Eating dog meat is common in many Asian countries, but research conducted as part of the South East Asian Infectious Diseases Clinical Research Network has discovered a potentially lethal risk associated with preparing dog meat: rabies.
In research published in the PLoS Medicine, Dr Heiman Wertheim and colleagues from the National Institute of Infectious and Tropical Diseases and the National Institute of Hygiene and Epidemiology in Hanoi, Viet Nam, report on two patients admitted to hospital showing signs of rabies infection. Neither patient was thought to have been bitten by a rabid animal in the preceding months.
Rabies is a very serious – and in nearly all cases fatal – disease. It is estimated to kill over 30,000 people each year in Asia, and the number of cases in China and Viet Nam is increasing. Symptoms include agitation, severe spasms, fever, fear of water and inability to drink liquids, and eventually death. Humans are usually infected after being bitten by an infected animal such as a dog or bat.
Rabies kills about 60 000 people each year, mostly in Asia and Africa. Children are at higher risk of rabies because they often play with animals; are more likely to receive a bite to the face or neck; and may not report bites or scratches received during play. Bites from rabid dogs cause up to 99% of human rabies cases. Rabies is almost always fatal once clinical signs occur. There is currently no effective treatment for rabies after clinical signs appear. However, the disease is preventable through vaccination either before or immediately after an exposure.
Rabies caused about 17,400 deaths worldwide in 2015. More than 95% of human deaths from rabies occur in Africa and Asia. About 40% of deaths occur in children under the age of 15. Rabies is present in more than 150 countries and on all continents but Antarctica. More than 3 billion people live in regions of the world where rabies occurs. A number of countries, including Australia and Japan, as well as much of Western Europe, do not have rabies among dogs. Many Pacific islands do not have rabies at all. It is classified as a neglected tropical disease.
When the researchers investigated whether the patients had come into contact with infected animals in the preceding months, they found that both had been involved in preparing and eating animals which may have been infected. In the first patient’s case, he had prepared and eaten a dog that had been killed in a road traffic accident; rabid dogs were known to inhabit the neighbourhood. The second patient had butchered and eaten a cat that had been sick for a number of days.
In both cases seen by Dr Wertheim and colleagues, it is thought that infection occurred during the slaughtering, and not by eating the meat as the meal was shared by others who did not become infected. In Asia, it is believed that eating dog meat enhances health and longevity. It is eaten throughout the year in the second half of the lunar month, particularly in the winter months, when it is believed to increase body heat.
Existing published research outlined below reveals evidence of rabies infection to humans at the following stages of the dog meat supply chain as referenced below – dog slaughter, butchering, preparation and consumption of raw meat. Furthermore, dog capturing and handling associated with the trade also increases the risk of dog bites and scratches, given the stressful circumstances surrounding dog capture and that many of the dogs are not used to be handled. However, inadequate research has been conducted to evaluate the circumstances in which dog bite incidences occur.
- Outbreak of rabies in Ba Vi, 2007: The District Department of Animal Health (DAH) reported that up to 30% of human rabies deaths were linked to exposure to the virus during slaughter and butchery of dogs.
- Research by the National Institute of Hygiene and Epidemiology (NIHE), 2007: Of ten laboratory confirmed cases of human rabies from northern hospitals, four did not have a history of dog bite- three of these patients had prepared dog meat from sick animals prior to onset of rabies illness, and the fourth patient had not handled or prepared a dog for consumption but had eaten dog meat.
- Research by the National Institute of Hygiene and Epidemiology (NIHE), 2007- 2009: Of 23 patients with laboratory confirmed rabies between 2007 and 2009, 22% did not have any history of dog or cat bites, but they had an experience of butchering dogs or cats, or consuming their meat
- Research by the Wellcome Trust of Great Britain, 2009: Wertheim et al. Published a case study of two men who died of laboratory confirmed rabies after killing, butchering, preparing and eating rabies infected animals.
- Statement by NIHE, 2011: ‘Butchering of dogs or cats for consumption is one of the routes of rabies transmission with cause of 1.6% human rabies in recent years.
In contrast to other commercial dog meat countries, such as Vietnam, China and the Philippines, there are no cases of human rabies cases reported in published literature associated with the dog meat trade in Thailand. However, this could be because dog meat is only consumed by a minority of Thais, and the majority of Thais involved in the dog meat trade are not involved in dog slaughtering, butchery or consumption. They are, however, involved in activities associated with dog capture and transport. It is therefore suggested that further research is conducted to analyze the circumstances surrounding dog bites, focusing in dog trading ‘hot spots’ in Thailand so as to evaluate the impact of dog trading on human rabies cases in Thailand. Interestingly, research conducted in Nakhon Phanom Province (a ‘hot spot’ for the dog meat trade) revealed that people who did eat dog meat were significantly less likely to know about rabies and its transmission, than those who did not eat dog meat
Whilst there is evidence of dogs being traded and transported between provinces and internationally within and from Laos, there have been no studies in these rabies endemic countries specifically reviewing the link of rabies and the dog meat trade. Further research is required.
- Introduction of rabies to Bali, 2008 (WHO): Rabies was introduced to the south of Bali, Indonesia, in 2008, when inadequate quarantine measures allowed the import of an unvaccinated rabid dog from Flores where dogs are routinely eaten. To avoid restricting the commerce in dog meat, the Flores authorities had decided not to impose effective controls on the translocation of dogs despite the obvious human cost. Rabies has since spread from the south of the island to the north as a result of the movement of dogs to supply the demand for dog meat, and there are now no rabies-free regencies.
- The rabies burden is now increasing in Indonesia, and rabies is now present in 24 out of 33 provinces in the country, and disappointingly, even more islands have been reporting rabies outbreaks in the last decade due to movement of dogs for various reasons.
- The current outbreak of rabies in Central Java has been attributed to the trade in dogs for meat from West Java.
- The number of people seeking post-exposure treatment and human rabies cases are increasing every year in Indonesia, and are expected to continue to increase unless the geographical spread of canine rabies is controlled.
There is increasing recognition, and evidence, of the risk all stages of the dog meat trade pose to rabies transmission to humans. Transmission of rabies through contact with the meat of an infected animal has been highlighted by several studies14 15, and the slaughtering of an unvaccinated rabies reservoir species (including dogs) in endemic areas needs to be considered a category III (severe) exposure, requiring prophylaxis. Although the risks vary, these have not yet been quantified and require further research and consideration.
Rabies is almost always fatal if it is left untreated. In fact, once someone with rabies starts experiencing symptoms, they usually do not survive. This is why it is very important to seek medical attention right away following an animal bite, especially if the bite is from a wild animal. Vaccination after exposure, PEP, is highly successful in preventing the disease if administered promptly, in general within six days of infection. Begun with little or no delay, PEP is 100% effective against rabies. In the case of significant delay in administering PEP, the treatment still has a chance of success.
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