Unleashing Hope: One Health’s Promise to End Rabies

Unleashing Hope: One Health’s Promise to End Rabies

Akshara Babu, MVSc Scholar, Guru Angad Dev Veterinary and Animal Sciences University, Punjab, India

Rabies, an ancient and deadly infectious disease that has haunted humanity since 500 BC, continues to cast its evil shadow over our world even today. According to the Food and Agriculture Organization (FAO), this noxious virus claims the lives of approximately 59,000 individuals each year, painting an extremely disturbing picture of the constant battle against this silent killer. To put it in even starker terms, this translates to one life lost to rabies every 9 minutes on a global scale, a grim reminder of the urgency to fight against this relentless foe.

Despite significant progress, rabies still poses a serious threat to human and animal health in many parts of the world, including India, making ongoing efforts in vaccination and public education critical to its control. This essay will explore multiple dimensions of rabies, encompassing its global impact, preventive strategies, hurdles in eradication, successes in the ongoing battle, and the indispensable role of sustained global cooperation and commitment in completely eradicating this age-old menace from our world.

Understanding Rabies: The Dreadful Menace

Rabies is a universally fatal viral disease that affects mammals, including humans through the saliva of infected animals, commonly dogs. This viral enemy is a mere envelope-wrapped strand of RNA, susceptible to common chemicals. But don’t be fooled. Once it infiltrates a human or animal body, it takes a treacherous journey that often culminates in fatal complications and death.

Domestic and wild canids serve as reservoirs of the rabies virus, acting as silent carriers capable of transmitting this deadly disease to both humans and other animals. Dogs and bats are responsible for all known human rabies infections. The transmission primarily occurs through bites, scratches, or even seemingly harmless mucosal contact with the infected animal’s saliva. According to the World Health Organization (WHO), about 99% of human rabies cases are caused by dog bites, making dogs the primary source of rabies-related deaths in humans. Upon entry into a human or animal host, a cloth of uncertainty covers the duration this insidious virus takes for the first ominous symptoms to manifest – a period we term the incubation period. The duration of this dangerous waiting game is a complex web of variables, intertwined with factors such as the bite’s location and severity, along with the volume of virus transferred. This temporal dance, conducted within the afflicted host, unrolls differently for each victim, rendering the predictability of this perilous malady a perpetual enigma. Though rabies typically boasts a relatively short incubation period, spanning from a few weeks to several months, there have been instances where the incubation period is exceptionally long. In such cases, the virus remains dormant in the body for an extended period before manifesting as clinical rabies. One such report from India details the tragic journey of a 48-year-old individual who developed rabies symptoms more than two decades after his initial exposure to the virus (Shankar et al., 2012). This revelation, like a rare wisp of fog, invites us to ponder the depths of rabies’s mysterious nature, where its secrets continue to challenge our understanding of this old and lethal malady.

Rabies symptoms in both humans and animals can be divided into two distinct stages: the prodromal stage and the furious or dumb (paralytic) stage. The prodromal stage in humans is marked by fever, headache, and general discomfort, whereas it often goes unnoticed in animals. In the furious form, both humans and animals exhibit extreme agitation, aggression, hyperactivity, and erratic behaviour, accompanied by muscle spasms and a fear of water (hydrophobia) due to laryngospasms. On the other hand, the dumb or paralytic form shows muscle weakness, paralysis, and a lack of aggressive or agitated behaviour. Individuals or animals with paralytic rabies may appear lethargic, excessively drool, and have difficulty swallowing. Ultimately, both forms progress toward total body paralysis, leading to respiratory failure, coma, and death.

The Global Burden of Rabies

While the menace of rabies is a global concern, the developing countries in Asia and Africa bear the heaviest burden of this disease. These regions are caught in the grip of an ongoing battle against this ancient scourge. India alone is responsible for around 36% of the world’s rabies deaths, while the exact toll of the disease here is unknown. Furthermore, the WHO statistics reveal a horrifying reality: 40% of these infections strike innocent children under the age of 15, robbing them of their childhood and a future filled with promise. Isn’t it truly alarming that we continue to lose tens of thousands of lives to an entirely preventable disease? Yes, you read it right.

Rabies: A 100% Preventable Disease

Rabies serves as a chilling reminder of the power of vaccinations and public health initiatives. Despite the terrifying nature of rabies, it can be entirely averted through a combination of the following approaches. While no single action can eradicate rabies on its own, the collective implementation of these below-mentioned strategies can work wonders in combating this grievous disease.

