EPIDEMIOLOGICAL STUDIES OF CANINE RABIES IN WUKARI METROPOLIS, TARABA STATE, NIGERIA.

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PROJECT TOPIC AND MATERIAL ON EPIDEMIOLOGICAL STUDIES OF CANINE RABIES IN WUKARI METROPOLIS, TARABA STATE, NIGERIA.

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• Name: EPIDEMIOLOGICAL STUDIES OF CANINE RABIES IN WUKARI METROPOLIS, TARABA STATE, NIGERIA.
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ABSTRACT

Canine rabies is endemic and occurs throughout the year in all parts of Nigeria. A descriptive cross sectional study was designed to assess knowledge, attitude and practice of dog owners towards rabies, to check for the presence of rabies antigens in brain tissue of dogs slaughtered for human consumption and to assess rabies vaccination coverage of dogs in Wukari. Structured questionnaires were prepared and administered to 200 dog owners by face to face interview. The questionnaire sought information on demographic characteristics of the dog owners, their association with dogs, knowledge, attitude and practice of dog owners towards rabies. Associations between demographic variables and knowledge, attitude or practice scores were assessed using χ2 analysis. Also, 188 brain samples from slaughtered dogs were analysed for presence of rabies antigen using direct fluorescent antibody test. Record files and vaccination certificates of dogs presented to the State Veterinary Hospital Wukari were assessed for anti-rabies vaccination coverage. Out of the 200 dog owners, only 26(13%) knew that rabies virus can be found in nervous tissue, 121 (60.5%) were aware that rabies can be spread through the saliva of a rabid animal, but majority of respondents 172(86%) did not know the age for first vaccination of dogs against rabies. Dog owners who were civil servants were 4.8 times more likely to have good knowledge (OR=4.84, 95% CI on OR 1.09-21.44) than those of other occupation groups. Positive attitude towards rabies increased with increase in age of dog owners, with respondents within the age group 20-30 years more likely to have negative attitude than those over 40 years. Civil servants were 9.8 times more likely to have good practice than other occupation groups. Rabies antigen was detected in 7.98% of slaughtered dogs. Out of 8,370 dogs presented to the State Veterinary Hospital Wukari, between January 2003 and December 2012, only 1,128(13.50%) received anti-rabies vaccine. The findings in this study showed inadequate knowledge, negative attitude and practice of dog owners towards rabies. The presence of rabies antigen in some dogs slaughtered for human consumption and low vaccination coverage in dogs indicate high risk of exposure of dog owners and dog meat processors to rabies. There is therefore a need for educational programmes targeted at dog owners to increase their level of knowledge and reduce the risk of exposure to rabies.

TABLE OF CONTENTS

Title page………………………………………………………………………………………. … i
Declaration…………………………………………………………………………………………ii
Certification …………………………………………………………………………………….. iii
Dedication ………………………………………………………………………………………. iv
Acknowledgement ………………………………………………………………………………… v
Abstract ……………………………………………………………………………………….… vi
Table of Contents ………………………………………………………………………………..vii
List of Tables ……………………………………………………………………………………………………………….. x
List of Figures ……………………………………………………… …………………………….xi
Appendix ……………………………………………………………………………………….. xii

1.0 CHAPTER 1: INTRODUCTION ………………………………………………………… 1
1.1 Background Information …………………………………………………………………….. 1
1.2 Statement of Research Problem ……………………………………………………………… 3
1.3 Justification of the Study ……………………………………………………………………. 4
1.4 Theoretical Frame Work …………………………………………………………………….. 5
1.5 Aim and Objectives ……………………………………………….…………………………. 7
1.5.1 Aim ……………………………………………………………..…………………………. 7
1.5.2 Objectives …………………………………………………………………………………. 7
1.6 Research Questions ………………………………………………………………………….. 8

