Zero Human Deaths due to Dog-Mediated Rabies by 2030- Can India do it?

A global call to eliminate dog mediated rabies by 2030 has been given by World Health Organization (WHO) and its partners in rabies control a few years back in 2015 and countries like India, which contribute to nearly 1/3rd of estimated rabies deaths in the world have aligned their strategies towards achieving this goal. Having achieved polio-free status through a concerted effort of multiple stake holders, India can surely do it, provided a sustained effort based on one health vision is adhered to for the next few years. The impediment in the country’s march towards this goal seems to be multi-pronged, i.e., cultural, social and economic. Further, budgetary constraints on local bodies prevent regular Catch, Neuter, Vaccination, and Release (CNVR) activities compounded by the prevailing prevention of cruelty to animal laws. A large estimated dog population of around 65 million (30 million pets & 35 million strays) do not make the situation any easier.

Estimates of mortality in India due to human rabies, an invariably fatal zoonotic disease, ranges from around 20,000 as per Association for the Prevention and Control of Rabies in India – World Health organization (APCRIWHO) survey of 2004 to about 12,700 symptomatically identifiable furious rabies deaths estimated by the Million Deaths study (MDS). About 96-98% of these deaths are attributed to dog bites. The National Health profile data shows a very low mortality of 55 deaths in humans due to rabies in 2021. In the past few years, as National Rabies Control Program assumed importance, as vaccine and Rabies Immunoglobulin (RIG) availability for PostExposure Prophylaxis (PEP) increased, human deaths due to rabies in India would definitely have come down substantially; but to what extent is debatable.

A recent work by APCRI-WHO in 2017 has revealed that 88.9% of animal bite victims sought treatment at healthcare facilities, but only 16% received RIG for category III exposure, highlighting the lacunae in the use of RIGs. Around 39.5% of the surveyed population had no idea of rabies as per the same report, signifying the low level of awareness in the population. A few studies have also revealed that a percentage of practicing doctors are not aware of the newer developments in PEP like Intradermal Rabies Vaccination (IDRV) and are apprehensive of adverse events following RIG administration. Suitable Information Education Communication (IEC) activities tailored to these sections are available and can be useful in increasing their current level of awareness and knowledge regarding rabies and its prevention.

The recent National Action Plan for Dog mediated Rabies Elimination (NAPRE) has framed its strategic priorities on the lines of the global action plan based on ‘one health’ vision. It requires a synchronized effort from all stake holders including the state and district program management units. Further, increased intersectoral coordination between veterinary and human health professionals and departments will make the task much easier because though animal rabies is also a notifiable disease, the ground reality is far from satisfactory due to various difficulties faced by the veterinary and animal husbandry departments, including shortage of trained manpower.

With an expanded vision and goal of achieving zero human deaths due to rabies by 2030, the National Rabies Control Programme (NRCP) is focusing on -

a. Advocacy for maintenance of a regular uninterrupted supply of Anti Rabies Vaccine (ARV) and Anti Rabies Serum (ARS) up to PHC level for timely Anti Rabies PEP for all animal bite victims and utilization of funds available under National Free Drug Initiative (NFDI) for procurement of ARV and ARS.

b. Establishment of model anti rabies clinics at district level.

c. Training on appropriate animal bite management, prevention and control of rabies, surveillance and inter sectoral coordination.

d. Strengthening surveillance of animal bites and rabies deaths reporting.

e. Creating awareness about rabies prevention

f. Strengthening inter-sectoral coordination with veterinary, municipal corporation and Panchayat raj institutions.

g. Support to the states under National Health Mission (NHM) for states and district level operationalization of the program activities as envisaged under NAPRE.

In our state, the pioneer of a dedicated Anti Rabies Clinic (ARC) is KIMS. Some medical colleges in the government sector like BMCRI, MIMS and HIMS are successfully managing animal bites with dedicated Anti Rabies Clinics at their centres using the intradermal route of vaccination for post exposure prophylaxis. More such centres, at least in the district headquarters housing government medical colleges is the need of the hour. Non-availability of vaccines due to various issues in government sector hospitals has been addressed effectively in the last few years making PEP more accessible to the common man.

Including animal bite prevention and treatment in state curriculums aimed at an appropriate age group would enhance awareness among children about PEP as about 40-50% mortality due to rabies is reported in children. If all of us work together, achieving the goal of zero deaths due to dog mediated human rabies by 2030 in India will not be difficult.