Dr. R K Bhardwaj, Dr. Antriksh Jamwal
In 2015, the world urged action by establishing a global target of zero human dog-mediated rabies fatalities by 2030.
Every year, 28th September is observed as World Rabies day to make people aware of rabies and improve prevention and control measures. It is commemorated on the death anniversary of Louis Pasteur, who first developed an effective Anti-rabies vaccine. It was first started in 2007 as an international campaign by Global Alliance for Rabies (GARC) in collaboration with many international human and veterinary health organisations like the World Health Organisation (WHO), the World Organisation for Animal Health (OIE) etc.
The mission of the day is to enhance knowledge about human and animal rabies. The Covid-19 pandemic emerged with a plethora of challenges for humankind, but specifically regarding the transmission and progression of disease and in general, about the vaccination. It ultimately culminated in hesitancy with regard to the acceptance of the vaccines at an earlier stage of pandemic, so the vaccine rollout in many countries was delayed with many reports of people avoiding vaccine.
Similarly, in rabies, the misconception and false theories have been in vogue since centuries. The theme of this year’s (15th World Rabies Day) is Rabies: Facts, not Fear! This year’s theme is aptly concerned with dissemination of correct and substantiated facts regarding rabies and also with an aim of avoiding fear amongst the masses, which has been there due to spread of misinformation and myths.
This programme has got more relevance in Asia and especially India, because Indian town and cities are home for large population of stray dogs which account to majority of human rabies cases due to bites. As per the World Organization for Animal Health, each year, more than 70,000 people die worldwide from rabies and every ten minutes someone dies from rabies. More human deaths from rabies occur in Asia than anywhere else in the world. It is alarming that within Asia, India has reported to have the highest incidence of rabies globally. Actual picture may be more devastating, as the true number of human rabies death is unknown, because many cases go unreported.
Facts: Rabies is one of the Neglected tropical disease that afflict people of more than 150 nations and territories worldwide, especially those living in poverty in low- and middle-income nations in the tropics and subtropics, and impose a major economic burden on these countries, according to the World Health Organization (WHO).
Rabies is endemic in India except the Andaman & Nicobar and the Lakshadweep Islands. It is 99 percent fatal but 100 percent vaccine preventable disease caused by Lyssa virus. It affects all warm blooded animals and transmitted by saliva, bite or scratches from animals mainly dogs, foxes, Jackals, Monkeys and Mongoose etc. After bite from rabid animal, viruses present in saliva travel at rate of 12-24 mm per day towards central nervous system. Incubation period of disease is from days to years. Rabies in human develops in two form i.e Furious and Paralytic form. Early symptoms may include fever and tingling at the site of bite followed by violent movements, uncontrolled excitement, hydrophobia, paralysis, coma and death.
Dogs are responsible for the great majority of human rabies deaths, accounting for up to 99 percent of all human rabies transmissions. Dog bites account for more than 95 percent of incidents, owing to the country’s estimated 60 million stray/free-ranging canines. Approximately 80 percent of human cases occur in rural areas. Globally, rabies deaths are rarely reported and children between the ages of 5-14 years are frequent victims. The annual estimated number of dog bites in India is supposed to be 17.4 million. 35-40 million stray dogs are supposed to be present in India. In 2018, India’s pet dog population was estimated to be at 19.5 million. By the end of 2023, the population is expected to exceed 31 million. Most of these dogs here in India fall into category of unrestricted-partially dependent type and free ranging type. There are roughly 25-30 million dogs in India, with a dog-to-man ratio of 1:5. Dog bites account for 91.5 percent of all animal bites in India, with 60 percent of strays and 40 percent of pets. Animal bites occur at a rate of 17.4 per 1000 people. Every 2 seconds, someone is bitten, and every 30 minutes, someone dies from rabies. The yearly number of person-days lost due to animal bites is 38 million, with a cost of $25 million for post-bite care.
The average cost of rabies post-exposure prophylaxis (PEP) is currently estimated at an average of US$ 108 which is a catastrophic financial burden on affected families whose average daily income may be as low as US$ 1-2 per person. Every year, more than 29 million people worldwide get a post-bite vaccination which is estimated to prevent hundreds of thousands of rabies deaths annually. Globally, the economic burden of dog-mediated rabies is estimated at US$ 8.6 billion per year.
Fears: Multiple types of fears are associated with rabies. It includes fear from rabid animal or fear already prevailing in the rabid plagued community, fear of water (hydrophobia) which is manifested during the clinical course of disease and fear from the vaccines caused by ‘fake news’ or myths regarding rabies, making people afraid to get vaccinated themselves or get their animals vaccinated. These fears can be removed or overcomed by learning, using and spreading facts among people.
Wound Management: In case of dog bite or scratch starts first aid treatment with washing of wound with soap and water for 10-15 minutes and wound should be cleaned with 70 percent alcohol (commercial spirit) or Betadine (Povidone iodine), as it aids in preventing the establishment of infection. Post-bite anti-rabies vaccination should be immediately started with human rabies immunoglobulins (HRIG), in cases of Category-3 bites, but rabies vaccination is only effective, if given during the incubation period of disease.
Control Strategy: Many NGOs like Rabies in India Foundation (RIA), Association for the Prevention and Control of Rabies in India (APCRI),Commonwealth Veterinary Association (CVA) and GRAC are also running rabies control programmes. Main constraints in control of rabies in India are lack of coordination and country shares border with six neighboring countries where rabies is endemic.
The ongoing battle to control rabies by brutally killing the stray dogs has not yielded results. Mass vaccination is the only effective solution and vaccinating 70 percent of a dog population in endemic areas creates a barrier of healthy immune dogs which prevent the disease from spreading. According to World organization on Animal Health (OIE), the cost of vaccinating dog’s remains minimal compared to the actual cost of emergency post-exposure treatments for the people who have been bitten and only 10 percent of the cost of these treatments would be sufficient to considerably reduce or even eliminate canine rabies.
Control of rabies in stray dogs by Animal birth control programme and oral vaccination can be effective procedures to control rabies. Control of rabies in wild animals is also of great importance which can only be feasible by oral antirabies bait vaccines. Let us take oath on this day to vaccinate our pets on regular basis and adopt stray dogs for controlling their population and educate the people about facts of the rabies, then only we can control this disease. Holding local or national events is a great way to share the message of rabies prevention, whatever the size of the audience. Every time someone is educated about rabies there is the possibility of saving a life.
(The author is Assistant Professor, Division of Veterinary Medicine, F.V.Sc & A.H-RS.Pura, SKUAST-Jammu)
Dr. R K Bhardwaj, Dr. Antriksh Jamwal