Prof. dr. Noël Tordo
Institut Pasteur de Guinée
Université Gamal Abdel Nasser – Conakry – Guinée
Head, Antiviral Strategies Unit
WHO Collaborative Centre for Arboviruses and Viral Hemorrhagic Fevers
OIE Reference Laboratory for RVFV and CCHFV
Your experience with rabies:
What is your education? How long have you been working with rabies? Why did you start working with rabies?
- I “got working” with rabies by chance; it was a proposed scientific topic just after my Master degree, which was about cloning/sequencing of Interferon ß (IFNß) gene, a gene involved in the immune response. This was before we knew that rabies virus was using many tricks to escape the IFNß response, and so the immune defense of the human body.
- Since then (1982) I am working on rabies virus. First at a very molecular level (cloning, sequencing, understanding virus/host interaction), but I rapidly turned into applied research by doing molecular epidemiology (where was the virus circulating), vaccines, antivirals (for prevention and treatment of rabies). The applied research was of course dependent on the use of the fundamental science to solve basic field problems.
WORLD RABIES DAY
September 28th is the World Rabies Day (WRD), a day dedicated to rabies prevention. What is the role of the rabies scientific community in increasing awareness about rabies? What is its significance to you? Are you doing something to increase awareness about rabies?
It must be stated that the idea of the World Rabies Day (WRD) emerged from 4 scientists being fed up with the inactivity despite the fact that many patients were dying from rabies (now we know that it is al least “60.000 people dying from rabies every year”). Thus rabies awereness really came from the scientific community itself. The strength of the GARC (Global Alliance for Rabies Control – established in 2007) has been to organize this “somehow limited initial” action at an international level and the World Rabies Day (2007) has given a clear bottom-up effect, inviting politicians, companies and international institutions to consider more rationally and to prioritize rabies in agendas. Concerning my share in the WRD, since 2007 I participate in a conference, a meeting, or any social event aiming to increase awareness about rabies. Since recently I am participating in the real African rabies world, held in Guinea!
By the way, most of the people do not know why 28th of September was chosen to hold the World rabies day. The 1st WRD, held in 2007, was organized on another day in September. However, in 2008, we looked for a prestigious and fixed date, which turned to be the 28th of September. This was the anniversary day of the death of Louis Pasteur (1895) and this day was free on the UN calendar
Do you think people, in general, know what rabies is? Do you think there is a need to increase awareness among the general population?
Most of the people have heard about the virus, which is known as the “deadly rabies”, which is particularly linked to fear. Some people in developing countries know that dog bites may transmit rabies. But, very few people know the real risk of dog bites, and that infection with rabies is characterized by a long incubation period.
Furthermore, not much is known about the available post-exposure interventions to avoid the risk of lethal infection with rabies, especially the fact that those interventions must be applied rapidly after exposure.
The global burden of rabies is estimated to be around 60.000 death per year. Do you think the global burden of rabies might be higher?
Models are the best we have to come up with reliable estimations. But it is crucial to motivating countries in the developing
world to better collect information about dog bites, rabies cases in both humans and animals.
Why is it a problem of mainly Asia and Africa? What countries experience the most number of rabies cases?
Real or estimated numbers are reported and the main rabies burden is in Africa and Asia. Rabies is mainly targeting the poor countries that are unable to control stray dog populations and underlines the need for better intervention strategies in animals and humans, such as vaccine development.
Is rabies a taboo in Asia and Africa?
As noted before, the fear of rabies in deeply written in human memories and all sort of myths exist. Sometimes “magic”, not effective treatments have existed over the years. In Asia and Africa particularly, but not exclusively.
Do you have a personal experience with a rabies victim?
The only direct personal experience I have with a rabies victim is with the young American Jeanna, who survived rabies upon heavy treatment in 2005. I was impressed by her energy to increase awareness about rabies to future young generations.
My other experiences are indirect, but remarkable as well : (1) my grandmother, born in Algeria, was afraid when she learned that I was studying rabies: she told me that rabid people in Algeria were suffocated between mattresses to shorten their suffering. I learned few years later that this was also practiced in France in the first half of the 20th century; (2) the way Guinean doctors and nurses describe the symptoms of rabid patients coming to hospital: patients are somehow “barking and biting” !!!
What in your opinion should scientists focus their research on?
Science has already given solutions and tools to vaccinate against rabies. Vaccination strategies, both for human and animal have to be applied now, although some research is still needed to maintain optimal protection while limiting the number of shots and visits. Due to the long incubation period between biting incident and symptoms (2 months in average for human), there is still space for research to develop antiviral molecules able to stop the virus before it reaches the central nervous system. On the other hand, rabies virus is “brilliant” for persisting in the nervous system while controlling natural defenses. A modified rabies virus devoid of pathogenicity but keeping its tropism to the nervous system could become an excellent Trojan horse to bring “good” into neurons.
One girl infected with rabies received treatments under the Milwakee protocol. Do you believe there is a medical explanation why this protocol would or would not work?
There were multiple debates around the Jeanna survival. The important point is that this event has opened a hope for treating the currently accepted “100% fatal disease” due to rabies infection: since 2005, scientists are thinking about antivirals and rabies therapy.
Do you think there will be a treatment for rabies in the future? Is there anything promising that you know of?
Several research groups in the world are involved in this quest. There are some hopeful results and promising compounds will emerge.
It is a fact that little public funding available for supporting research to rabies. Do you think this is a mistake and why?
This is a mistake since rabies research is opening excellent perspectives to solve one of the most ancient known diseases, to provide a unique platform for the “One Health” concept, combining human, animal and environmental research and to explore an exclusive host-pathogen relationship in the nervous system and understand the molecular basis of neurotropism/pathogenicity.