CONTROL AND ERADICATION OF RABIES IN INDIA
Barathiraja S*
Dept. of VBC, Rajiv Gandhi Institute of Veterinary Education and Research, Kurumbapet, Puducherry, India.*barathirajasnew@gmail.com. 8098507404.
INTRODUCTION
Rabies is a Zoonotic viral disease caused by lyssavirus (negative-sense single-stranded RNA virus which is enveloped and have bullet-shaped geometry) of the family of Rhabdoviridae. The disease is prevalent in all continents, except Antarctica with over 95% of human deaths occur in Asia and Africa regions. Globally about 80% of human rabies cases occur in rural areas and children at 5-14 years of age are frequent victims of death1. The situation is more pronounced in India and the country reports about 36% of the world’s rabies deaths2. Available data from the National Health Portal of India clearly indicate the severity of disease (i.e.) major public health concern in India causing about 20,000 deaths annually3.World organization for animal health (OIE: Office International des Epizootics) reports that around 99% of human cases are due by the bite of rabies- infected dog4. The health of Human and animal are interdependent in the globalized world and majorly influenced by the ecosystems in which they co-exist. So, ‘one health concept’ approach is essential to prevent any Zoonotic diseases especially rabies5. Louis Pasteur’s (27.12.1822 to 28.08.1895) risky move saved a boy who had been severely attacked by a feral dog from almost certain death by using attenuated rabies vaccine (in the year 1885)6. Annually, world rabies day is celebrated on 28th September (marks the anniversary of Louis Pasteur death) to raise the awareness about control and prevention of rabies.
AWARENESS ON DISEASE TRANSMISSION
It is important to know the mode of disease transmission, so that the possible strategies can be followed for the control of the disease. The disease is endemic in India and is transmitted within the animals and between the human beings and animals by bite of infected animals (transmission through saliva), especially by dogs (Figure. 1A). The incubation period of rabies (time between the bite of infected dog and the development of signs and symptoms of disease) is typically 2-3 months but may vary from one week to one year7. The people should stay away from rabies infected dogs to avoid the disease. Figure 1B lists the tips to be followed probably to avoid dog bites.
VACCINATION AND WOUND MANAGEMENT
Post-exposure prophylaxis (PEP) measures include wound management and vaccination. Immediately after dog bites, the wound should be washed with soap for 15 minutes (Figure. 3) and approach medical persons for anti-rabies vaccine and immunoglobulin treatment based on the type of wound.
Figure.3: Rabies post-exposure prophylaxis7.
NATIONAL RABIES CONTROL PROGRAMME
National centre for Disease Control (NCDC) functioning under Directorate general of Health Services, Ministry of Health and Family welfare, Government of India (GoI) implemented National Rabies control Programme (NRCP) for the control and prevention of rabies in India. The prophylaxis vaccine dose and site of vaccine is indicated in the guidelines. The vaccine should have stated potency of ≥2.5IU per IM dose, irrespective of reconstituted volume. In case of category III wounds, equine or human rabies immunoglobulin should be administered intramuscularly. Pre-exposure prophylaxis may be offered to high-risk populations such as laboratory staff handling the virus or infected material and come in contact with rabies cases, Veterinarians, animal handlers, and dog catchers. The Indian Association of Pediatrics (IAP) recommends pre-exposure prophylaxis to children on a voluntary basis. Three dose of vaccine is recommended on 0, 7 and 21 or 28th day (0.1ml intra-dermal) 12.
Table.1. Management of wound in dog bites1.
Category of wound Description Post-exposure prophylaxis
Category I Licks on intact skin or contact of intact skin with secretions or excretions of rabid animal. PEP is not required if the history is reliable.
Category II Nibbling of uncovered skin, minor scratches or abrasions without bleeding. Vaccine should be administered as soon as possible.
Category III Single or multiple transdermal bites or scratches, licks on broken skin, contamination of mucous membrane with saliva form licks and exposure to bats. Vaccine and rabies immunoglobulin should be administered as soon as possible. Immunoglobulin can be administered up to 7 days of first dose of vaccine.
Table.2. Vaccination schedule to be followed for dog bite cases (Site of injection: Deltoid muscle in adults and anterolateral thigh for infants and small children12.
