All pet dogs should receive parental vaccinations and all stray dogs should be given oral vaccine against rabies through baits
Rabies disease has terrified humans from times immemorial. In past, crude, inhumane and unscientific methods such as burning the site of dog bites by hot iron rods were used. Ultimately, Louis Pasteur developed a vaccine against rabies by attenuating the virus through its passage in rabbits. Rabies is a deadly disease caused by a bullet shaped neurotropic single stranded RNA (ss RNA) virus known as Lyssavirus. Once clinical symptoms appear, rabies is virtually 100 percent fatal. Rabies is a zoonotic disease and in up to 99 percent of cases, domestic dogs are responsible for rabies virus transmission to humans. While rabies is a 100 perent vaccine preventable disease, more than 59,000 people die from the disease around the world each year.
September 28 is World Rabies Day, a global health observance started in 2007 to raise awareness about rabies and bring together partners to enhance prevention and control efforts worldwide. The theme for the 14th World Rabies Day-2020 is “End Rabies: Collaborate and Vaccinate.” The World Rabies Day is one of the largest global awareness days and preparations for its observance begin worldwide during the month of April when the annual theme is chosen and announced.
World Rabies Day is an opportunity to reflect on our efforts to control this deadly disease and remind ourselves that the fight is not yet over. Major health organizations including the World Health Organization (WHO), the World Organization for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) and certain NGOs such as the Global Alliance for Rabies Control (GARC) have pledged to eliminate human deaths from dog-transmitted rabies by 2030.
The theme for World Rabies Day-2020 “End Rabies: Collaborate and vaccinate,” has three components. (1) End rabies: a reminder that we have 10 years to end human deaths from dog rabies and that we can raise awareness at the global level through the End Rabies Now campaign; (2) Collaborate: we need to continue collaboration at the international, national and local levels to eliminate rabies, especially keeping in mind that it’s a disease that knows no borders and (3) Vaccinate: vaccination of high risk people needs to be done and we also need to vaccinate dogs to prevent rabies at its source so that we can reach elimination.
In countries of South-Eastern Asia, Rabies is still an important public health problem. An estimated 45 percent of all deaths from rabies occur in this part of the world. The situation is especially pronounced in India, which reports about 18 000 to 20 000 cases of rabies a year and about 36 percent of the world’s deaths from the disease. Rabies incidence in India has been constant for a decade without any obvious declining trend. This situation is rooted in a general lack of awareness of preventive measures, which translates into insufficient dog vaccination, an uncontrolled canine population, poor knowledge of proper post-exposure prophylaxis on the part of many medical professionals, and an irregular supply of anti-rabies vaccine and immunoglobulin (RIG), particularly in primary-health-care facilities.
In India, rabies affects mainly people of lower socio-economic status and children between the ages of 5 and 15 years. Indian children often play near stray dogs which are many and roam freely. The children are used to sharing their food with these dogs which results in frequent bites. In one study most children attacked by dogs were unaware of having been bitten and their parents often ignored the attacks or simply treated the wounds by applying indigenous products such as hot peppers or turmeric. Only a few parents sought medical advice, usually with delay.
According to one study only 70 percent of the people in India have ever heard of rabies and only 30 percent know to wash the wounds after animal bites. Of those who get bitten, only 60 percent receive a modern cell-culture-derived vaccine. Ironically, in this era of mass communications and advanced health systems even physicians sometimes know little about proper prophylactic measures following animal bites. A report from a medical college showed that most medical interns were not very familiar with proper post-exposure prophylaxis because during training they saw few cases of animal bite, which were managed in other specialized hospitals.
It is crucial to administer anti-rabies immunoglobulin (RIG) immediately after a bite categorized as severe (grade III). But erroneous wound categorization by health-care providers, especially in cases presenting late for treatment, greatly increases the chances that rabies will develop. Intradermal vaccination, recommended by the World Health Organization (WHO) in low-resource settings, has been practiced recently in India because of its lower cost and high immunogenicity.
All pet dogs should receive the parental vaccinations and all the stray dogs should be given the oral vaccine against rabies through baits (that is dog foods laced with oral rabies vaccine) and stray animals should be sterilized to reduce the vector population. All children, who are the most frequent victims of bites, should be vaccinated against rabies as pre-exposure prophylaxis, particularly in areas with an uncontrolled dog population.
Several measures must be taken to control rabies effectively. Public education campaigns need to be conducted to make people aware of the existence of rabies, especially in remote areas, and of the vital importance of seeking medical care immediately after an animal bite. Steps must be taken to ensure the uninterrupted availability of vaccines and anti-rabies immunoglobulin (RIG) in all hospitals and in remote primary-health-care centers.
Primary care providers should be trained to administer proper prophylaxis, including intradermal vaccination. Medical colleges need to provide interns with sufficient training and exposure to animal bite management. The primary school curriculum should include developing rabies awareness among students.
Author is an alumnus of SKUAST-K with Masters Degree in Livestock Production and Management (LPM)