Bridging the Gap: Human-Animal-Environment Health for Rabies Control

Bridging the Gap: Human-Animal-Environment Health for Rabies Control

Dr. Juli Chakma¹ and Dr. Divyaprakash R Choravada²

Assistant Professor, Dept. of Animal Nutrition, IVSAH, Siksha ‘O’ Anusandhan, (Deemed to be University), Bhubaneswar, 751003

Assistant Professor, Dept. of Animal Biochemistry, IVSAH, Siksha ‘O’ Anusandhan, (Deemed to be University), Bhubaneswar, 751003

Introduction

Rabies is a severe, often fatal viral disease transmitted to humans and animals through the saliva of infected animals, typically via bites or scratches. As a zoonotic disease, rabies has a significant global impact, with approximately 55,000 human deaths reported annually worldwide (Pieracci, 2019). The virus primarily attacks the brain and spinal cord, causing acute inflammation (encephalitis) that ultimately leads to death. Clinically, rabies manifests in two primary forms. Furious rabies, affecting about two-thirds of patients, is characterized by hyperactivity, hallucinations, coordination difficulties, and extreme fear of water (hydrophobia) and air (aerophobia). Death usually occurs within a few days. Paralytic rabies, affecting the remaining third of patients, is marked by progressive paralysis of various body parts. Dogs are the primary reservoir for human rabies, accounting for over 99% of cases worldwide. However, other animals, including bats, jackals, and foxes, can also transmit the virus. While dog bites are the primary mode of transmission in Africa, Asia, and Europe, bat bites are more commonly associated with rabies cases in America. Despite its preventable nature and significant public health implications, rabies remains a neglected disease. The annual global burden of rabies is substantial, with the United States reporting approximately 5,000 cases each year. This highlights the urgent need for effective prevention and control strategies in both developed and developing countries. Rabies is a neglected tropical disease classified by the World Health Organization (WHO) alongside dengue, leprosy, and trachoma. Despite being preventable through vaccination, rabies remains a significant global health challenge, causing an estimated 59,000 human deaths annually across more than 150 countries. While the disease can infect various mammals, dogs are the primary source of human rabies, accounting for over 99% of cases (Hampson et al., 2015). Eliminating canine rabies is therefore a critical component of global efforts to eradicate this fatal illness. Recognizing the interconnectedness of human, animal, and environmental health, the One Health framework provides a comprehensive strategy to combat rabies (Lavan et al., 2017). This approach encompasses five key pillars: sociocultural, technical, organizational, political, and resource-oriented factors. To achieve the eradication goal, the alliance prioritizes three essential actions: making human vaccination and immunoglobulin accessible and affordable, ensuring timely treatment for bite victims, and implementing widespread dog vaccination campaigns in high-risk regions.

Way forward

A One Health rabies management program is at its juvenile stage. A strong political commitment along with a rigid governmental action could be crucial in making it successful. Here is a conceptual framework on how to control or manage rabies using a One Health approach (Fig. 1 and 2). Rabies prevention and management can be significantly enhanced through a One Health approach, which necessitates collaboration among human, animal, and environmental health sectors. To effectively implement this strategy within a specific national context, several key measures should be considered:

1. Systematic Data Collection and Compilation

A robust One Health approach necessitates a comprehensive and standardized data collection system to effectively monitor rabies prevalence, trends, and impact. Regular reporting enables the assessment of program progress, identification of endemic and sporadic disease outbreaks, and evaluation of socioeconomic consequences. This information is crucial for developing and implementing targeted control strategies at the national level. The non-specific nature of rabies symptoms often leads to underreporting and diagnostic challenges, particularly in areas with limited access to specialized healthcare facilities. Consequently, establishing a system that accurately captures dog population numbers, suspected and confirmed rabies cases, and overall rabies infection rates is essential for developing effective control roadmaps. Additionally, understanding human-dog population densities, vaccination coverage for both humans and animals, and conducting comprehensive data analysis are critical components of successful rabies prevention programs (Fahrion et al., 2016).

2. Coordination and Data Sharing

Effective rabies control necessitates seamless collaboration and data sharing among human, animal, and environmental health sectors. A centralized system for data collection, storage, and reporting is crucial for identifying problem areas and developing appropriate management strategies. While many countries have established formal monitoring systems, challenges persist, particularly in regions with limited resources or where rabies is considered a rare disease. In countries with low rabies prevalence, data collection often relies solely on formal surveillance systems. However, in regions like India, operational difficulties in sample submission to laboratories and inconsistent data reporting to government agencies can hinder data accuracy and completeness. To address these challenges, robust data management systems and capacity building initiatives are essential for generating reliable and actionable information.