Types of Prophylaxis Route of administration Dose of vaccine Day of dose No. of injections Total no. of visits
Post exposure Prophylaxis Intra Dermal 0.1ml per dose Day 0,3, 7 and 28 2 4
Intra Muscular 1 entire vaccine vial Day 0,3,7,14 and 28 1 5
Pre Exposure Prophylaxis Intra Dermal 0.1ml per dose Day 0, 7 and booster on either day 21 or 28 1 3
Intra Muscular 1 entire vaccine vial Day 0, 7 and booster on either day 21 or 28 1 3
Re-exposure Intra Dermal 0.1ml per dose Day 0 and 3 1 2
Intra Muscular 1 entire vaccine vial Day 0, 7 and booster on either day 21 or 28 1 1
Figure.4: Approaches for control and Prevention of Rabies.
CONCLUSIONS
Someone dies from rabies every nine minutes around the world. The vaccine for the rabies was found successful in the year, 1885 by Louis Pasteur. But still, the disease is difficult to control in all over the world, especially in India, the country with high dense population. It is very clear that ‘No bites No rabies’. So, avoid dog bites especially in case of rabies infected dogs. The children are at high risk of rabies and the reason being, they do not aware about the disease, cannot escape from dog bites as like adults and may not report to the parents or guardians after dog bite or scratch. It is more important to focus on children as they are frequent victims of rabies death. The children should be informed about the rabies especially during school time. The book chapter on rabies at each level could be quite useful for the control of the disease. There is a need for public awareness through mass media communication. Pre-exposure prophylaxis will also protect the risky population against rabies. Wound management in terms of washing immediately, antiseptic and, suture (if needed) are essential. Based on the requirements, rabies immunoglobulin needs to be administered.
As per the one health concept, ‘protect the animals to preserve human life’. Dogs should be vaccinated annually (first dose at three months of age). Dog owners need to follow the complete regime of treatment during post-bite vaccination (0, 3, 7, 14, and 28 day). There is a need to focus on street dogs about the rabies vaccine. Veterinary graduates and Non-Government Organizations (NGOs) in collaboration with the government need to address the issue of street dogs. The awareness program in case of rural and urban areas should be different in terms of providing the information. People should be informed about personal hygiene, especially during and after handling of animals. Frequent vaccination campaigns for dogs at each village could be more effective to prevent rabies in dogs, which are the major source of disease transmission with the human population. The presence of volunteers at every village level may help the government to prevent the disease. The people in the community should be informed about vaccination and also the location of primary health centre (PHC) and veterinary dispensary. They should be informed that, there is nothing to panic by dog bite, let them wash the wound with soap for 15 minutes immediately and get vaccinated as soon as possible. If the bite is at very far from the brain, they can get vaccinated within 24 hours (need not to rush to hospital and not to involve in unnecessary arguments with health takers). The antirabies vaccine programme should be centralized, so that, any person can get vaccinated at any PHC (beyond the state of domicile). Mission rabies charity (launched in September 2013) is a great lead initiated by Worldwide Veterinary Service (WVS). It follows one health approach and they keep involving dog vaccination, in India. The notable contributions include a 6 month campaign at Goa, India to sterilize 20,400 dogs and a ring vaccination of risk dogs at that area. In the year 2017, they have reached 92,000 vaccinations in India (including international volunteer projects in Ranchi) and they continue to do it13. There is a need of collaboration among medical health professionals, veterinary graduates, NGOs and government officials to control the rabies, so that the aim of ‘Goal of zero rabies by 2030’ can be achieved
.“Collaborate, Vaccinate and Eliminate Rabies”.
https://www.pashudhanpraharee.com/updates-on-control-eradication-of-rabies-in-india/
REFERENCES
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- National Health Portal, India. https://www.nhp.gov.in/world-rabies-day-2019_pg.
- OIE. https://www.oie.int/animal-health-in-the-world/rabies-portal/
- OIE. https://www.oie.int/en/for-the-media/onehealth/).
- VBI vaccines. https://www.vbivaccines.com/wire/louis-pasteur-attenuated-vaccine/
- WHO. Fact sheet. https://www.who.int/news-room/fact-sheets/detail/rabies.
- Pearson Education, 2004. Inc., publishing as Benjamin Cummings PowerPoint Lecture
- https://rabiesalliance.org/sites/default/files/resources/201802/Five_tips_to_prevent_dog_bites_poster.pdf.
- WHO.https://www.who.int/neglected_diseases/news/Rabies_WHO_has_published_new_recommendations_for_immunization/en/
- WHO. Prophylaxis guidelines. https://www.who.int/rabies/PEP_Prophylaxis_guideline_15_12_2014.pdf.
- National centre for Disease Control (NCDC). 2019. https://ncdc.gov.in/WriteReadData/linkimages/GuidelinesforRabiesProphylaxis.pdf.
- Missionrabies. http://www.missionrabies.com/projects/india/.
