RABIES: ALL FOR ONE, ONE HEALTH FOR ALL

RABIES: ALL FOR ONE, ONE HEALTH FOR ALL

Dr. Mukul Gabhane¹, Dr Renu Singh², Dr. Diksha Singh¹ and Dr Prashant rokade¹

MVSc Students, Department Of Veterinary Pathology, DUVASU¹, Mathura

            One health could be a collaborative, multisectoral, and transdisciplinary approach—working at the nearby, territorial, national, and worldwide levels—with the objective of accomplishing ideal wellbeing results by recognizing the interconnection between individuals, creatures, plants, and their shared environment. All for one” communicates the duty each and each one of us has within the fight to dispense with rabies. All individuals can work towards one health, and everyone can contribute to sparing a life. Communities can work together to assist person individuals and creatures, and everybody can work towards a single objective viably. A single person making a qualification, to a community, to our one objective, to how one immunized animal secures all, and how a single course of Post Introduction Prophylaxis can save a life.

The One health approach is the foremost fruitful demonstrate that has been embraced by numerous nations for Rabies end. The target for Rabies disposal can as it were be accomplished by maintained and synergistic political commitment and authoritative back of all partners from the most noteworthy level up to the town level. One health Approach is the all-inclusive recognized implies and a sound way of understanding complex issues and challenges by tackling the ability of concerned partners over the divisions. The Rabies avoidance and control by “One health Approach” is additionally challenging within the Indian Setting due to shifted authoritative structures and needs over divisions included at the National and sub-national levels. The key challenges for realizing one health within the setting of Rabies are as beneath:

The key challenges for realizing One Health in the context of Rabies are as under:

1. Lack of understanding about One Health Concept among the concerned stakeholders.
2. The priorities are different for different sectors and accordingly poor and inadequate resource allocation for undertaking activities and achieving the target.
3. Fragmented activities of animal health components such as dog population management and mass dog vaccination across the sectors.
4. Poor surveillance, reporting of human and animal rabies cases and lack of structured mechanism of data sharing across human and veterinary sectors.
5. Large Stray dog population both in urban, peri-urban and rural areas.
6. Biodiversity and challenging wildlife sector at urban, peri-urban and rural interface resulting in spillover.
7. Limited logistics and poor supply chain management for undertaking the activities of Human and animal health components.
8. Lack of awareness among professionals as well as general communities about the legal framework.

“Rabies could be a 99.9% dangerous, 100% preventable disease.” September 28 is World Rabies Day. Established in 2007, World Rabies Day focuses to raise mindfulness around the world’s deadliest irresistible illness and offer help the world come together to fight the disease. It centers on continuing to work towards eliminating rabies around the world, getting a handle on the One Health approach to rabies control, which suggests collaborating over human, animal, and normal fragments and Centering on the “Zero by 30” objective to decrease rabies passings in people to zero universally by 2030.

Rabies could be a dangerous zoonotic disease mostly  transmitted to people through bites from infected dogs. Each nine minutes, someone in moo- and middle-income nations passes on from rabies, undoubtedly in spite of the fact that this disease is completely preventable. As one of the deadliest zoonoses known to us, rabies still kills around 59,000 people each year, speaking to both a overpowering open health and financial burden. Of these cases, around 99% are procured from the chomp of an tainted canine. Each nine minutes, some person in moo- and middle-income countries kicks the bucket from rabies. This Dog-mediated rabies kills thousands of people each year in India, speaking to one-third of the evaluated around the world rabies burden. Rabies causes dynamic and inflammation of the brain and spinal cord which clinically happens in two forms:

1. Furious rabies – characterized by hyperactivity and hallucinations.
2. Paralytic rabies – characterized by paralysis and coma.

Rabies is entirely preventable disease and can be eliminated by applying a systematic One Health approach. Vaccines, medicines and technologies have long been available to prevent death from rabies. However, this ancient disease still threatens the lives of millions of people in up to 150 countries. Rabies today is largely a disease of poverty, almost always linked to dog bites, with most deaths occurring in neglected communities in Africa and Asia. Despite the existence of proven control strategies and agreement on the path to eliminating human rabies deaths, mortality numbers from rabies remain high. Now, the World Health Organization (WHO), World Organization for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) have set a target for global dog-mediated human rabies elimination by 2030. This Rabies control programs offer a practical route to building One Health capacities that can also address other zoonotic threats, including those with pandemic potential.

