Dr Rajinder Kumar Bhardwaj & Dr Ranju Bala
Every year, 28th September is observed as World Rabies day to raise awareness about rabies and enhance prevention and control measures. It is commemorated on the death anniversary of Louis Pasteur who developed first effective anti-rabies vaccine. World Rabies Day was first started in September, 2007 as an international campaign coordinated by the Global Alliance for Rabies Control (GARC) in collaboration with many international human and veterinary health organizations like the World Health Organisation (WHO), the World Organisation for animal health (OIE), the Pan American Health Organization and the USA centers for Disease Control and Prevention. The mission of the day is to raise awareness about the impact of human and animal rabies and effective preventive and control measures. 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 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 ‘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. This programme has more relevance in Asia and especially India, Because Indian town and cities are home for over 30 million of stray dogs which account to 97 perc ent of human rabies cases due to bites. The number of dogs on India’s streets has declined by 10 percent from 1.71 crore in 2012 to 1.53 crore in 2019, according to figures tabled in Lok Sabha by Fisheries, Animal Husbandry and Dairying Minister Parshottam Rupala.
Uttar Pradesh, Andhra Pradesh, Telangana, Bihar, Assam, Tamil Nadu, Madhya Pradesh , Jharkhand and West Bengal showed decline in stray dog’s population. However, Karnataka, Rajasthan, Odisha, Gujarat, Maharashtra, Chhattisgarh, Haryana, Jammu & Kashmir and Kerala showed increase in stray dogs’ population. The Union Territory of Lakshadweep, Dadra & Nagar Haveli, state of Manipur and Mizoram has negligible canine population and almost free from rabies. The global economic burden of rabies is estimated at US$ 8.6 billion from over 29 million people across the world receiving post-bite vaccinations annually. As per World Organisation for Animal Health, (2013) each year, 70,000 people die worldwide from rabies and every ten minutes someone dies from rabies. More human deaths from rabies occur in Asia (>31,000 per year) than anywhere else in the world, It is alarming that within Asia, India has reported to have the highest incidence of rabies globally (20, 565 deaths per year) as compare to 23,700 rabies deaths per year in whole Africa. Actual picture may be more devastating, as the true number of human rabies death is unknown, because many cases go unreported. Rabies is 10th most common cause of human deaths. Rabies is endemic in India except the Andaman & Nicobar and the Lakshadweep Islands. Rabies is deadly but wholly 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. In case of dog bite or scratch, start 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). Post bite anti-rabies vaccination should be immediately started with Human rabies immunoglobins (HRIG) in case of Catergory-3 bites. Pilot project on prevention and control of human rabies was initiated under 11th five years plan since January, 2008 to test the strategy for prevention of rabies death in humans which was extended to 2011 in five main cities of Ahmadabad, Bangalore, Delhi, Pune and Mudrai. National Rabies Control Programme was approved during 12th Five Year plan to control the rabies in the country had human and animal components. The human health component was rolled out in 26 States and UTs, while animal health component was started as pilot testing in Haryana and Chennai, to accelerate the action towards the elimination of dog-mediated rabies by 2030. ‘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 National Action Plan for Rabies Elimination (dog mediated) in India is based on the three key principles of prevention, promotion and partnership to provide coordinated support for the anti-rabies drive. The two core components to achieve the elimination of dog mediated human rabies are human health component to prevent human deaths due to rabies by ensuring timely access for post-exposure prophylaxis for all animal bite victims and creating well responsive public health system. Animal health component includes achieving at least 70 per cent anti rabies vaccination coverage among dogs in a defined geographical area annually for three consecutive years. The success of NAPRE will rely on quality canine and human rabies-related data, which is currently unavailable or sparse. Systematic data collection and analysis are imperative prior to plan an action strategies. Currently, data is being collected but at different sources by different entities. The methods of data collection are incomplete and lack key data critical to action planning and implementation. A smart data collection system that is user friendly, time-saving and responsive cross-platform is a need of hour. It will encourage compliance in data collection across all levels of healthcare workers so that they can enter data accurately and swiftly. The success story of development of a data-driven rabies elimination program (2013- 2019) in Goa State, had resulted in human rabies elimination and a 92 per cent reduction in monthly canine rabies cases. Smartphone technology enabled systematic spatial direction of remote teams vaccinated over 95,000 dogs (70 per cent population) and educated 150,000 children annually. An estimated 2249 disability-adjusted life years (DALYs) were averted over the program period at 526 USD per DALY, making the intervention ‘very cost-effective’ by WHO definitions. This One Health program demonstrates that human rabies elimination is achievable at the state level in India. It is recommended that Goa like rabies elimination programme should be launched in other states and union territories for control of the rabies. Many NGOs like Rabies in India Foundation, Association for the Prevention and Control of Rabies in India, Commonwealth Veterinary Association and GRAC are also running rabies control programmes. Main constraints in control of rabies in India are lack of coordination, lack of comprehensive data of dog population and country shares border with six neighbouring countries where rabies is endemic. Previous method to control rabies by killing the stray dogs had not yielded results and was cruelty to animals. Mass vaccination is the only effective solution and vaccinating 70 per cent of 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 (Spaying and neutering) 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. 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 the rabies, so that we can achieve our goal of zero human deaths due to dog-mediated Rabies by 2030. 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 Professors, Veterinary Medicine at SKUAST-Jammu).