2.0 CHAPTER 2: LITERATURE REVIEW……………………………………….………… 9
2.1 Aetiology …………………………………………………………………………………….. 9
2.2 Pathogenesis ………………………………………………………………………………… 10
2.3 Transmission and Epidemiology …………………………………………………………… 10
2.4. Rabies in Nigeria…………………………………………………………………………… 12
2.5 Diagnosis …………………………………………………………………………………… 13
2.5.1 The Direct Fluorescent Antibody Test (DFA) …………………………………………… 14
2.5.2 Seller Staining…………………………………………………………………………….. 15
2.5.3 Mouse Inoculation Technique (MIT)……………………………………………………… 15
2.5.4 Tissue culture infection technique (TCIT)………………………………………………… 15
2.5.5 Direct Rapid Immunohistochemical Test (dRIT)………………………………………… 16
2.5.6 Polymerase Chain Reaction (PCR)……………………………………………………….. 16
2.6 Vaccination …………………………………………………….. …………………………. 17
2.7 Control and Prevention …………………………………………………………………….. 18
2.8 Knowledge, Attitude and Practice towards Rabies …………….. …………………………. 20

3.0 CHAPTER 3: MATERIALS AND METHODS………………………………..……….. 21
3.1 Study Area ……………………………………………………… ………………………… 21
3.2 Study Design ……………………………………………………………………………….. 22
3.3 Information on Vaccination of Dogs ………………………………………………………. 22
3.4 Information on Knowledge, Attitude and Practice…………………………………………. 22
3.5 Sample Size Determination, Collection and Processing ……….. …………………………. 23
3.5.1 Sample size determination ……………………………………………………………….. 23
3.5.2 Sample collection ………………………………………………………………………… 24
3.5.3 Direct fluorescent antibody test procedure ………………………………………………. 24
3.6 Data Analysis ………………………………………………………………………….…… 26

4.0 CHAPTER 4: RESULTS ………………………………………….……………………… 27
4.1 Vaccination of Dogs ……………………………………………………………………….. 27
4.2 Knowledge, Attitude and Practice …………………………………………………………. 33
4.2.1 Demographic characteristic of dog owners ………………………………………………. 33
4.2.2. Association with Dogs …………………………………………………………………… 33
4.2.3 Knowledge of dog owners towards rabies ………………………………………………… 36
4.2.4 Attitude of dog owners towards Rabies ………………………………………………….. 40
4.2.5. Practice of dog owners towards Rabies ………………………………………………….. 44
4.3 Detection of Rabies Antigen in Slaughtered Dogs ………………………………………… 48

5.0 CHAPTER 5: DISCUSSION ……………………………………………………………. 49
5.1 Discussion…………………………………………………………………………………… 49
CHAPTER 6: CONCLUSION AND RECOMMENDATION………………………….. 56
6.1 Conclusion ……………………………………………………….………………………… 53
6.2 Recommendation …………………………………………………………………………… 54
REFERENCES ………………………………………………………………………………… 56
APPENDIXES ………………………………………………………………………………….. 64
Appendix i: Questionnaire for dog owners ..…………………………………………………… 64

LIST OF TABLE PAGE
Table 4.1 Sex specific distribution of dogs vaccinated in Veterinary Hospital, Wukari, Taraba State, Nigeria……………………………………………………………..29
Table 4.2. Age specific distribution of vaccinated dogs in State Veterinary Hospital, Wukari Taraba State, Nigeria 2003-2012………………………………………………… 31
Table 4.3 Demographic characteristics of dog owners in Wukari, Taraba State Nigeria…………………………………………………………………………… 34
Table 4.4 Association of dog owners with dogs in Wukari Taraba State Nigeria……………………………………………… 35
Table 4.5 Responses of dog owners to knowledge of rabies in Wukari, Taraba State………………………………………….. 37
Table 4.6 Association of demographic variables of dog owners with categorized knowledge scores of rabies in Wukari, Taraba State…….. 38
Table 4.7 Multivariable logistic regression analysis of demographic variables and categorized knowledge scores of dog owners in Wukari, Taraba State, Nigeria………………………………………………………………………………… 39
Table 4.8 Responses of dog owners on attitude towards rabies in Wukari, Taraba State, Nigeria……………………………………………………………………………41
Table 4.9 Summary of demographic variables with categorized attitude scores of dog owners in Wukari, Taraba State, Nigeria………………42
Table 4.10 Multivariable logistic regression analysis of demographic variables and categorized attitude scores of dog owners in Wukari, Taraba State, Nigeria…… 43
Table 4.11 The responses of dog owners on practice towards rabies in Wukari, Taraba State Nigeria………………………… 45
Table 4.12 Association of demographic variables of dog owners with categorized practice scores in Wukari, Taraba State Nigeria………… 46
Table 4.13 Multivariable logistic regression analysis of demographic variables and categorized practice scores of dog owners in Wukari, Taraba State, Nigeria………………………………………………………………………….. 47
Table 4.14 Sex and age distribution of dogs slaughtered for human consumption in Wukari whose brain tissue samples tested positive for Rabies antigen…………………. 48

