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How The Donkey Sanctuary is supporting multi-species rabies vaccination campaigns

02 November 2024
6 mins read
Volume 15 · Issue 9

Abstract

Rebekah Sullivan and Emma O'Hagan discuss tackling rabies through global vaccination campaigns, safeguarding donkeys and communities in line with ‘One Health’ principles.

The Donkey Sanctuary is a global charity working to improve the lives of donkeys and mules worldwide. To achieve this aim, the charity works with different projects and organisations to address key health challenges for donkeys and mules. These vary from country to country and depend on the each donkey's situation. A donkey living in the UK as a companion animal will have very different healthcare needs and challenges to one working overseas. Working donkeys can be found in communities in many different regions of the world. It is common for such communities to have multi-animal species present, such as dogs.

Figure 1. One of the authors, Emma, teaching dental examination.

Therefore, diseases that can affect different species, particularly zoonoses, are of particular importance. Rabies is one such disease; this article describes the relevance of rabies in donkey-owning communities and what The Donkey Sanctuary is doing to support methods of rabies prevention.

The dangers of rabies

Rabies is one of the deadliest diseases for mammals and is of huge global importance as a zoonosis. The World Health Organization (WHO) estimates that 59 000 human deaths are caused by rabies annually (WHO, 2024). It is likely that the actual figure is much higher than this estimate, as deaths may be under-reported. Rabies is a lyssavirus, transmitted in the saliva of infected mammals, such as dogs. Consequently, the main cause of rabies is receiving a bite from an infected animal, but licks or scratches on broken skin are a severe risk as well. Infection can also arise when infected saliva comes into contact with the eyes, mouth or nose. Knowledge of the routes of virus transmission and methods of prevention are vital for those living in, or travelling to, rabies endemic areas and working with potentially affected animals.

99% of human deaths are caused by bites from an infected dog and therefore control of rabies in canines has been the cornerstone of many rabies vaccination campaigns. The international ‘Zero by 30’ campaign aims to end dog mediated human rabies deaths by 2030 (World Organisation for Animal Health, 2018). In working equid communities, owners (including children) may live in close contact with donkeys. Most people know that dogs can transmit rabies, but may not be aware that donkeys can also be a risk to their human handlers. Consequently, although rabies is of a lower prevalence in equids than it is in other mammalian species, it is still vital for animal health professionals to raise awareness amongst communities. Donkey owners need to know that they should always avoid letting donkey saliva come into contact with any broken skin. Many rabies cases in donkeys arise from bites from an infected dog or predator, such as a hyena. There are also regional differences; for example, in Mexico, bats are major virus carriers, responsible for biting and infecting donkeys, humans and other mammals.

Figure 2. The Donkey Sanctuary Lamu Clinic vet, Sharon, vaccinating a local puppy.

The most well-known presenting sign of rabies is being frightened of water. However, this is only one possible sign. Initially, there may only be signs of tingling or numbness around the bite or scratch site. The main symptoms are seen when the virus has travelled to the nervous system. There are two main forms of rabies, the furious and paralytic form. The furious form is linked with aggressive symptoms, for example self-mutilation when animals bite themselves, while the paralytic sees a gradual loss of mobility and muscle function. Dogs, equids and humans can contract both forms, and both forms may present in the same individual as the disease progresses. A salient feature of rabies in donkeys is self-mutilation of the genitals. One of the major risks for human handlers is the lack of recognition of the paralytic form of rabies cases before the ‘furious’ symptoms develop. Donkeys may just seem ‘off colour’ in the initial stages, and therefore it is crucial to raise awareness of the non-specific early signs of rabies in equids. In countries where rabies is prevalent, equine health professionals have to be extremely careful while examining any dull donkey or mule.

The importance of vaccination

Rabies is 100% preventable through the effective use of vaccinations. Although there have been extremely rare cases of human survival after rabies infection (Nadeem et al, 2020), without appropriate post-exposure vaccination treatment, anyone exposed to the rabies virus will almost certainly endure an agonising death. Many UK-based professionals will be aware that courses of pre-exposure vaccinations are advised for anyone at risk of exposure to the rabies virus when travelling or working abroad. People commonly ask why, if rabies is responsible for so many human deaths, pre-exposure vaccination programmes are not rolled out globally? The answer is multi-faceted, with economics being a key aspect. It costs approximately $1 USD to vaccinate a dog, compared with $100 USD to provide post-exposure vaccinations to a human (Vega et al, 2021) and post-exposure vaccinations are always required, irrespective of whether pre-exposure vaccination courses have been received. Therefore, vaccination campaigns seek to reduce the risk to humans by reducing the numbers of potentially infected animals that they may come into contact with.