3. Efficient and Effective Surveillance

Animal health sector traditionally prioritizes economically significant livestock diseases, often overlooking rabies. Including rabies in the national disease surveillance program would significantly enhance data collection and inform strategic mass vaccination and population management efforts (Acharya et al., 2020). A robust surveillance system is essential for determining the immune status of susceptible animal populations and understanding disease transmission dynamics (Banyard et al., 2013). Given the close proximity of humans, domestic animals, and wildlife, controlling rabies in wildlife is crucial for preventing spillover to domestic animals and humans (Eisinger and Thulke, 2008). Large-scale oral vaccination campaigns targeting wildlife, particularly foxes, raccoons, and coyotes, have proven successful in other countries (Frueling et al., 2013; Costa et al., 2012) . Implementing a similar approach, with a focus on ecological and epidemiological factors, could significantly reduce the risk of rabies transmission. By distributing oral rabies vaccine baits in natural habitats, buffer zones, national parks, community forests, and suburban areas, it is possible to mitigate the threat posed by wildlife rabies.

4. Sufficiency and Availability of Post-Exposure Prophylaxis (PEP)

Post-exposure prophylaxis (PEP) is the cornerstone of human rabies prevention following exposure to a potentially rabid animal. Timely access to PEP is critical in preventing disease progression and fatalities. While urban areas often have better access to both pre-exposure prophylaxis (PrEP) and PEP through government and private healthcare facilities, rural populations face significant challenges in accessing these life-saving interventions. To achieve the goal of zero human rabies deaths by 2030, ensuring widespread availability of PEP is paramount. An integrated dog bite case management (IBCM) approach, which involves collaboration between public health and veterinary sectors, can enhance the assessment of rabies risk for both humans and animals, leading to more effective interventions. While IBCM can provide immediate benefits, long-term rabies control requires a comprehensive strategy encompassing local, national, and international efforts. By strengthening surveillance systems, promoting vaccination, and implementing effective animal population management programs, it is possible to significantly reduce the burden of rabies and ultimately eradicate the disease (Undurraga et al., 2017).

5. Increasing Vaccine Coverage

Mass dog vaccination is a highly cost-effective strategy for rabies control. While compulsory dog vaccination is not a standard practice, achieving a vaccination coverage of at least 70% of the dog population is crucial to significantly reduce rabies incidence and human exposure. Investing in mass vaccination campaigns offers long-term benefits in terms of cost-efficiency and public health. To maximize the impact of vaccination efforts, implementing robust dog registration, confinement, and compulsory vaccination policies is essential. Additionally, booster vaccinations are crucial for maintaining immunity levels and preventing vaccine failures. By combining these strategies, it is possible to effectively control rabies in both human and animal populations.

6. Increasing Vaccine Efficacy

Vaccination is a cornerstone of rabies prevention. However, vaccine efficacy can be compromised by factors such as improper storage, transportation, handling, and manufacturing defects. Ensuring both the quality and efficacy of the vaccine is paramount for successful rabies control programs.

7. Increasing Awareness

Effective public awareness campaigns are crucial for combating any epidemic, including rabies. Unfortunately, many communities lack essential knowledge about rabies due to factors such as low literacy rates, socioeconomic disparities, and the disease’s relatively low priority status. To address this issue, public awareness programs should focus on educating communities about dog vaccination, the availability of post-exposure prophylaxis (PEP), and preventive measures to avoid dog bites.

8. Strengthening Laboratory Capacity

Enhanced diagnostic capabilities through well-equipped laboratories are essential for effective rabies control. Implementing preventive measures such as vaccination programs necessitates accurate and timely diagnostic data. While India has some laboratories meeting international standards, expanding accessibility and improving laboratory services remains crucial. Rapid diagnostic tests can expedite initial screening, but they should complement, rather than replace, comprehensive laboratory investigations. Relying solely on clinical signs for diagnosis can lead to inaccurate results. Therefore, ensuring both the availability and affordability of reliable laboratory services is vital for effective rabies control and surveillance

9. Research Activities

To comprehensively understand rabies epidemiology, transmission dynamics, and socio-economic impacts, conducting field research is essential. By identifying associated risk factors and local disease patterns, informed strategies for multi-sectoral rabies management can be developed.

Key research areas include:

• Epidemiological Studies:Investigating the magnitude of rabies infections through the development of robust assessment tools.
• Diagnostic Advancements:Improving the accessibility and affordability of diagnostic tests for early detection.
• Population Management and Awareness:Promoting responsible dog ownership, implementing humane population control measures, and enhancing public awareness about rabies prevention and management.
• Data Collection:Gathering comprehensive data on dog populations, including size, turnover, accessibility, and ownership status, to inform control strategies.
• Community Engagement:Collaborating with NGOs, community-based organizations, and media to disseminate information about rabies prevention, PEP, and first aid for animal bites.

These research efforts will contribute to the development of effective rabies control programs and ultimately reduce the human and animal burden of this preventable disease.

Conclusion

Rabies remains a significant public health challenge, necessitating a comprehensive and multi-sectoral approach. The One Health framework provides a robust foundation for addressing this complex issue. By combining systematic data collection, effective surveillance, enhanced laboratory capacity, and targeted public awareness campaigns with a strong emphasis on vaccination and post-exposure prophylaxis, it is possible to make substantial progress in rabies prevention and control. Interdisciplinary collaboration, coupled with research and innovation, are crucial for overcoming the challenges posed by rabies. Through concerted efforts at local, national, and international levels, the ultimate goal of rabies elimination can be achieved.

References

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