Opportunities and challenges to Eliminate Dog Mediated Rabies in India
Saurabh Tiwari1, Debajyoti Sarkar2, Abhijeet Fernandes2, Prabha Sharma3 1Ph.D. scholar, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh 2Ph.D. scholar, ICAR-National Dairy Research Institute, Karnal, Haryana 3Ph.D. scholar, Lala Lajpat Rai University of Veterinary & Animal Sciences, Hisar, Haryana
Abstract
Rabies is a zoonotic disease affecting wide range of warm-blooded animals and accounts for large number of annual deaths worldwide. Several animals harbour and spread the virus, among which humans are the dead end host interacting most frequently with dogs and bats. In India, reports indicate a high prevalence of dog bite cases followed by death, owing to high stray dog population, lacking adoption of post-exposure prophylaxis and poor knowledge about animal behaviour. To achieve rabies free status, a holistic approach is required globally to break the transmission cycle, control the stray dog population, vaccinate the animals and educate the public. Adequate funding from government, stringent implementation of policies and public support could successfully meet the goals to eliminate the disease.
Introduction
Rabies is a fatal disease of all warm-blooded animals caused by Lyssa virus of the family Rhabdoviridae. It is a bullet shaped, neurotropic virus, affecting the nervous system, and is characterized by aggressiveness and progressive paralysis which terminates to death due to respiratory failure. The spread of rabies is most likely through a bite as the virus is present in the saliva 4 days before the onset of the symptoms. The respiratory route of transmission occurs in very rare cases, man to man transmission through corneal transmission has been reported, whereas, transmission of disease through unpasteurized milk is theoretically possible, however, it has not been reported yet. The onset of clinical signs depends upon the distance of bite wound with central nervous system. This virus initially spread through the nerve @ speed of 12-14 mm per day and later @ 200-400mm/day to reach the brain. To date, maximum incubation period of disease has been reported to be 35 years. The disease is also known as ‘Jalantaka’, which is attributed to hydrophobia in infected human beings. In India, only six cases of full recovery from the disease have been reported, such an example is a 13 year old girl “Sarika”, form Thane, Maharashtra. Despite the progression of symptoms, such incidences of recovery bring us a hope similar to burning of match stick in a deep dark room.
Epidemiology of the disease
In India, rabies is an endemic disease where about 20,000- 30,000 annual deaths occur out of worldwide 59,000 annual deaths (National Health Portal, GOI), and 90% of affected population constitutes of children from age group 5 to 15 years old. The disease is persistent in the wild among carnivores, bats, raccoons and skunks which act as a reservoir. An animal may not manifest the signs and may be a carrier, which possess more threat to the highly-dense dog populated area. The information regarding state-wise distribution of stray dog population is quite unorganized and witnesses unrestrained growth of dog population, thus, leading to increase in dog bite cases. Despite the implementation of ABC program to reduce the stray dog menace, bite incidences still appear uncontrolled. For instance, between 2008 and 2018, about 1.91 lakh dog-bite cases have been reported in Bengaluru.
Manifestation of disease in humans and animals
In animals, the disease is manifested in two forms: furious form and dumb/paralytic form. The furious form is characterized by aggressiveness, where pet animal manifests decreased ability to recognize its owner, wild animal loses fear of natural enemies, ingestion of inedible items, etc. In the contrary, an animal rarely attempts to bite in dumb/paralytic form; cattle display abnormal bellowing and drooling of saliva, while horses and mules may show colic signs. In humans, hydrophobia, aerophobia, and nervous signs like agitation, confusion, difficulty in swallowing, convulsions, and unconsciousness appear, which culminates to death. The virus has been reported to survive as long as 12 years in frozen mouse carcasses. Virus may reach domesticated dogs or stray dogs following ingestion of infected prey species.
Roadmap to eliminate rabies in India
Many countries have been declared as rabies-free due to strict implementation of guidelines by the competent authority of the country to control stray dog population, mass vaccination of stray dogs and ensuring pet dogs to be vaccinated through pet licensing. Under the prevalent circumstances of high stray dog population and endemic nature of disease, certain elimination strategies for rabies have been discussed. These can be drafted and implemented with best use of available resources and considering prevalent socio-economical constraints in our country.
Fig. 1. A holistic approach to eliminate rabies
- Extensive extension activities to address the problem
Rabies is often neglected because deaths following infection are scattered and never exceed to the levels to cause an epidemic crisis. A study describes that only about 70% of Indians have heard of rabies, only 30% know regarding washing of wounds following a dog bite, and only 60% of dog-bite victims get vaccinated (Sudarshan et al., 2006; Ichhpujani et al., 2006). Because of this fact about a lack of knowledge among the masses, generating awareness, especially among weak socio-economic class is quite necessary. It is often observed that children are playing with the newly born pups, throwing stones at dogs, develop human-animal clashes, however, the aggressive and inconceivable behaviour of rabid dog often leads to biting incidents. Due to less attention to the higher population density of stray dogs in areas with poor economic strata, territorial clashes among dogs during breeding season poses an increased risk of dog biting. In such areas, following identification of sick animals, people should be encouraged to report competent authorities like veterinary hospitals and NGO’s engaged in ABC programs. This could significantly improve the animal welfare practices with a reduction in incidences of dog bite and rabies infection.
