Rabies in rural Cambodia : A pilot study on social acceptance of an oral vaccination campaign of dogs and community rabies awareness

Abstract: Rabies is a deadly zoonotic disease that kills approximately 60,000 people every year, with around 60% of the cases in Asia. There exists no treatment for rabies once symptoms have started to appear and the disease always leads to death of the patient. Therefore, prophylactic treatment, such as pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), is of uttermost importance. 99% of human rabies cases is caused by transmission from a rabid dog, most commonly by dog bites. Cambodia is one of the countries in the world with highest incidence rate of rabies, with 3.5 times as high incidence rate as India. Together with the highest dog-human ratio in the world and 95% of dog bite victims not getting PEP, rabies is a serious threat to the Cambodian people. The best way to stop human rabies is to stop dogs from being infected. This is done by vaccinations, traditionally as injections. To reach herd immunity, 60-70% of the dog population needs to be vaccinated. However, since the majority of the dogs in Cambodia are free-roaming and are not used to being restrained and has never seen a veterinarian, it is hard to reach all of the dogs during vaccination campaigns. This is why oral rabies vaccinations (ORV) might be a good alternative or complement to vaccine injections. Since there is no need to handle dogs when giving ORV, it is possible to reach the dogs that otherwise would have been impossible or dangerous to give injections to, and this way, it is possible to reach the threshold for herd immunity in the population. This study aimed to evaluate the social acceptance of ORV in rural villages with unvaccinated dogs in three provinces in Cambodia and evaluate the general rabies knowledge in the same areas. This was done through mixed method, with dog owner questionnaires, key informant interviews and focus group discussions. The study found that the social acceptance towards ORV is very good and almost everyone in all of the provinces were positive towards ORV. The will to vaccinate the dogs was high, as long as the vaccine is free of charge or cost no more than $3. However, the general rabies knowledge was surprisingly low in all the provinces compared to earlier studies done in Cambodia, with 40% not knowing what rabies is and about 50% not knowing that rabies has a 100% mortality. Other studies have found that villages with unvaccinated dogs generally have a lower level of rabies knowledge, which can explain these findings.