Rabies
in Tanzania

On March 7, the staff at FAME Hospital notified public health authorities of the suspected rabies case. Hospital staff reported some other dire news: three other boys had been herding cattle with the deceased at the time of the attack. The four boys had killed the dog with sticks, and all had been bitten in the process. It was now a race against time to provide potentially life-saving vaccination to the surviving boys who had been exposed to rabies. The clock was ticking.

With support from the Ifakara Health Institute (IHI) and the District Medical Officer of the Ngorongoro District, hospital staff took quick, decisive action. On March 9, a team including a doctor and social worker from FAME Hospital and two rabies control experts from IHI drove to the boy’s village to identify anyone who may have been exposed to rabies and offer them PEP. On arrival, the group interviewed the boy’s mother and completed a verbal autopsy questionnaire.⁹ In the absence of laboratory confirmation, this helped to confirm the clinical diagnosis of rabies. The team identified the three surviving boys bitten by the dog and found that five adult family members of the deceased boy had had extensive contact with his saliva before he died. The team also identified two girls who had recently been bitten by another unidentified dog in an unprovoked attack.

Led by the social worker, who was from the area and spoke the Maasai language, the team discussed rabies with the community. Although community members were aware of the risk of acquiring rabies from dogs, none knew that vaccination could prevent rabies if administered after exposure. The family of one of the girls bitten by the second dog had taken her to a health facility for treatment after she was bitten; however, she was not given PEP and her parents were left with the impression that all appropriate care had been provided. All 10 of the people exposed—the three surviving boys exposed to the first dog, the five adult family members exposed to the deceased boy’s saliva and the two girls exposed to the second dog—were grateful to learn about PEP and elected to receive the life-saving intervention. They were given the first dose of the PEP regimen the following day—just four days after the first case was identified.

Although the local health dispensary within the NCA did not stock rabies vaccine, the response team had brought vaccines from FAME Hospital with them and left a sufficient supply at the dispensary for all 10 exposed people to receive a complete PEP vaccination series. All contacts completed the PEP regimen and remained healthy.

The doctors’ clinical suspicion of rabies and quick reporting of the case were key to containing the outbreak, as was the team’s early, decisive action to conduct contact tracing and provide prevention to those who needed it. The team found that collaboration among multiple partners enabled a swift response and successful community engagement, and that eliminating barriers to PEP access resulted in full adherence. Until rabies is eliminated in Tanzania using sustainable and cost-effective strategies such as dog vaccination, the strategic action undertaken by the response team demonstrates how a rabies outbreak can be contained.