India is estimated to suffer the greatest rabies burden of any country, Although the timely delivery of human post-exposure prophylaxis (PEP) prevents death from rabies, focusing on the post-bite treatment of people (a dead-end host) has no impact on the incidence of rabies in the canine reservoir population, leaving other members of the community vulnerable to acquiring the disease. The effectiveness of mass dog vaccination in eliminating rabies from the reservoir animal population, and thereby preventing viral transmission to humans, has been known for over a century, enabling dog-mediated rabies to be eliminated in numerous countries. Modern rabies management highlights the importance of achieving zoonotic disease prevention and control through consideration of human, animal, and environmental components in a One Health approach.

Dog-mediated human rabies can be eliminated by tackling the disease at its source: infected dogs. Making people aware of how to avoid the bites of rabid dogs, to seek treatment when bitten and to vaccinate animals can successfully disrupt the rabies transmission cycle.

The burden of disease is disproportionally borne by rural poor populations, with approximately half of cases attributable to children under 15 years of age.

As one of the deadliest zoonoses known to us, rabies still kills around 59,000 people every year, representing both a heavy public health and economic burden. Yet it is 100% preventable if we address the disease through a one health approach.

Transmission of Rabies occurs when saliva containing the rabies virus is introduced into an opening in the skin, usually via the bite of a rabid animal. Though rare, transmission can also occur through infected saliva contacting mucous membranes (eyes, nose and mouth) or a scratch or other break in the skin. The potential for these rarer modes of transmission creates the need for laboratory and biologics workers and other at-risk people to use personal protective equipment. Masks and goggles or face shields protect mucous membranes, while gloves and gowns cover any breaks in the skin.

Once the virus enters the nervous system, rabies post exposure prophylaxis (PEP) is no longer effective and death is almost inevitable. Since clinical signs and symptoms in humans do not appear until after the virus enters the nervous system, it is futile to wait for the appearance of clinical signs and symptoms to start PEP. Hope for the development of an effective treatment once the virus has entered the nervous system still lies in the heart of rabies research.

Its variable incubation period is one of the many mysteries of rabies. Another problem is its unpredictable manifestation of a wide array of clinical signs. These signs and symptoms are pretty much what you’d expect if you had rabies in humans. You might feel a twinge or twitching at the bite, have trouble swallowing, be afraid of water, change your voice or make sounds like a dog, have some kind of autonomic instability like slow heart rate and hyperalivation, change in your behaviour, not being able to move your arms or legs, having a hard time moving your face, being sensitive to things like light, sound, and touch, having a fear of flying, having involuntary muscles twitching, being paralyzed, having paresis, and a bunch of other things. If a bite of a potentially rabid animal occurs, immediately follow these steps:–

• Wash the bite wound with soap and water
• Promptly seek medical attention and guidance from a physician.
• Take rabies PEP

By Focusing on mass vaccination of animals and dog population management are key, but the latter should follow animal welfare guidelines. Inhumane killing and torturing of animals must be strictly prohibited via government initiatives, and if putting down animals is the only available option, in such cases inhumane killing of animals should be replaced by lawful euthanasia. Similarly, pet ownership and public safety records can be made available with a legislative provision for mandatory registration. Population management of street or community dogs can also be done by animal birth control techniques such as spaying and castration. Prior to these activities, an effective data collection and reporting system is required.

A One Health approach has proven successful in several neighbouring countries such as Bhutan, Bangladesh and Sri Lanka. Only seventeen cases of rabies have been reported from Bhutan between 2006 and 2016.

No single sector can eliminate rabies on its own. Knowing that animal, human and environmental health is intrinsically interconnected, the health of animals impacts everyone’s health. In the case of dog-mediated rabies, only a coordinated response across sectors will allow us to bring the number of human deaths from dog-mediated rabies to zero.

