“All For One & One Health for All ”
Dr.Vittal Patil,Veterinary Officer,
Department of AH&VS, Govt. Of Karnataka.
Email.id- vittalpatil764@gmail.com
Abstract
Rabies is a fatal zoonotic disease most often transmitted to people via bites from infected dogs. This course provides a general introduction to rabies, and the One Health approach currently taken to prevent it. It consists of seven video-lectures, demonstration videos, and lessons learnt from people who work at the front line of rabies elimination programme around the world. It targets both a general audience and those who would like to learn more about rabies and the pathway to eliminating this disease – like prospective and current public health and animal health practitioners in rabies endemic countries.
Global concerns to ecosystem function and public health are intertwined and demonstrate the tight connection between the health of people and wildlife. Urban environments, where there are obvious social-ecological linkages, make these challenges more pressing. The One Health idea, which provides an organizing framework, promotes the health and wellbeing of urban communities and ecosystems. One health must consider societal differences in environmental disadvantages, exposures, and policy if it is to be effective.
Keywords: One Health, viruses, Zoonotic disease, Urbanization and environmental justice
Introduction
September 28 is World Rabies Day. Established in 2007, World Rabies Day aims to raise awareness about the world’s deadliest infectious disease and help the world come together to fight the disease. The theme for 2023’s World Rabies Day is “ALL FOR ONE AND ONE HEALTH FOR ALL” focuses on:
- Continuing to work towards eliminating rabies around the world
- Embracing the One Health approach to rabies control, which means collaborating across human, animal, and environmental sectors
- Focusing on the “Zero by 30” goal to reduce rabies deaths in people to zero globally by 2030.
In the United States, rabies deaths in people are very rare, due to successful animal control and vaccination programs, and a robust healthcare structure that can provide rabies vaccines to people shortly after they have contact with a possibly rabid animal. Each year, 4 million Americans are bitten by animals, but very few people develop symptoms and later die from rabies. These systems work together to prevent rabies in people. About 60,000 Americans get postexposure prophylaxis (PEP) shots each year to prevent rabies infection after being bitten or scratched by an infected or an animal suspected of being infected. The good news is that rabies can be prevented through vaccination of both animals and people.
Every year, 28th September is observed as World Rabies day to raise awareness about rabies and enhance prevention and control measures. The mission of the day is to raise awareness about the impact of human and animal rabies and effective preventive and control measures.
The highlights of the topic All for one and one health for all, show 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 a 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 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 road map 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’s 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 ‘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 towns and cities are home for over 30 million of stray dogs, which account to 97 percent 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 husbandary and Dairying Minister Parshottam Rupala.
It is alarming that within Asia, India has reported to have the highest incidence of rabies globally (20, 565 deaths per year) as compared to 23,700 rabies deaths per year in whole Africa. Actual picture may be more devastating, as the true number of human rabies deaths 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 Mongooses etc. After bite from rabid animal, viruses present in saliva travel at a rate of 12-24 mm per day towards the central nervous system. The incubation period of disease is from days to years. Rabies in humans develop in two forms i.e Furious and Paralytic form. Early symptoms may include fever and tingling at the site of the 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 the wound with soap and water for 10-15 minutes and the 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 year 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. cination 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 a 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. 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 methods of controlling rabies by killing 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 prevents 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 a regular basis and adopt stray dogs to control their population and educate the people about 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.
ENVIRONMENTAL JUSTICE INTEGRATION INTO ONE HEALTH
Despite the trans disciplinary nature of One Health, environmental justice ideas are rarely mentioned as a major consideration. The origins of One Health within the corpus of knowledge of Western science can be largely attributed to public health and the biological sciences, two professions that have historically battled prejudice and racism (Clark & Hurd 2020; Devakumar et al. 2020). The injustices brought about by structural and systemic racism have aggravated and impeded racial and ethnic health disparities (Clark & Hurd 2020). Therefore, One Health must particularly address how societal inequalities affect human, animal, and environmental health if environmental justice and One Health are to be effectively integrated.
