WORLD RABIES DAY
Rabies, undoubtedly is a deadly and one of the oldest diseases known to mankind and has been widely documented by the earliest human civilizations. Going through history, the origin of the word Rabies is either from the Sanskrit “rabhas” (to do violence) or the Latin “rabere” (to rage). The ancient Greeks called Rabies “lyssa” (violence). Rabies is a highly fatal major zoonotic disease that affects the central nervous system of humans and animals, resulting in fatal encephalitis (inflammation of the brain), nervous system disorder and death.
Rabies is a vaccine-preventable viral disease present in more than 150 countries around the world. Globally, almost 59,000 people die each year from dog mediated rabies. Most of the deaths are estimated to have occurred in Asia (59.6%) and Africa (36.4%), with especially high incidences in India, Pakistan and Bangladesh. Among ancient zoonotic diseases, rabies is one of the most demonian and feared infectious disease, even though it has huge public health significance because treatment is rarely successful. Public awareness about prevention is crucial for controlling the disease and saving the lives of humans and animals. Despite being a preventable disease, impact of rabies is increasing day by day, which is a worrisome issue in developing and developed Nations.
Rabies in our country is transmitted commonly by dogs and cats around 97%, followed by wild animals (2%) such as mongoose, foxes, jackals and feral dogs, and occasionally by horses, donkeys, monkeys, cows, goats, sheep and pigs. Apart from humans, Rabies also causes significant mortalities among livestock animals such as bovine, cattle and small animals. People are usually infected following a bite or scratch from rabies infected animal and transmission to humans by rabid dogs account for up to 99% of cases. Rarely the disease can also be transmitted from non-bite exposures, which can include scratches, abrasions, or open wounds that are exposed to saliva or other potentially infectious material from a rabid animal. Contraction of Rabies through inhalation of virus-containing aerosols or transplantation of infected organs is described, but extremely rare. Human-to-human transmission through bites or saliva is theoretically possible but has never been reported/ confirmed. The same applies to transmission to humans via the consumptions of raw meat or milk of infected animals. In some parts of the world, it is reported that Rabies can be transmitted through the exposure of bat. In India so for there is no evidence to suggest the presence of bat transmitted Rabies.
Many control measures have been designed to eradicate the rabies with the concept of Zero human rabies death by 2030. However, due to lack of multi-sectoral management approach on rabies control, the rabies cases are on a rise. Rabies is a challenging human and animal health concern that requires a multipronged as well as interdisciplinary strategy for prevention and control. Rabies is a classic ‘One Health’ challenge: around 99% of human Rabies deaths arise from exposure to a rabid dog, vaccinating at least 70% of at-risk dogs is the cheapest and most effective way to stop rabies transmission between canines and from dogs to humans. Standard animal vaccines for providing pre-exposure prophylaxis to dogs and human vaccines for providing optimum post-exposure prophylaxis to dog bite victims needs to be made available. Efforts must be made to ensure access to affordable vaccines for bitten individuals, especially those who live in rural, impoverished, and underserved areas.
Finally, empowering local communities by making everybody aware of the fact that rabies can be avoided, they can have their dogs vaccinated and they should always seek appropriate medical care in case of a dog bite. Rabies is a typical example of a zoonotic infection that does not fit into the domain of any single department having the responsibility of controlling Rabies. Although there is an animal reservoir involved, mortality and morbidity mainly affect human beings. Therefore, for prevention, control and elimination of Rabies an effective and concerted effort from the Animal Husbandry sector, Human Health sector, Local governing bodies, communities and other stakeholders, is the need of the hour.
Realizing the need of “One Health” the Administration has successfully developed multi-disciplinary road-map to combat Rabies by way of National Action Plan for dog-mediated Rabies Elimination (NAPRE) and the same needs to be implemented in the Union Territory of Jammu & Kashmir, in letter and spirit. The Action Plan involves wider consultation across the stakeholders wherein a joint strategic framework has been chalked-out to implement the One Health approach, which is based on recommendations of various international agencies like World Health Organization, World Organization of Animal Health (OIE) and Global Alliance for Rabies Control.
Under NAPRE efforts have been made to ensure availability of Anti Rabies Vaccine (ARV) and Anti Rabies Serum (ARS) to all animal bite victims at all levels of health facilities. Organizing necessary capacity building sessions for professionals in appropriate animal bite management and encouraging pre-exposure prophylaxis for High-Risk Groups. Robust and effective IEC campaigns need to be made and encouraging Public-Private Partnership through involvement of NGO, local communities, etc. Strengthening inter-sectoral coordination mechanism between the Veterinary and Medical sectors for regular sharing of reports/ data on animal Rabies and set up guidelines for joint responses for Rabies outbreaks. Efforts have been made for estimation of canine population, identification of high risk zones and further science based planning and implementing strategic mass dog vaccination programme, followed by post vaccination assessment which has been taken on priority.
Effective dog population management, promoting responsible dog ownership and proper solid waste management are important areas which have been very much taken into consideration. For successful implementation, all stake-holders were involved in the planning process, raising awareness on the disease with active mobilization of NGOs, community-based organizations, animal welfare societies, media, leaders and other influential groups. Promotion of operation research, strengthening surveillance and diagnostic capacities with respect to Rabies were prioritized by the Administration.
Rabies being primary example of a disease at the animal-human-environment interface: cases in dogs, humans and livestock are directly correlated. For making elimination of rabies possible, all relevant sectors have to collaborate, communicate, coordinate and work together. Together, we can find concrete solutions for a healthier and more sustainable world. If we do not act now, hundreds of thousands of people will die of rabies before 2030. By promoting collaboration across all sectors in a coordinated way, a One Health approach can achieve the best health outcomes for people, animals and plants in a shared environment thereby achieving rabies prevention, control and eradication.
(The Author is a Veterinarian and Technical Officer (Poultry), Directorate of Animal Husbandry Kashmir, Red Cross Road, Gaw Kadal, Srinagar Kashmir)