Rabies: A Model for One Health Success

Human Rabies is a neglected zoonotic disease having a very high case fatality rate among all the vaccine preventable diseases. Rabies prevention is a classic “One Health” challenge which doesn’t fit into domain of any single department. It needs close working collaboration and coordination between human and veterinary sectors (both government & private) extended to community practice. It requires engaging communities and health workers to build awareness about the problem, prevent animal exposures, provide post-exposure prophylaxis, prevent rabies transmission by managing mass dog vaccination and dog population. However, rabies elimination efforts have been fragmented and uncoordinated across various stake holders and regions. All known interventions for rabies elimination are rarely applied simultaneously.

Government of India launched National Action Plan for Dog mediated Human Rabies Elimination (NAPRE) using “One Health approach” by 2030 on 28th September 2021, under National Rabies Control Programme. More than 96% of human rabies in India occurs due to exposure to dog. In India, the number of persons dying due to dog mediated human rabies has reduced to 5,726 (Jeromie Wesley Vivian Thangaraj et al., APCRICON 2024, Bhubaneswar, Odisha, Aug. 2024) from 20,000 (WHO-APCRI National Multicentric Rabies Survey, 2003-04).

Presently, 21 state governments have made human rabies a “Notifiable Disease” and even many state veterinary departments have made animal rabies a “Notifiable Disease”. Now Integrated Disease Surveillance Programme - Integrated Health Information Platform (IDSP-IHIP) portal is being strengthened to capture information on human rabies, animal bite/exposures and other zoonotic diseases across the country, both in government & private sectors.

All state governments, professional organizations and others shall conduct regular public awareness programmes / Information, Education, and Communication (IEC) activities regarding prevention of animal bites, especially among school going children and to take post exposure prophylaxis as early as possible, especially lifesaving rabies immunoglobulin or rabies monoclonal antibodies in case of bleeding wounds. World Rabies Day observed on 28th September can be a good occasion to create public awareness.

Government of India has started “Rabies Free City Initiatives” which is a critical step towards rabies elimination through interventions like providing post exposure prophylaxis for bite victims, pre-exposure prophylaxis for high-risk groups and mass dog vaccinations. Five cities in Karnataka were chosen viz. Bangalore (Tier-1 city), Belgaum, Mangalore, Hubli Dharwad and Mysore (Tier-2 cities).

Model Anti-Rabies Clinics (ARC) shall be started at all medical colleges and district hospitals in the country to provide post-exposure rabies prophylaxis and upload the data on IDSP-IHIP portal. On the lines of “National One Health Mission”, each and every state government shall establish “One Health Secretariat / Directorate”. They will regularly conduct Inter-sectoral coordination meetings or the State level Joint Steering Committee chaired by Chief Secretary or Additional Chief Secretary will direct all the concerned departments to share the data from their department and implement the state specific strategies.

In view of efforts towards elimination of dog mediated human rabies by 2030, name of “National Rabies Control Programme” is to be changed to “National Rabies Elimination Programme”. Accordingly, objectives and strategies also need to be changed with increased allocation of funds for the programme to meet the desired goal.

As done in Universal Immunization Programme (UIP), the rabies vaccines and RIG/RmAbs must be obtained by the central government and provided to all the state governments and union territories as grant-in aid under National Rabies Elimination Programme, since resources and political commitment vary from state to state.

Lastly, a phased, multipronged strategy based on close coordination, cooperation, collaboration and communication between human, veterinary and other sectors with “One health approach” is necessary to make India “Dog mediated human rabies free by 2030”.