A HEALTH AND ENVIRONMENTAL JUSTICE PRAXIS FOR DRIVERS
Health outcomes are subsequently categorized as a result of the lack of environmental equity across racial and economic lines. When discussing environmental justice and one health, urban green space and biodiversity are frequently at the forefront of discussions (Nesbitt et al. 2019 and Wolch et al. 2014). Environmental quality is a major factor in many of the methods by which these health inequities develop. Recent research has shown how urban environment (such as green spaces and biodiversity) is good for people’s physical and mental health (Hartig et al. 2014; Bratman et al. 2019; Methorst et al. 2021). Even while parks, green areas, and green roofs are becoming more and more popular in many cities, there are differences in the accessibility and availability of urban green infrastructure between and within cities (Wolch et al. 2014).
In a similar vein, recent studies offer convincing evidence that wealth disparity in urban areas predicts patterns of species richness and biodiversity. Neighborhoods with higher levels of economic mobility frequently have better access to urban biodiversity because of this luxury effect, which shows that socioeconomic prosperity positively predicts richness and biodiversity (Leong et al. 2018). Given that the luxury effect and biodiversity are exacerbated by increased industrial activity such as brownfield sites and highways, both of which can increase the risk of cancer and shorten life expectancy, the intersection of legacies of residential segregation, temperature and aridity gradients, and heterogeneous patterns of urban development has the potential to mitigate or negate the impacts of the luxury effect on the level of the community.
High temperature due to Urbanization
Urban heat islands are places with higher daytime and nighttime temperatures. The consequence is that neither the environment nor city residents experience significant cooling relief (Heaviside et al. 2017). This causes more heat waves, or a string of consecutive hot days, to occur (Wang et al. 2019). Fortunately, urban greening strategies like expanding shade-giving tree canopies and growing heat-absorbing flora help lessen the effects of urban heat. Heaviside et al. (2017) found that urban areas tend to be 10°C hotter than their rural counterparts and high temperatures and heat waves have been linked to increased morbidity and death, particularly in metropolitan areas, mostly because of heat-related cardiovascular and respiratory disorders. This temperature difference is mostly the result of the enormous amount of impermeable surfaces and construction materials that are present in cities that trap and hold heat (Oke 1973).
Additionally, as the world’s population becomes increasingly urbanized, the consequences of urban heat will spread out further and further. Urban heatislands can alter how infectious diseases are spread by arthropod vectors to humans and other animals. Ziter et al. (2019) study found that impermeable surfaces significantly improve overnight temperatures. These elements may combine to create the ideal environment for a particular mosquito species, especially when combined with local humidity and tree shadow. Cities already have heat islands, and climate change’s increased temperatures will have a complex effect on urban biodiversity and transform urban ecosystems. Because of the heat or the resulting desiccation of their habitats, some creatures (like amphibians) might not be able to endure higher temperatures. The ranges and breeding seasons of other, more heat-tolerant species, such as insects that resemble poikilotherms, non-native species, or invading species with significant adaptive abilities, may be extended. Unfortunately, due to restricted mobility or diminished habitat connectivity in urban areas, certain species may not be able to alter their ranges to avoid the effects of urban heat, which will undoubtedly lead to species extinction.
One Health and Social Ecological System
A social-ecological systems approach is helpful for assessing One health challenges because it recognizes the reciprocal interactions and feedback between human and natural systems. Equal consideration of social and ecological systems explains interrelationships and makes interactions quantifiable, allowing for more detailed program performance evaluations. Social-ecological systems frameworks also support the complex, dynamic, and nonlinear nature of One Health systems, which comprise several components, each of which may be challenging.
Due to the possibility that management actions targeted at one component of a system may have unexpected and unanticipated effects on other components, this complexity emphasizes the importance of understanding how these components interact. Consider taking care of city rats as an example. Almost every city on Earth has brown and black commensal rats, when sufficient resources allow for an increase in animal populations. Rats are known to harbor a range of zoonotic pathogens and viruses, and there is emerging understanding of the consequences of rat infestations on mental health, according to Himsworth et al. (2013).
Treatment:
It is important to remove the virus from the wound as early as possible by immediately washing the wound with water and soap followed by application of antiseptics that reduce/eliminate chances of nerve infection.
