Dr Rashmi Kumari Gupta
World Rabies Day was celebrated on September 28, at global level, with the objective of raising awareness about rabies prevention and control. This day marks the anniversary of Louis Pasteur’s death, the French chemist and microbiologist, who developed the first rabies vaccine. The theme for World Rabies Day 2024 is “Breaking Rabies Boundaries” to highlight the ongoing global efforts to overcome the barriers in the fight against rabies. Rabies, even though, a preventable disease, consistently causes the deaths of many humans and animals around the world. Number of human deaths globally due to dog-mediated Rabies is estimated to be 59,000 annually. Only, a few countries (Japan, the United Kingdom, Australia, New Zealand) & Andaman Nicobar Islands have managed to completely eradicate the disease, by their geographical isolation and excellent governmental initiatives. Several countries in Western Europe and the Americas have made significant advances in eliminating rabies. Unfortunately, rabies in India continues to be under-prioritized in public health discussions despite of high burden of human rabies deaths. In India, Rabies leads to 18,000-20,000 deaths every year that accounts for 36% of the global and 65% of the human Rabies deaths in the South East Asia region.
Challenges for Elimination
Gaps in Knowledge, attitudes and practices
One of the reasons attributed to the high number of rabies deaths is the lack of awareness in the population about this fatal disease and its prevention. A major part of rural India is still lacking basic knowledge regarding the appropriate management of animal bite wounds and vaccine administration. After a dog bite, their first aid measures seem to be worse, due to various myths and misconceptions about the initial home management of wounds, such as the application of red chili, turmeric, tobacco leaves, or the visit to a tantric or local temple to perform some religious customs. Besides the lack of knowledge, misplaced attitudes and practices of the communities persist regarding post-bite management of wounds.
Irregular vaccine supply
The endemicity of rabies in India can be linked to several factors, including inconsistent supplies of immunoglobulins and anti-rabies vaccines, especially in rural areas, lack of storage facilities and maintenance of cold chain and inaccurate forecasting of the amount required. The lack of financial support for rabies prevention and control by governments is a crucial shortcoming contributing to the non-availability of PEP at peripheral health centers.
Uncontrolled canine population
In India, according to a report, there was one dog for every 36 people, with only 20% of these dogs being pets. With the population of India estimated to be 1.45 billion, this equates to 40 million dogs.
Reasons for Increase in stray dog population in spite of regular animal birth control operations are; feeling of social insecurity among the dogs in their environment; lack of rescue centers for orphan dogs and no provision of rehabilitation of diseased dogs.
Limited Canine Vaccination
Parenteral vaccination of Free Roaming Dogs (FRD) encounters obstacles of vaccine failures due to faulty inoculation or a break in the cold chain process which is a pivotal point for prevention of animal mediated rabies. Also the accessibility of FRD for vaccination is difficult due to the challenges of finding them, catching and restraining them.
Wildlife Reservoirs: Rabies in wild animals complicates elimination efforts as controlling the disease in wildlife is far more challenging than in domestic animals.
Inadequate Surveillance and Reporting
Fragmented Rabies Control Program
Limited Political commitment
Strategies For Rabies Elimination:
Prevention and Control Strategy
Human mortality arising from dog-associated rabies can be minimized by administering post-exposure prophylaxis to exposed individuals; by vaccinating at least 70% of dog population to interrupt the transmission cycle; or by a combination of both strategies.
Educational outreach
The promotion of awareness about rabies is one of the foundational pillars of any strategy to eliminate rabies. Although the general awareness of the disease has increased, there remain gaps in the way the dog-bite wounds are managed and early provision of PEP is sought. The attitudes of communities towards FRD in these countries also needs to be altered. Educating communities about promotion of responsible ownership of dogs should form part of rabies awareness drives.
Stray dog population management
* Population control: Sterilization programs in dogs can help to reduce stray dog population in a humane and sustainable way.
* Legislation and Policy: Enforcing responsible pet ownership laws, including compulsory vaccination and registration of dogs.
Timely and accessible Post-Exposure Prophylaxis:
To ensure availability of Anti Rabies Vaccine (ARV) and Anti Rabies Serum (ARS) to all Animal Bite Victims at all levels of health facilities.
Strengthening Surveillance and diagnostics
A One Health based surveillance approach that is ably supported by a network of laboratories catering to vulnerable areas, including rural and remote localities, has been suggested as a mandatory requirement for the elimination of rabies.
Vaccination in Wildlife
In areas where wildlife (such as foxes, bats etc.) are rabies reservoir, oral rabies vaccination (ORV) through baits can reduce rabies transmission among wild animals. Regular monitoring of wildlife rabies cases can help target ORV campaigns effectively.
One Health Approach
The Centre for One Health, under the Ministry of Health and Family Welfare’s National Centre for Disease Control (NCDC) with the support of the United Nations Development Program (UNDP) in India will supplement its efforts to strengthen rabies prevention and control through digitalization of rabies vaccinations. The digitalization process will involve real-time monitoring of rabies vaccine stocks and tracking of beneficiaries, as well as ensure that all doses of the rabies post-exposure prophylaxis regimen are administered.
Global Alliance for Rabies Control (GARC)
Global freedom from the threat of dog-mediated rabies is feasible only with the integrated investment strategy and intersectoral approach, supported by the World Health Organization (WHO), the Food and Agriculture Organization (FAO) and the World Organization of Animal Health (OIE). Aptly called ‘United Against Rabies’ (UAR), these three organizations are collaborating towards the achievement of common objectives to eliminate rabies from the world by 2030.
(The author is Associate Professor, Department
of Community Medicine, GMC Jammu)
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