In a single bite, a rabid dog can infect a person. It is therefore essential to limit human exposure to rabies by tackling the disease at its animal source. Implementing large-scale dog vaccination, promoting responsible dog ownership, and raising awareness of the available solutions are all critical actions against rabies that require a comprehensive and holistic approach. Cooperation between animal health and human health professionals is crucial.  Not only does it have a positive impact on the livelihood and economy of communities, but also lays the foundations of stronger health systems that have the capacity to respond to zoonotic threats beyond rabies.

Building a coordinated response against rabies will set the path for the control of other zoonotic diseases. When working towards our common goal of “Zero human deaths from dog-mediated rabies by 2030”, we are not only focusing on the efforts needed in the animal health sector. Pivotal actions are needed from the human health sector, including giving access to human medical care and post-bite treatment, especially in rural areas with limited or non-existent access to health education campaigns and where 80% of human rabies cases occur.

While we have all the tools to end dog-mediated rabies, including high-quality vaccines for dogs and humans, it has proven difficult to successfully coordinate and invest sufficient resources in its control. Rabies still circulates in two-thirds of the countries worldwide, sustaining poverty in endemic areas. Yet it is rarely targeted by formal surveillance systems. Consequently, the presence of the disease and the related social and economic burden are often greatly underestimated. This, in turn, leads to neglect by policymakers and funding agencies.

Rabies elimination should be better prioritised and investing in its progressive control also offers an opportunity to strengthen public health systems more broadly and to improve equity and access to care for all. Rabies is a very telling example of how operationalising One Health at all levels can contribute to a world that is better able to prevent, predict, detect and respond to health threats, thus improving the health of humans, animals and the environment.

The elimination of human deaths from dog-mediated rabies is one of the priorities. We call on countries worldwide to take the necessary steps to ensure a coordinated One Health response to this deadly zoonosis. Rabies may still be fatal, but it is also highly preventable. It only takes a unified effort to make sure that human rabies deaths become history.

As part of the ‘Zero by 30’ strategy to end human deaths from dog-mediated rabies by 2030, international organizations recommend a One Health framework that includes Integrated Bite Case Management (IBCM). However, little is understood about the implementation of IBCM in practice. This study aims to understand how IBCM is conceptualized, exploring how IBCM has been operationalized in different contexts, as well as barriers and facilitators to implementation. Four main themes were identified:

1) Stakeholders’ and practitioners’ conceptualization of IBCM and its role in rabies elimination

2) Variation in how IBCM operates across different contexts

3) Barriers and facilitators of IBCM implementation in relation to risk assessment, pep provisioning, animal investigation, one health collaboration, and data reporting

4) The impact of the covid-19 pandemic on IBCM programs.

This study highlights the diversity within experts’ conceptualization of IBCM, and its operationalization. The range of perspectives revealed that there are different ways of organizing IBCM within health systems and it is not a one-size-fits-all approach. The issue of sustainability remains the greatest challenge to implementation. Contextual features of each location influenced the delivery and the potential impact of IBCM. To design and implement future and current programs, guidance should be provided for health workers receiving patients on assessing the history and signs of rabies in the biting animal. The study findings provide insights in relation to the implementation of IBCM and how it can support programs aiming to reach the Zero by 30 goals.

There are several challenges for   reducing the burden of rabies within their populations. First, to control and eliminate rabies high vaccination coverage, typically around 70% of the susceptible dog population must be sustained for 3-7 years via recurrent annual campaigns. Second, post-exposure prophylaxis (PEP)—which is needed immediately after a bite from a rabid dog to prevent the fatal onset of rabies—is often expensive for both bite victims and governments. As a result, PEP availability is frequently limited, especially in rural areas. PEP costs can even drain the finite budget available for rabies, without impacting the incidence of rabies in dog populations that are the source of exposures. Third, surveillance is typically weak and does not capture accurate data on either human or animal rabies cases. This significant under-reporting leads to a lack of awareness and understanding of the burden of rabies, which further results in limited community/stakeholder engagement and inadequate funding. Thus, the absence of robust surveillance gives rise to a cycle of underestimating the disease burden and consequently neglecting control measures, such as dog vaccination and PEP provisioning.

