often on technical matters,” but they have not produced a comprehensive national information campaign against rabies. As for the possibility of using the media’s health reporters for free publicity about the problem, Grotto conceded that this was not considered, “although I answer all questions when I am asked.”
This article was initiated by The Post and not by the government ministries.