“A bite from a mad dog is more dreaded than anything I know; which arises from the horribleness of the disease, the uncertainty of the animal’s being mad, or of the infection being received: The not knowing at what period to expect the effects, or to feel confident of having escaped it, keeps the person in a state of cruel suspense for months, or even years.”—Daniel Johnson, Sketches of Field Sports as followed by The Natives of India with observations on the animals (1822). India carries the worst burden of human rabies fatalities caused by dogs worldwide. Despite this, rabies remains a low priority in public health discourse.
World Rabies Day is held every year on September 28. This date was chosen since it marks the anniversary of the death of Louis Pasteur, the first person to successfully develop a rabies vaccine. World Rabies Day was established to promote awareness and advocate for worldwide rabies eradication, and it is intended to bring all individuals, organizations and stakeholders together in the fight against rabies. The theme for this year is “Rabies: Facts, Not Fear.”
Fears, misunderstandings, and ignorance regarding rabies and its prevention have existed for hundreds of years. As a result, this year’s theme focuses on disseminating facts about rabies rather than creating fear about the disease through misinformation and misconceptions. Rabies is a 99 per cent fatal, yet 100 per cent preventable disease. Let us use facts to raise awareness and educate others about rabies. The word ‘fear’ has three meanings in this year’s theme – fear relates to the general fear caused by rabies, the fear people experience when encountering rabid animals, and the fear that people feel when living in communities plagued by it.
According to the World Health Organisation (WHO), Neglected Tropical Diseases (NTDs) are a collection of infectious illnesses that afflict over a billion people worldwide, especially those living in poverty in low- and middle-income nations in the tropics and subtropics, placing a substantial economic burden on these countries.
From 1951 (when the first plan was issued) until 2002, rabies was never a priority for control in the Five-Year Plans for National Development in Independent India (post-1947). Rabies control activities were only listed in the eleventh plan (2007–2012) as pilot projects for human rabies control, for which Rs 8.65 crore was funded.
Rabies management in animals, animal birth control, and stray dog vaccination are all mentioned as animal welfare components to be handled by the Animal Welfare Board of India for the first time in a Five-Year Plan. The Finance Minister of India’s annual budget for 2018 allotted 40 crore rupees towards a few experimental projects under the National Rural Health Mission, including human rabies management. In 2019 and 2020, the sum has been lowered to Rs 25 crore.
According to WHO estimations, India is endemic for Rabies, accounting for 36 per cent of global fatalities. However, rabies-related deaths in our nation are substantially under reported for a variety of reasons. India has had a National Rabies Control Programme in place since the 12th Five Year Plan to tackle the illness. The National Rabies Control Programme has created standard case definitions for reporting any suspected, probable, or confirmed human case of Rabies, as well as procedures for reporting human fatalities due to Rabies on the Integrated Health Information Platform.
In this regard, the Ministry of Health and Family Welfare has requested that Human Rabies be designated as a Notifiable Disease under the Clinical Establishment Registration and Regulation Act of 2010, or the respective State Public Health Act or Nursing Home Act, so that all government and private health facilities are required to report all suspected, probable, and confirmed Human Rabies cases in accordance with standard guidelines.
As per WHO reports, Rabies kills 20,565 people in India each year. India accounts for the most deaths in Asia (59.9 per cent of human Rabies deaths) and globally (35 per cent of human Rabies deaths). India accounts for roughly 35 per cent of the estimated 59,000 yearly human fatalities caused by dog-mediated rabies worldwide. More than three-quarters of cases in India occur in rural regions, where access to diagnostic services and post-exposure prophylaxis (PEP), both of which are important for disease prevention, is restricted.
Because of the country’s estimated 60 million stray/free-roaming dogs, dog bites account for more than 95 percent of cases, and many cases of human rabies go undetected, are misdiagnosed, or are under-reported. Despite the availability of safe and effective vaccines, there is a lack of knowledge about and access to post-exposure prophylaxis (PEP), including rabies immunoglobulin. Despite the paucity of disease statistics, one may claim that rabies does not have the same impact on human health in India as illnesses such as tuberculosis, malaria, and HIV.
Rabies reporting and notification are also useful for quickly identifying the foci and, if necessary, implementing control measures. Human and animal case surveillance includes the reporting of suspicious cases (based on the history and clinical symptoms/signs) as well as the collection of samples for laboratory confirmation. Reporting of human exposures by suspected rabid animals, as well as post-exposure dosages provided, should be included in surveillance procedures.
To create a strategy and to attain the high objective of eliminating dog-mediated human rabies deaths by 2030, contemporary public health experts and policymakers should refer to the substantial historical and current scientific literature on evidence-based rabies control strategies. Measures to cope with India’s large free-roaming dog population will also be critical; without them, rabies control efforts would become unsustainable in the long run.