LIST OF FIGURES PAGE
Fig 4.1 Annual distribution of total number of dogs vaccinated in Wukari from 2003-2012………………………………………………… 28
Fig. 4.2 Distribution of total number of dogs vaccinated by breed in Wukari, Taraba State Nigeria 2003-2012………………….… 30
Fig. 4.3 Average monthly seasonal variation of vaccinated dogs in Wukari Taraba State Nigeria 2003-2012………………………… 32

LIST OF APPENDIX PAGE
Appendix i: questionnaire for dog owners …………………………. 63

CHAPTER ONE

INTRODUCTION

1.1 Background Information
Rabies is a viral zoonotic disease of all warm blooded animals, which is worldwide in distribution and causes acute encephalitis. It is also known as hydrophobia and is caused by a neutrophilic bullet-shaped, enveloped RNA virus, of the genus Lyssavirus and the family Rhabdoviridae. The disease is transmissible to all mammals (WHO 2006). Rabies originated about 3000BC and is one of the most typical zoonoses that have been well known since ancient times (Takayama, 2005). The disease is endemic in developing countries including Nigeria and other parts of sub-Saharan Africa and Asia (Harry et al., 1984; WHO, 2005). It is characterized by acute progressive encephalitis, hydrophobia, excitability and hypersalivation.
This disease occurs in more than 150 countries and territories and about 55, 000 people die of rabies every year, mostly in Africa, Asia, and South America (Beard, 2001; WHO, 2010). Forty percent of people who are bitten by suspected rabid animals are children under 15 years of age and dogs are the source of 99% of human rabies deaths (WHO, 2010). Every year, more than 15 million people worldwide receive a post-exposure preventive regimen to avert the disease – this is estimated to prevent 327 000 rabies deaths annually (WHO, 2010).
Rabies was first reported in Nigeria in 1912 in humans (Boulger and Hardy, 1960) but the first laboratory confirmation was in 1925, by demonstration of Negri bodies in the brain smear of a mad dog (Ekele and Okoh, 1984). The disease has been declared endemic in Nigeria by several authors (Umoh and Belino, 1979; Fagbami et al., 1981).
The rabies virus causes acute encephalitis in all warm blooded mammals including man and the outcome is almost always fatal, with a variable incubation period (Nadin-Davies, 2000; Awoyomi et al., 2007; CDC, 2007; WHO, 2010). Although species of mammals are susceptible to rabies virus, only a few serve as reservoirs for the disease (Garba et al., 2009). In Nigeria, the domestic dog serves as the principal reservoir host and transmitter of rabies virus to animals and humans (Dzikwi et al., 2010; WHO, 2010).
The disease manifests in three classical stages; prodromal stage, excitatory stage and the paralytic stage (Bishop et al., 2002). Once symptoms of the disease develop, rabies becomes fatal to both man and animals (WHO, 2005). Humans get infected through close contact with infected saliva via scratches or bites (CDC, 1983; WHO, 2011). Non bite exposure can also occur via abrasions, mucous membranes or open wounds that are exposed to infected saliva or other infective materials such as cerebrospinal fluid or brain tissue (Fearneyhough, 2001). Human to human transmission has been reported through organ transplant from an infected donor, and transmission via inhalation of virus-contained aerosol have been reported (Srinivasan et al., 2005; Takayama, 2005; CDC, 2007; WHO, 2008). Human to human transmission by bite is theoretically possible but has never been confirmed (WHO, 2010).
Vaccination against rabies is an efficient way for its control (Turner et al., 1976), and statistics have shown that successful immunization of 70-80% of dog population in a country can result in control of the disease (Beran, 1971). In Nigeria however, it has not been possible to successfully control or eradicate rabies, instead evidence shows that the disease is on the increase (Ogunkoya, 1997 and Taiwo et al., 1998). This may be as result of presence of several free ranging dogs, poor vaccination rates in dogs and some cultural practices that inhibit control of rabies (Jordona, 2009). Several tests are used in the diagnosis of rabies, but the Direct Fluorescent Antibody test (DFA) is the gold-standard approved by World Health Organization (WHO) and Office International des Epizootics (OIE). The DFA is sensitive, specific and cheap (Dean et al., 1996).

