Rabies remains a costly public health threat, says Jefferson virologists

October 17, 2003

No one in this country gets rabies anymore. It's a Third World problem. Everyone vaccinates their cats and dogs and there's a safe, effective - albeit expensive - vaccine for people. Most of us hardly think about rabies at all.

Maybe we should start. Rabies, an ancient viral disease that conjures up images of mad dogs foaming at the mouth, hasn't really gone away.

"Rabies continues to be a problem, more than most people realize," says renowned virologist Hilary Koprowski, M.D., professor of microbiology and immunology and director of the Biotechnology Foundation Laboratories and the Center for Neurovirology at Jefferson Medical College of Thomas Jefferson University in Philadelphia. "People think that because there are few or no cases of human rabies in this country, there is no problem. But people are bitten all the time by dogs, cats and wild animals that are susceptible to rabies."

The death of a Virginia man in March - the first raccoon rabies-related human death - underscores Dr. Koprowski's point.

What's more, he says, rabies control costs in the U.S. are soaring, approaching $1 billion a year.

Dr. Koprowski should know. Decades ago, he helped develop a life-saving rabies vaccine that replaced the painful series of shots in the stomach that those who were exposed had to endure. The vaccine, together with an effective public health-initiated vaccination campaign for domestic cats and dogs, has reduced the cases of human rabies in this country to a trickle. Today, Dr. Koprowski remains on the forefront of rabies vaccine research.

Dr. Koprowski has organized a week-long conference on rabies at Jefferson from Monday, October 20 to Friday, October 24. Experts from across the globe will discuss topics ranging from the current situations of rabies in Europe, Asia, Africa, the Americas and Australia to advances in understanding how the rabies virus causes disease to new insights into the epidemiology of the disease.

Rabies shows up in the newspaper and magazine headlines from time to time. More than two decades ago in the late 1970s, rabies made the news when an outbreak of raccoon rabies reached epidemic proportions and began quickly moving up the East Coast from Virginia and West Virginia. A subsequent Centers for Disease Control and Prevention and United States Department of Agriculture-led mass inoculation program of wildlife (through an oral vaccine in bait) has virtually stopped the spread of raccoon rabies, and scientists hope to contain it below the Great Lakes to the north, the Appalachians to the west and from the Gulf of Mexico to the south. In fact, says Charles Rupprecht, V.M.D., Ph.D., Chief of the Rabies Section at the Centers for Disease Control and Prevention in Atlanta, who along with Dr. Koprowski and others then at the Wistar Institute in Philadelphia was instrumental in developing the raccoon vaccine, aerial and ground drops of bait-containing vaccine have just ended for the season in western Pennsylvania. It was the first licensed wildlife vaccine in the country.

Today, says Dr. Koprowski, rabid bats - both insect-eating and vampire - have emerged as a new concern. Every state but Hawaii and every province in Canada has reported rabid bats. Cryptic rabies - a condition in which a person contracts rabies while sleeping in a dwelling with a rabid bat, despite no evidence of exposure - has become a problem.

"We need to know more about how the virus is transmitted from bat to humans and about the biology of rabies," notes Brian Mahy, Ph.D., senior scientific research advisor at the National Center for Infectious Diseases at the CDC. Globally, rabies continues to threaten humans in the developing world on a much larger scale in places such as India and Southeast Asia and Africa, says Dr. Rupprecht. "There may be as many as 50,000 cases of human rabies a year in India," he says.

In Asia alone, says Dr. Koprowski, approximately 7,400,000 post-exposure rabies treatments are given annually.

The number of bites from suspect animals is probably much higher. Poor sanitary conditions, a lack of public health infrastructure and economic problems plague these areas, resulting in everything from uncontrolled, feral dog populations to out-of-date, unsafe vaccine preparations.

Dr. Koprowski notes that the current worldwide shortage of rabies antibodies, normally produced from animal blood cells, is particularly worrisome for developing nations.

Antibodies against rabies may be used in conjunction with the vaccine in cases of severe bites. Because rabies is incurable and fatal, treatment is given as soon as possible after exposure.

While controlling rabies, Dr. Koprowski says, is a "matter of vaccinating wildlife and all domestic animals," he notes that researchers "need to find out how the virus acts at the molecular level. Then we may be able to devise a drug against it." In the meantime, new research continues to look for safer, less expensive and more effective vaccines, a particular concern for developing nations.

Thomas Jefferson University

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