Rabies can be prevented by vaccinating pets, staying away from wildlife, and seeking medical care after potential exposures before symptoms start.
Symptoms:
The first symptoms of rabies may be similar to flu and may last for a few days, which includes: Fever, Headache, Nausea, Vomiting, Anxiety, Confusion, Hyperactivity, Difficulty swallowing, Excessive salivation, Hallucinations, Insomnia.
India’s Initiatives for Cure Against Rabies:
National Action Plan for Dog Mediated Rabies Elimination by 2030:
- It is a multi-pronged strategy based on One Health Approach.
- The concept of One Health recognizes that the health of people isclosely related with the health of animals, plants and their shared environment.
- In One Health approach, multiple sectors communicate and work togetherat the local, regional, national, and global levels with the goal of achieving optimal health outcomes.
Mission: To achieve zero human deaths due to dog-mediated Rabies by 2030.
Principles:
Prevention: Introduce cost-effective public health intervention techniques to improve accessibility, affordability, and availability of post-exposure prophylaxis to all people in need.
Promotion: Improve understanding of rabies through advocacy, awareness, education and operational research.
Partnership: Provide coordinated support for the anti-rabies drive with the involvement of community, urban and rural civil society, government, private sectors and international partners.
CONCLUSIONS
One health endeavor will rise as cities become increasingly prevalent in the world. Since One Health is essentially about interactions between people and nonhuman things, it is crucial to identify these fundamental relationships between people, animals, and the environment as early as possible. This will help to focus research efforts. These interactions can be utilized to identify the human and nonhuman communities that may be most in danger, as well as the geographic scope of data collection.To appropriately integrate Environmental Justice in One Health activities, researchers and practitioners must work to develop their cultural competence in order to engage with individuals from other cultures.This effort calls for increased empathy, knowledge of local history, perseverance in confronting oppressive structures, and awareness of one’s own privilege. Building these skills strengthens the basis of One Health.
REFERENCE
Clark US, Hurd YL. 2020. Addressing racism and disparities in the biomedical sciences. Nat. Hum. Behav., 4(8):774–77
Hampson K, Coudeville L, Lembo T,2015; Estimating the global burden of endemic canine rabies. PLoS Negl Trop Dis. 9(4): e0003709.
Hartig T, Mitchell R, De Vries S, Frumkin H. 2014. Nature and health. Annu. Rev. Public Health 35:207–28
Heaviside C,Macintyre H, Vardoulakis S. 2017. The urban heat island: implications for health in a changing environment. Curr. Environ. Health Rep. 4(3):296–305 .
Himsworth CG, Parsons KL, Jardine C, Patrick DM. 2013. Rats, cities, people, and pathogens: a systematic review and narrative synthesis of literature regarding the ecology of rat- associated zoonoses in urban centers. Vector-Borne Zoonotic Dis. 13(6):349–59.
LeongM,Dunn RR,TrautweinMD. 2018. Biodiversity and socioeconomics in the city: a review of the luxury effect. Biol. Lett. 14(5):20180082.
Methorst J, Rehdanz K, Mueller T, Hansjürgens B, Bonn A, Böhning-Gaese K. 2021. The importance of species diversity for human well-being in Europe. Ecol. Econ. 181:106917
Nesbitt L,Meitner MJ, Girling C, Sheppard SRJ, Lu Y. 2019. Who has access to urban vegetation? A spatial analysis of distributional green equity in 10 US cities. Landsc. Urban Plan. 181:51–79
Oke TR. 1973. City size and the urban heat island. Atmos. Environ. 7(8):769–79
Taylor LH, Hampson K, Fahrion A,2017; Difficulties in estimating the human burden of canine rabies. Acta Trop. 165: 133–140.
Taylor E, Banyard AC, Bourhy H,2019; Avoiding preventable deaths: The scourge of counterfeit rabies vaccines. Vaccine. 37(17): 2285–2287.
Wang C,Wang ZH,Wang C,MyintSW. 2019. Environmental cooling provided by urban trees under extreme heat and cold waves in U.S. cities. Remote Sens. Environ. 227(March):28– 43.
WHO Rabies Modelling Consortium:2019; The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study. Lancet Infect Dis. 19(1): 102–111.