1.2 Statement of Research Problem
Canine rabies is endemic and occurs throughout the year in all parts of Nigeria. About 10,000 persons are exposed to rabies annually in the country (Umoh et al., 1988). Rabies remains a serious public health hazard in many developing countries where dog bites continue to be the main mode of transmission of the disease to humans (Widdowson et al., 2002). Although it is a vaccine preventable disease, it still poses a significant problem in many countries in Asia and Africa where 95% of human deaths occur even though safe and effective vaccines for both human and veterinary use exist (WHO, 2010).
In Nigeria, rabies infections both in animals and humans are grossly under reported (Fagbami et al., 1981) and reliable data on rabies are scarce in many parts of the world, making it difficult to assess its impact on human and animal health (WHO, 2006). The epidemiology, virology, transmission, pathology, clinical manifestation, diagnosis and treatment of rabies infection have been described extensively by many authors, yet the incidence of rabies is increasingly on the high side (Adedeji et al., 2010). Dog meat is consumed as a special delicacy by some communities in Nigeria (Ajayi et al., 2006) and is a common practice in Kaduna, Plateau, Cross River, Kebbi, Taraba and Ondo States (Okonko et al., 2010). The presence of rabies antigen in the saliva and brain tissue of apparently healthy dogs slaughtered for human consumption in some parts of Nigeria and the obvious consequences of bites from healthy dogs resulting in human deaths have been reported ( Baba, 2006; Garba, 2007; Garba et al., 2008; and Aliyu et al., 2010).
Dog bite is a common medical condition and factors such as non-vaccination of dogs by owners, high proportion of stray dogs and poor first aid treatment of dog bite injuries have made this a serious public health problem (Joshua et al., 2012). Little or no information is available on the epidemiology of rabies in Wukari metropolis even though there is an obvious presence of dogs and dog meat is consumed here. Many dog processors and owners may not know about the devastating effect of rabies in humans and the potential risk of handling dogs. They may engage in some practices that may therefore expose them to the disease.

1.3 Justification of the Study
Several studies have been carried out to show the prevalence of rabies antigens in brain tissue and saliva of apparently healthy dogs slaughtered for human consumption in some parts of Nigeria, but no report is available on the epidemiology of rabies in Wukari Taraba State.
From records of the veterinary hospital in Wukari, in November 1993, two cases of rabies were reported in adult dogs that had no history of previous vaccination, but were said to have been vaccinated nine months before the outbreak. Also, in May and June 2001, two and eleven cases of rabies were reported respectively in the hospital. These cases were confirmed by the rabies laboratory in National Veterinary Research Institute Vom. These show the presence of the disease in Wukari Taraba State.
From observations made in the State Veterinary Hospital, Wukari, dog bite cases are a frequent occurrence, but these are usually not recorded, hence the need for a study on canine rabies and its associated public health implications in Wukari, Taraba State. It appears many Nigerians still see rabies as insignificant and do not take serious measures to prevent or control its occurrence. Many are still ignorant about the disease and do not vaccinate their dogs because they claim it changes the taste of dog meat and affects the development of canine teeth for hunting and protection (Idachaba et al., 2009).
The detection of rabies antigen in slaughtered dogs will give information on the possible role of dogs in the epidemiology and spread of rabies in Wukari Taraba State and serve as basis for design of control and prevention programme for the disease.

