END RABIES: COLLABORATE, VACCINATE

END RABIES: COLLABORATE- VACCINATE

Dr. Srikanth Vallabhaneni, M.V.Sc. Scholar,
Sri Venkateswara Veterinary University, Tirupathi, Andhrapradesh, India – 517502 .
Contact @ 7989487841, srikanthvety20@gmail.com

Introduction:

Rabies is an acute viral disease that causes fatal encephalomyelitis in virtually all the warm-blooded animals including humans. Rabies is an enzootic and epizootic disease of worldwide importance. It is one of the oldest diseases affecting humans and one of the most important zoonotic diseases in India. Globally, 2 persons die every hour due to rabies.
The virus is found in wild and some domestic animals, and is transmitted to other animals and to humans through their saliva (following bites, scratches, licks on broken skin and mucous membrane). In India, dogs are responsible for about 97% of human rabies, followed by cats (2%), and others (1%).
Cats, wolf, jackal, mongoose and monkeys are other important reservoirs of rabies in India. Cow, buffalo, sheep, goat, bear, pig, donkey, horse and camel have occasionally been involved in transmission. Rabies from bats, rodents and squirrels has not been conclusively reported from India. The average incubation period is between 30- 90 days. It ranges between 2 weeks and 6 years. Factors which may influence the length of the incubation period include the site of bite, the amount of virus in saliva of the biting animal, and the age and immune status of the victim. The proximity of the site of virus entry to the CNS increases the likelihood of a short incubation period.
The disease is invariably fatal and perhaps the most painful and dreadful of all communicable diseases in which the sick person is tormented at the same time with thirst and fear of water (hydrophobia).
Fortunately, development of rabies can be prevented to a large extent if animal bites are managed appropriately and in time. In this regard the post-exposure treatment of animal bite cases are of prime importance. Roughly 36% of the world’s rabies deaths occur in India each year, most of those when children come into contact with infected dogs.

Control and Prevention Strategies:

Rabies is preventable through effective interventions like

1. Awareness of rabies disease engages communities and empowers people to save themselves by seeking the care they need. This includes an understanding of how to prevent rabies in animals, when to suspect rabies, and what to do in case of a bite.
2. Pre exposure Prophylaxis (PrEP): Persons who are at a high risk of contracting rabies (veterinarians, those working in rabies research or diagnostic laboratories, animal handlers including bat handlers, wild –life officers, people travelling to high risk areas, children) should be offered pre-exposure prophylaxis. Serological testing should be done every six months in all people who are at high risk. A booster is recommended if the titre falls below 0.5 IU.
3. Strengthening diagnostic capabilities: Diagnosis of rabies in most situations is done by clinical symptoms and signs suggestive of rabies with or without a history of animal bite in the past. Rabies can be confirmed by virus isolation, detection of anti-rabies antibody, viral protein or RNA. Rabies specific antibody can be detected in serum or cerebrospinal fluid (CSF) samples. Human saliva or brain biopsy material can be used for virus isolation. Rabies antigen can be best detected by immunofluroscence of brain biopsy material or peripheral innervated tissues. Other tests include PCR, detection of viral RNA by reverse transcription polymerase chain reaction (RT-PCR), PCR-ELISA, real-time PCR, hemi-nested PCR, Nested PCR Flouroscent Antibody Test (FAT), Rapid Immunodiagnostic test (RIDT)/Direct Rapid Immunohistochemical Test(dRIT), Cell culture and Mouse inoculation test, Rapid fluorescent focus inhibition test (RFFIT) and fluorescent virus neutralization test (FVNT). However, all the above tests may yield a falsely negative result even after the onset of symptoms so more than one test should be used to confirm rabies.
4. Proper Treatment of Exposed Animals and Humans: Treatment should include proper wound management, passive immunization with RabiesImmunoGlobulin (RIG), Active immunization with Anti Rabies Vaccine (ARV).
5. Post-exposure prophylaxis (PEP) consists of a series of rabies vaccines and, in some cases, rabies immunoglobulin (RIG), administered after a suspected exposure to rabies. Appropriate wound management and prompt access to quality-assured PEP is almost 100% effective in preventing human rabies deaths.
6. Mass dog (both Pet and Stray) vaccination is a proven, cost–effective way to save human lives by stopping transmission of rabies at its source. While a variety of animal species can host rabies, dogs are responsible for 99% of human cases. Eliminating rabies in dogs is therefore key to sustainably preventing human disease.
7. Controlling Dog Population: India has a dog population of around 25 million and an estimated dog: man ratio of 1:36. The policy of Animal Birth Control (ABC) should be adopted and strictly implemented.
8. Generating awareness about rabies amongst school children and initiating Rabies Awareness campaigns in the community will go a long way in control of rabies.
9. Strong political commitment would definitely boost the importance of this fatal but preventable disease.
10. Improving the management of animal bite cases by training of health professionals, operationalizing the Intradermal Dermal route of Immunization in selected centres, facilitating wider coverage of postexposure prophylaxis (PEP), and making PEP cost effective and reachable to the remote village level.
11. Ensuring availability of rabies vaccines and Immunoglobulins (RIG) at all Health Centres.
12. Supporting Non Governmental Organizations: The NGOs and Animal Welfare organization in the country would also play an active role during mass vaccination campaign, creating public awareness on rabies, and by providing fund support for rabies control program
13. Strengthening surveillance including Clinical Surveillance (Syndromic, During Outbreak), Laboratory Surveillance (Serological, Virological), and Wildlife Surveillance.
14. Research and Development of novel vaccines and treatment options to control the disease.
15. Dog Movement Control/ Management: Cross border movement should accompany certificate of vaccination, health certificate and shipping permit.
16. Organizational and one health framework for rabies elimination: Although various sectors, groups, and organizations may initiate rabies control initiatives, Veterinary Services and Human Health Services should take leadership in their overall coordination and promotion in the country. This will facilitate the streamlining of activities to effectively eliminate rabies.
17. Strong Regional, National, International coordination, Inter-sectoral coordination, and Public-private partnership.
18. Policy and legislative framework for rabies elimination including High-level political support, Legislation and Enforcement, Resource mobilization.
    Conclusions and future perspectives:
    More than 30 years ago, the global eradication of smallpox demonstrated that well supported surveillance campaigns are essential to reduce and potentially eliminate an infectious disease. Fortunately, a great deal of progress has been made against rabies.
    Animal management, including public education, responsible dog ownership and vaccination strategies, have been identified as the keystone of modern control programs. Using this model, the connection between rabies in dogs and humans has been clearly demonstrated through the successful elimination of canine rabies.
    The key priorities in the fight against rabies are enhanced laboratory capabilities, improved access to modern vaccines, enforcement of responsible dog ownership, and enhanced public education and awareness of the disease.
    With an emerging global economy, India clearly must implement mechanisms to reduce and eliminate rabies. To reduce rabies in humans, authorities should make the control and prevention of canine rabies a public health priority.
    The overall national strategy should include improved animal surveillance through laboratory diagnosis, a more rapid response to human exposures (with provision of post exposure prophylaxis, PEP) and education of the public and health care providers.

““ TOGETHER WE CAN ERASE RABIES ””

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