Rabies: Dreadful but preventable disease

Dr R K Bhardwaj, Dr Ranj Bala
In 2015, the world urged action by establishing a global target of zero human dog-mediated rabies fatalities by 2030.
World Rabies day is observed on 28th September every year for awareness of people about rabies and enhance prevention and control measures. The day is commemorated on the death anniversary of Louis Pasteur, who first developed an effective Anti-rabies vaccine. It was first initiated by Global Alliance for Rabies (GARC) in collaboration with many international human and veterinary health organisations like the World Health Organisation (WHO) and the World Organisation for Animal Health (OIE) in 2007 as an international campaign.
The theme of 16th World Rabies Day is ‘Rabies: One Health, Zero Deaths’. This highlights the connection of the environment with both people and animals.
The theme is most relevant to the current situation and global trends for rabies and also health in general. It focuses on One Health, coupled with the reminder of the “Zero by 30” goal and the fact that dog-mediated human rabies elimination is possible if we stand united against this dreadful disease. There was severe impact of COVID-19 on public health, which has also affected the rabies control programs globally. It was due to more focus on prevention and control of COVID-19. The theme is selected to bring focus back on rabies so that momentum can be regained towards achieving rabies elimination.
The concept of One Health is well established in control programs of various diseases like COVID-19 and antimicrobial resistance around the world which is indistinguishably linked and interdependent on the health of people, animals and the environment. The importance of One Health was also discussed at major platforms like in the G20 summit-2020, as well as the development of the WHO Neglected Tropical Disease roadmap and the One Health companion document that specifically mention rabies. Rabies elimination typifies the One Health approach, with participation and collaboration from human, animal, and environmental sectors. This One Health aspect of the theme has been engineered to be inclusive, ensuring everyone participation to bring change and help us to collectively achieve the goal of rabies elimination by 2030. The spirit behind this theme encourages collaboration, partnership, and a joint approach towards rabies elimination or “Zero Deaths”, in line with the “Zero by 30: Global Strategic Plan for the elimination of dog-mediated human rabies deaths by 2030”.
The second part of the theme refers to “Zero deaths”. This aligns directly with the Zero by 30 Global Strategic Plan and highlights that rabies is preventable and that it can be eliminated as well. In fact, rabies is the only vaccine-preventable Neglected Tropical Disease. This part of the theme also reminds us that we have a clear goal to work towards, and while significant progress has been made, we need to continue to work
Rabies is one of the Neglected tropical disease that afflict people of more than 150 nations and territories worldwide, especially those living in poverty with 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 an acute and highly fatal viral encephalomyelitis which affects all warm blooded animals. It is caused by a number of viruses, but the Rabies Lyssavirus is the most significant in terms of public health, since it causes nearly all human and dog rabies infections.
The rabies virus is endemic in dogs, wolves, foxes, jackals, mongooses, monkeys etc in India. Spread of infection is caused by bite of an infected animal.
Rabies is a vaccine-preventable viral disease, where 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.
Every year, more than 59,000 people die as a result of a dog bite due to a lack of understanding about the importance of seeking medical attention. The majority (35712) of these deaths occur in Asia. India is endemic for rabies, accounting for 59.9 percent and 35 percent of Asia and global mortality, respectively. The true burden of rabies is unknown in India, but according to current data from World Health Organization, rabies kills 20,565 people every year. In India, 30-60 percent of reported rabies infections and deaths occur in youngsters under the age of 15 years as a result of bites. But statistics of 2018 is different as Centre Bureau of Health Intelligence (CBHI) reported only 116 deaths due to rabies in India. There is huge gap between estimated and actual reported cases of human rabies. There is need to have a strong surveillance system to report exact data on human rabies which will help to develop strategies as per regional condition to achieve the WHO goal of Zero deaths due to Human Rabies by 2030.
To overcome the under reporting of human rabies cases, Department of Health and Family Welfare, Ministry of Health and Family Welfare, GOI declared human rabies as a notifiable disease by D. O No.2283429/NRCP/DZDO-NCDS/DGHS of dated 20-09-2021 under Clinical establishment registration and regulation act 2010 or respective state public health act or nursing home act. It has become mandatory for all government and private health facilities to report all suspected, probable and confirmed human rabies cases as per guidelines given by National Rabies Control Program.
Reporting of rabies and notification are also of value for rapid identification of foci and the implementation of control measures. Since, rabies is highly infectious and fatal disease and affect domestic, wild animals and of public health significance. Notification will help in contact tracing and immediate prophylactic measures to prevent infection in other people exposed to same source. It will also help in prompt identification of emerging rabies foci in animals and measures to curtail the spread of rabies to other animals and humans.
The annual number of dog bites is estimated to be at 17.4 million with stray dogs’ population of 35-40 millions in India. In 2018, India’s pet dog population was estimated to be at 19.5 million which is expected to exceed 31 million by the end of 2023. Most of these dogs fall into category of unrestricted-partially dependent type and free ranging type. 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 persons. 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.
Rabies fatalities in humans are entirely avoidable with proper vaccination and timely medical intervention. In cases of bite of a stray or unvaccinated carnivore or insectivore animal, the wound must be cleaned immediately with a lot of running water and soap solution, as it prevents the establishment of infection. Forty to Fifty per cent alcohol or povidone iodine solution can also be applied on the wound if available. This should be done at early stages with an immediate focus to avail a primary medical treatment at a hospital.
As part of India’s 12th five-year plan (2012-2017), the Ministry of Health and Family Welfare announced financing for a National Rabies Control Program in 2014. The National Centre for Disease Control in New Delhi and the Animal Welfare Board of India were working together to reduce human rabies mortality by half by the end of 2017. However, little information on the program’s accomplishments is accessible in public domains.
“National Action Plan for Dog Mediated Rabies Elimination from India by 2030” launched on World Rabies Day 2021, is a multi-pronged strategy based on One Health Approach. The programme is running with the vision to achieve zero human deaths due to dog-mediated Rabies by 2030 and mission to progressively reduce and ultimately eliminate human rabies in India through sustained, mass dog vaccination and appropriate post-exposure treatment.
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 anti-rabies bait vaccines.
So, let us take oath on this day to vaccinate our pets on regular basis and adopt stray dogs while vaccinating them against Rabies and controlling their population in addition to educating the people about facts regarding rabies, only then only we can control this disease. Notification of rabies is also important to prevent its spread. 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 authors are Associate Professor, Division of Veterinary Medicine, F.V.Sc & A.H-R.S.Pura, SKUAST-Jammu.)