1.4 Theoretical Frame Work
Dogs are the main reservoir hosts of rabies and source of infection to humans (WHO, 2010). Dog bites serve as the primary mode of transmission to humans which allow the passage of saliva containing virus across the broken skin (Fearneyhough, 2001). Vaccination against rabies virus is a highly effective method of preventing rabies in animals and humans (Jakel et al., 2008). Dog rabies control relies on mass vaccination of dogs in order to achieve population immunity levels sufficient to inhibit rabies transmission (Perry and Wandeler, 1993). This also provides the most cost-effective and efficient strategy for controlling canine rabies (Clifton, 2007). The likelihood of spread of rabies virus may be increased by free-roaming and unvaccinated dog populations.
Knowledge is the capacity to acquire, retain and use information. It is a mixture of experience, discernment and skill (Badran, 1995). Attitude refers to inclination to react in a certain way to certain situations; to see and interpret events according to certain predispositions; or to organize into coherent and interrelated structures (Badran, 1995). Practice is the application of rules and knowledge that leads to action (Badran, 1995). Lack of sufficient knowledge on rabies and its preventive measures, poor management practices and irresponsible ownership among dog owners are possible factors that may contribute to the spread of rabies virus.
Detection of rabies antigen in slaughtered dogs signifies the presence of the virus which is a significant factor in the transmission of rabies from slaughtered dogs to the processors. The test to be used for this study is the direct fluorescent antibody test (DFA), which is the gold standard for the diagnosis of rabies approved by the WHO and OIE (CDC, 2011). The test is based on the detection of rabies virus antigen by visual observation of specific antigen-antibody reaction. This technique operates on the principle that anti-rabies IgG labeled with fluorescein isothiocyanate reacts with specific antigen in the brain smear and the product is viewed under ultraviolet light as described by Dean et al., (1996). Brilliant apple green fluorescence indicates the presence of the rabies antigen. The occurrence of a disease in a population is influenced by some determinants which may either represent the host, environment or agent (Pfeiffer, 2002; Martin et al., 1987). These determinants can affect the frequency, distribution or dynamics of the disease in a population. Risk factors such as age, gender, breed, season and location have been reported to play significant roles in the epidemiology of rabies (Widdowson et al., 2002; Owai, 2009). Therefore, the assessment of frequency of dog bites and vaccination of dogs, assessment of knowledge, attitude and practice of dog meat processors and dog owners, detection of rabies antigens in dogs slaughtered for human consumption coupled with education of the people on rabies will be very useful in elucidating the epidemiology of rabies in Wukari Taraba State.

1.5 Aim and Objectives
1.5.1 Aim: To elucidate the epidemiology of rabies and assess knowledge, attitude and practice of dog owners to rabies in Wukari, Taraba State, Nigeria.

1.5.2 Objectives
1 To analyse reports on suspected rabies cases recorded in the area.
2 To analyse rabies vaccination records based on age, sex and breed of vaccinated dogs.
3 To assess the knowledge, attitude and practice of dog owners to rabies in the area.
4 To detect the presence of rabies antigen in brain tissue of dogs slaughtered for human consumption.

1.6 Research Questions
1. What is the distribution of reported suspected cases of rabies by age, sex, breed and season in the study area?
2. What is the distribution of rabies vaccination with respect to age, sex, breed of dogs vaccinated and season?
3. What is the level of knowledge, attitude and practice to rabies, of dog owners in the study area?
4. What is the prevalence of antigens to rabies among slaughtered dogs in Wukari?

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