To overcome these challenges, the Tripartite [World Health Organization (WHO), World Organisation for Animal Health (OIE), Food and Agriculture Organization (FAO)] along with the Global Alliance for Rabies Control (GARC) developed the ‘Zero by 30’ global strategic plan to end human deaths from dog-mediated rabies by 2030. Within this strategy, international organizations jointly recommend a One Health framework, recognizing the interconnections between the health of humans, animals, and their shared environment. To control and eliminate rabies, the strategy advocates Integrated Bite Case Management (IBCM). WHO describes IBCM as an advanced surveillance method involving “investigations of suspected rabid animals and sharing information with both animal and human health investigators for appropriate risk assessments. Through multisectoral collaboration and communication, this One Health approach aims to enhance surveillance by increasing the detection of animal cases and human exposures, as well as to improve PEP allocation and compliance.

Role of Veterinary Sector in Rabies elimination includes, as at the Centre, Ministry of Fishery, Animal Husbandry and Dairying, GOI will be the key stakeholder and nodal agency for technical guidance to the states for the activities planned under the animal health component. The program in the States will be implemented through the State Veterinary Department, Veterinary colleges, Municipalities, and Panchayati Raj Institutions. Some duties assigned to veterinarians are :

• Advocacy with different stakeholders for prioritizing animal Rabies to achieve commitment at all levels so that resources could be mobilized for the elimination of Rabies.
• Mapping of high risk, medium risk and low risk areas of Rabies in association with health department and other stakeholders.
• Ensure uninterrupted supply of logistics (money, manpower and material) for undertaking strategic mass vaccination and ring vaccinations activities for the areas targeted for Rabies elimination.
• Capacity building for Veterinary Professional, Paravets, dog catchers, post-vaccination survey staff and other allied personnel.
• Strengthening of Rabies diagnostic laboratories from the veterinary sector.
• Intersectoral coordination and sharing of information on Rabies the health and wildlife health sector to facilitate better implementation.
• To be part of joint investigations whenever there are human Rabies cases or increasing dog bite cases.
• Coordinate with different stakeholders/agencies/international organizations (e.g., FAO, OIE, WHO, SAARC) for technical support on Rabies prevention and control.
• Regularly publishing and updating technical guidelines on animal Rabies.
• Regulation of Rabies sera and sera-producing pharmaceuticals as per the Drugs and Cosmetics Act, 1940 and rules in vogue.
• Monitor and evaluate the control programs implemented by the field units.

Coordinate and conduct operational research on Rabies in collaboration with national, international, diagnostic and research institutions.

Establishment/strengthening of check-post/quarantine centres since unvaccinated as well as diseased animals can easily enter and introduce Rabies in areas where Rabies cases have reduced.

Veterinary Colleges & Veterinary Universities can incorporate training of veterinary students on Mass Dog Vaccination (MDV) and Mass Dog Population Management(MDPM) as per norms of Animal Welfare Board of India.

Increase the involvement of veterinary students in activities of MDV and MDPM during their routine internships.

CONCLUSION

Rabies, a viral zoonotic disease has been haunting humanity from long time ago. Despite of all the preventive measures, Rabies remains the serious zoonotic concern. Recent, rabies control programs offer a great example to operationalize One Health – building the structures and trust that are crucial to establish systems for other zoonotic diseases, including those that are pandemic-prone. Ensuring equitable access to health services and rabies post-exposure prophylaxis for underserved communities not only saves lives but also strengthens national health systems. With the mission of Zero by 30, we have shared a global goal. Together in unity we can eliminate rabies, leaving no one behind. The theme further emphasizes the importance of equality, and strengthening overall health systems by ensuring that One Health is not for a select few but rather something that should be available to everyone. By collaborating and joining forces across sectors, engaging communities and committing to sustain dog vaccination, together as 1 we can work towards 1 goal to eliminate 1 disease to make One Health available to all – using rabies as the example.

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ONE HEALTH APPROACH: THE NEED OF THE HOUR

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