Vaccination programs should be carried out at frequent intervals rather than organizing free vaccination programmes on important days like world rabies day, world veterinary day, etc. Awareness could also be created using audio-visual aids to disseminate the knowledge regarding clinical signs apparent in different animals and miserable suffering in humans after onset of clinical signs, followed by death. Knowing about the deadly fate of disease could create imprint social awareness to greater extent among people. Continuous efforts are required in extension activities to spread the awareness and achieve the goals without losing the momentum.
- Judicious use of social media, journals and active public participation
In 21st century, people tend to invest more time with gadgets on social media, instead of interacting with the physical world. Simple news gets viral within hours of leak, which could make social media to serve as an affordable medium to all classes of society to spread a highly impactful message among the masses. Over time, a soft corner has also developed among people against violence or poor treatment towards stray dogs. Social media could be used to encourage people to adopt stray or abandoned dogs as pets and take responsibility for their judicious breeding, which could control their population and improve welfare practices towards animals. Moreover, the pet owners should be encouraged to keep their pets at a distance from stray dogs and follow the vaccination schedule strictly. People are also required to be familiar with the seriousness of the dog bites from a suspected/rabid animal and approach for help without any panic. People should be encouraged to learn primary management of a dog bite wound until medical assistance arrives. In a case of dog bite, the wound should be irrigated thoroughly with soap and water for at least 10 minutes followed by post-exposure vaccination.
In mass media like television, radio, and newspapers, regular broadcasting of programs dedicated to rabies has a potential to generate awareness among a large section of society, thus, preventing and avoiding rumours or panic following rabid dog attacks. Nukkad nataks, plays in schools and extensive advertisements with help of hoardings in places most frequently visited by people could also add up to the efforts of generating awareness.
- Introducing animal welfare practices to school curriculum
The children are the best learner and audience with extreme curiosity in their minds about exploring interesting subjects. Schools can attract the children and enlighten them regarding animal behaviour and their body language, improve human-animal interaction by teaching them about the do and don’ts with the animals; nurture empathy with some playful activities and audio-visual interactions. Children of age-group (about 5-15 yrs old) should be vaccinated for pre-exposure prophylaxis in areas of the rampant dog population.
- Role of a veterinarian:
A veterinarian with its holistic knowledge regarding the disease and welfare practices plays a pivotal role in preventing transmission of zoonotic diseases. Moreover, people not aware of the symptoms in rabid animals might expose themselves while husbandry practices or interacts with an infected pet. A veterinarian can potentially educate pet owners or those engaged in farm activities with animals, which could break the transmission cycle of disease from animals to humans. The disease transmission through dog bites could chiefly be controlled by ABC program and without veterinarians, it seems to be impossible. All this necessitates the role of a veterinarian to achieve success in achieving rabies-free status for our country.
- Government and public participation in Animal Birth Control (ABC) programme
Various NGO’s and government hospitals are dedicated to spay dogs to control undesired and unmanageable population growth. People should come forward to spay their pets to prevent unwanted puppies, control dog population, and prevent them from ailments like mammary tumours, pyometra, etc. The government could play a vital role in controlling rabies by taking measures such as necessary licensing to have a pet animal, which ensures regular vaccination of dogs for rabies and prevent them to be abandoned by the owners. Strict implementation of regulations to control the population of stray dogs by adopting ABC program is also required. Promoting indigenous breeds of dogs like Chippiparai, Bakarwal, Rajapalayam, etc. or pedigree breeds as pets with proper breeding, treatment, and vaccination could reduce the problem of stray dogs. Kennel Club of India entertains identification and registration of purebred dogs, but our country lacks a strong monitoring agency to supervise incidents of zoonotic transmission of diseases such as rabies.
Vaccination is a tricky task in stray dogs as proper identification of animals is difficult, which could be tackled with proper implementation and expanding scale of activities carried out in ABC programs. Government or NGO’s should be assisted in terms of cooperation and financial support, but strict monitoring is also required to ensure the welfare practices carried out by them. Motivating people to adopt stray dogs at an early age could be another alternative.
Mass vaccination of about 70% of dog population in an area in a short period, with restriction of the dog movement to prevent spill over could hasten the pace to eliminate rabies. At the field level, to make it a success, enormous financial resources, and manpower is required, which is a major hurdle in the implementation of such guidelines and financial assistance from the government could accelerate its success rate.
There is a need for ‘one-health approach’ involving collaborative efforts of veterinarians, medical experts, epidemiologists, biologist, forest department and, public itself to curb the increase in endemic status of rabies in India. The management of disease also requires an epidemiological aspect, where humans should not disturb the ecological harmony to transmit the disease from wild animals (sylvatic cycle) to domestic animals/pets and eventually human beings. To tackle the sylvatic cycle, the movement of people to unauthorized forest areas and trafficking of wild animals or their products should be restricted and penalty should be implemented for breaking the rules. The vaccination of wild animals at the interface of forest and human dwellings through oral baits could serve as an option, but requires enormous inputs and planning. Oral baits are usually a fishmeal polymer blocks, coated sachet baits, or commercially available baits like Rabigen/Rabidog (Virbac laboratory, France), etc. which are usually air-dropped in a large area of forest.
Conclusions
A holistic and unique approach is required to curb the transmission of rabies among animals and humans. Mass vaccination and sterilization, an increase in manpower for ABC programs and generating awareness among masses are vital to control the stray dog population and reducing the dog-bite cases. Pre-exposure prophylactic treatment in humans could ensure the reduction in case fatality. To achieve the goal, stringent planning and implementation are required from grass root level along with advancement in research for early diagnosis and absolute cure for the disease.