1. Education and Awareness: Rabies is often said to be a disease of neglect. The fundamental knowledge of immediate wound cleaning with soap for 15 minutes, followed by seeking medical care for post-exposure prophylaxis, should be imparted to people from all walks of life, regardless of their formal education. Introduction of rabies education in schools, using easily understandable visuals and hands-on drills to instruct children on preventing potential bites and guiding them on proper actions in the event of a bite, should be undertaken. It is essential to address the tendency among children to hide dog bites from their parents, fostering open communication so that parents can take appropriate measures.
2. Vaccination: The cornerstone of rabies prevention resides in the vaccination of animals, chiefly dogs, which are the primary source of human rabies exposure. Mass vaccination campaigns for both stray and pet dogs are integral in curbing the disease’s transmission cycle within dog populations.
3. Stray dog population reduction: Efforts to reduce the stray dog population through effective animal birth control measures should be sustained in conjunction with the promotion of responsible pet ownership.
4. Mitigation of wildlife reservoirs: Continuous surveillance and initiation of the use of bait rabies vaccines for wildlife reservoirs is pivotal in reducing its prevalence in the wild.
5. Enhanced Surveillance: Effective tracking of rabies outbreaks is vital. Advanced integrated surveillance systems and adequate data sharing help in enabling timely interventions and closely monitoring the progress of vaccination programs.
6. Pre-exposure prophylaxis: Groups that are at utmost risk of rabies infection like veterinarians, animal rescuers, children, pet owners, puppies, ecologists, wildlife specialists, etc. should receive a pre-exposure vaccine course to prime the body against the infection and thereby reduce the impact of natural infection.
7. Post-Exposure Prophylaxis: Getting early and appropriate medical help after potential rabies exposures plays a central role in preventing the development of symptoms and saving lives. It’s also very important that post-exposure treatment involving vaccines and immunoglobulins should be easily available and affordable, especially in places with limited resources.

Challenges to Combat Rabies

In the persistent battle against rabies, formidable challenges persist on multiple fronts. Unwavering determination and sustained efforts are essential to triumph over this cunning virus.  Resource limitations, especially prevalent in low-income countries, pose an obstacle in the fight to eradicate this fatal disease. In India and other developing nations with endemic rabies, it is crucial to establish effective notification systems for rabies in animals. Accurate data recording of cases in humans and animals should be made stringent. Research for the development of cost-effective and easily accessible vaccines is ongoing. Efforts should be made to produce more affordable immunoglobulins for wider accessibility. Simultaneously, innovative surveillance and control strategies are being explored, injecting hope for a rabies-free world. Amidst these challenges, a shared commitment to saving lives prevails, as the global community takes bold steps towards a safer and healthier future.

The One Health’s Promise

Numerous global organizations, such as WHO, World Organization for Animal Health (WOAH), FAO, and Global Alliance for Rabies Control (GARC) have joined forces in the battle against rabies, fostering collaboration, capacity building, research, and vaccination initiatives united under the banner ‘Unite Against Rabies.’ The strategic plan to eliminate human rabies by 2030 centres on the One Health approach, uniting experts from diverse fields, including human and animal health professionals, epidemiologists, wildlife experts, environmental scientists, and policymakers. A remarkable success story (Gibson et al., 2022) emerged in Goa, India, where human dog-mediated rabies cases dropped from 17 in 2014 to zero in 2018-19, despite an increase in dog bite incidents during the same time frame. The state also recorded a remarkable 92% decrease in confirmed canine rabies cases, providing a blueprint for other regions to aspire to a rabies-free status. It is a resounding reminder that progress is possible, and the seemingly unconquerable threat of rabies can be defeated. This achievement marks a significant milestone on the path towards a world without rabies.

Towards a Rabies-free World

The journey towards a rabies-free world is no longer an unattainable dream but a tangible reality, fuelled by the unwavering commitment of global organizations and the implementation of the One Health approach. The One Health approach emerges as a beacon of hope and a powerful catalyst for change. As we stand on the cusp of the third decade of the 21st century, the united efforts of organizations, experts, and advocates at all levels have already yielded remarkable results. With concerted efforts, collaborative research, and innovative vaccination campaigns, we are making remarkable strides in reducing the incidence of rabies, as exemplified by the success story in Goa, India. The promise of One Health to end rabies is an embodiment of hope unleashed, transforming a once-dreaded menace into an achievable challenge, sparing countless lives and ensuring a safer, rabies-free world for generations to come. World Rabies Day serves as a reminder of our shared commitment to this vital cause, emphasizing the critical need for ongoing global cooperation and widespread awareness in our collective fight against this disease.

References

1. Food and Agriculture Organization. (2017). Towards a rabies-free world as unparalleled global initiative gets underway. https://www.fao.org/news/story/en/item/1040394/icode/
2. Gibson, A.D., Yale, G., Corfmat, J. et al. (2022). Elimination of human rabies in Goa, India through an integrated One Health approach. Nat Commun.13(1), 2788. https://doi.org/10.1038/s41467-022-30371-y
3. Park, K. (2021). Park’s Textbook of Preventive and Social Medicine. (26^th Edition). M/s Banarsidas Bhanot Publishers.
4. Shankar, S. K.; Mahadevan, Anita; Sapico, Silvano Dias; Ghodkirekar, M. S. G.; Pinto, R. G. W.; Madhusudana, S. N. (2012). Rabies viral encephalitis with probable 25-year incubation period!. Annals of Indian Academy of Neurology, 15(3), 221-223. | DOI: 10.4103/0972-2327.99728. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424805/
5. World Health Organization. (2023). https://www.who.int/news-room/fact-sheets/detail/rabies
6. World Health Organization. Rabies in India. https://www.who.int/india/health-topics/rabies
7. World Health Organization. (2017). Towards a rabies-free world as unparalleled global initiative gets underway. https://www.who.int/news/item/28-09-2017-towards-a-rabies-free-world-as-unparalleled-global-initiative-gets-underway

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