Figure 3. Author, Rebekah, conducting a foal health check.

How The Donkey Sanctuary is supporting vaccination campaigns

The Donkey Sanctuary is currently involved in two major vaccination programmes in Mexico and Kenya. The primary aim is to improve the health and welfare of donkeys and mules by reducing the risk of disease from fatal conditions, including rabies and tetanus. By conducting these vaccination campaigns, the team are also able to improve their engagement with donkey-owning communities and local governments. This allows the teams to have greater insight into the health and welfare of the working donkeys in those communities and explore what more the organisation can do to support donkeys and owners.

In Kenya, the vaccination campaign is focussed on prevention of rabies in dogs and donkeys, while in Mexico the campaign centres on prevention of rabies in donkeys and mules. Dogs are vaccinated in Mexico, but as part of a separate, government-run project. Mexico has been validated by the WHO for having eliminated dog-transmitted rabies as a public health problem, whereas dog-mediated human rabies is still presenting in Kenya. Given the risk of bats spreading rabies in Mexico, donkeys and mules continue to be vulnerable to infections. Therefore, the sanctuary aims to includedonkeys and mules into government vaccination schemes for livestock. In Kenya, as dogs are the biggest risk for rabies transmission, the organisation is actively supporting the vaccination of dogs. Once the uptake of dog vaccination is sufficient, they will act as a barrier to disease transmission – protecting both donkeys and humans from the disease. In each country, the charity aims to support governments or partners and fill in gaps in vaccination provision. While it is not possible to meet all needs, the aim is to address the greatest need and focus on those areas that not only impact donkey welfare, but also the welfare of their human owners and handlers. This is in keeping with the One Health, One Welfare ethos, which recognises that the health and welfare of humans, animals and the environment are interlinked.

In June 2024, the authors travelled to the Lamu archipelago in Kenya to work with the resident Donkey Sanctuary clinic team as part of a multipurpose trip. The vaccination campaign was one aspect, the other was to take part in the induction and training of some new additions to the vet team and to further develop a welfare assessment tool, with the aim of gaining a greater understanding of the programmatic needs for donkeys in Lamu. Sharing knowledge and expertise between veterinary teams is vital to ensure successful collaboration for the improvement of the lives of donkeys.

The vaccination campaign is a multiyear project (2024-2027) that links with other projects within Lamu. Donkeys are an essential part of the way of life in Lamu. They are used for transport because the infrastructure on the island is largely unsuitable for motorised vehicles. The vaccination campaign is being run in conjunction with the county government veterinary services, to vaccinate dogs and donkeys against rabies. The campaign also vaccinates donkeys against tetanus. The inclusion of tetanus vaccinations for donkeys is because of the significant number of tetanus cases seen by the veterinary clinic in Lamu.

Figure 4. The Donkey Sanctuary Lamu clinic vet, Elesvande, vaccinating a donkey at the clinic.

The teams vaccinated animals at the main Donkey Sanctuary Lamu clinic and travelled by boat to other villages on Lamu island (boat travel is far more accessible than travelling bt land) and other islands within the archipelago. The project team was made up of professionals from several veterinary clinic institutions, including small animal clinics and government services. This collaboration served to strengthen the relationship between Lamu County Veterinary Services and local animal welfare organisations. Information about the vaccination campaign was spread by the town crier making announcements on loudspeaker, letting owners know about the dates and times to bring their dogs and donkeys to be vaccinated. Over a period of approximately 6 weeks, 1786 donkeys and 2521 dogs were vaccinated.

Conclusions

Rabies is a disease that can affect everyone and by working together we can assist in the global effort to prevent human deaths from rabies. By supporting governments in tackling this issue, we are raising awareness of donkeys and their importance to people's livelihoods. We hope this will help to increase government support in other areas of donkey and mule welfare.