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Rabies is endemic to India and accounts for about 36% of the world’s rabies deaths. Although the true burden of rabies in India is not fully known, approximately 20,000 people die from rabies each year and 99% of animal-to-human transmission of rabies is through dog bites. The poor people and children between the ages of 5 and 15, in particular, who often play and share food with the stray dogs, are often victims of dog bites. Why higher incidence of canine-related rabies? Because of the growing dog population or increasing incidents of dog bites.
India has approximately 30 million stray dogs and the annual incidence of dog bites is approximately 1.75 million. But who are the culprits? The garbage that accumulates every day in Indian households is disposed of outdoors, the garbage cans overflow and the butchers also dump the garbage into the sewer system. The more rubbish, the more strays will be attracted. The more dogs roam free, the more their population will grow and the more difficult it will be to control their population. Animal lovers, on the flip side, usually feed dogs, but nobody is responsible for their vaccination or their birth control. Then why do dogs bite? The human-animal conflict is increasing. Any hostility from the human aggressors makes the dogs aggressive, whereupon they can resort to biting in self-defense. While the Prevention of Cruelty to Animals Act (PCA), 1960, talks about culling stray dogs, the Animal Birth Control (Dogs) Rules of 2000 (ABC) allow the population of stray dogs.
Rabies is a serious human and animal disease caused by the rabies virus. The virus is present in the saliva of infected animals and is most commonly transmitted through bites from infected dogs, bats, and raccoons. Interestingly, rabies can also be transmitted without a bite if the saliva gets through scratches directly into the eyes, nose, mouth, or an open wound. An unvaccinated dog can develop rabies if bitten by a rabid dog. A bite breaks the integrity of the skin, causing the virus to invade. The virus enters the body, travels through the nerves to the central nervous system. The rabies symptoms appear when the virus reaches the brain. The closer the bite is to the brain, the faster symptoms will appear. Known signs of rabies infection in humans include initially flu-like symptoms and as the disease progresses the person may develop fear, confusion, or excitement.
Muscle spasms occur in the throat and larynx. The person feels a pain in the throat and produces a lot of saliva, which causes the foaming effect. Trying to drink water can trigger the cramps. Swallowing becomes difficult and the person cannot drink water. This leads to an apparent fear of water or hydrophobicity. For this reason, rabies is sometimes called hydrophobicity. Eventually paralysis develops and leads to death. Although rabies is a fatal disease, there is a 100 percent chance of survival if the person is treated before symptoms appear. There are effective human vaccines and immunoglobulins against rabies. Rabies is a vaccine-preventable disease.
These are some of the reasons why human rabies is neglected and treated only as a dog bite. Most dog bite cases go unnoticed due to lack of attention. Even if they are aware, the poor populations are more vulnerable due to the unavailability or lack of access to vaccines in rural areas. All states except Gujarat and Kerala have a rabies vaccine shortage of 20-80 percent. In addition, the Indian government is not successfully implementing rabies prevention strategies. This may cause French scientist Louis Pasteur to turn in his grave who developed the earliest effective vaccine against rabies, first used on July 6, 1885 to treat a human bite victim.
Dog bites can be prevented. Don’t panic, keep calm. Think about prevention! When a dog bites, it is important to assess the wound to determine its severity. Some dog bites and scratches can be minor while others need to be treated as emergencies.
The WHO classified rabies exposure as follows:
Category I: Touching or feeding animals, licking intact skin (no exposure);
Category II: Nibbling bare skin, small scratches or abrasions without bleeding (Exposure);
Category III: Single or multiple transdermal bites or scratches, contamination of mucous membranes or skin injuries with saliva from animal licks, exposure through direct contact with bats (severe exposure).
The only way to control and prevent rabies is to vaccinate either before exposure or immediately after exposure. All bite wounds and scratches should be treated as soon as possible after exposure. The bitten area should be washed immediately with soap or dish soap and running water for about 15 minutes. If soap is not available, wash thoroughly with water alone. Recall, Wound washing is the first aid treatment against rabies. If the bite site is bleeding, apply pressure with a sterile cloth and apply an iodized or similar antiseptic to the wound and see a doctor immediately. The wound should not be covered with dressings or bandages. Avoid applying local traditional remedies such as jhhad-phoonk, gobar, castor oil, turmeric, or irritants such as chili powder, vegetable juices, acids and alkalis on the wound. Whenever possible, the biting animal should be safely caged and gather information about the type of animal that bit, if it was a wild or stray animal, or a domestic animal, if its vaccination was up to date, if the animal was strange behaved or any unusual behavior and the bite conditions. This information should be made available to healthcare professionals for further evaluation and treatment. The biting animal should be locked up and kept under observation for 10 days. If the animal is rabid, it will usually show clinical signs or die within the 10 day observation period. However, it is not advisable to simply observe the biting animal for 10 days without starting post-exposure prophylaxis (PEP).
The PEP can be converted into a PrEP (pre-exposure prophylaxis) if the animal remains healthy during the observation period. There are currently not an effective treatment for rabies after the onset of clinical symptoms.
PEP:It is the administration of a rabies vaccine with or without rabies immunoglobulin (RIG) after exposure to rabies. The Rabies PEP regimen involves the administration of four doses of rabies vaccine given intramuscularly on days 0, 3, 7 and 14. For immunocompromised individuals, a fifth dose can be given on day 28. RIG should be administered for severe Category III exposures and infiltrated into wounds that require suturing. RIG and the first dose of rabies vaccine will be given on the first day of treatment (day 0). RIG can be given up to the 7th day after the first rabies vaccination. Depending on the nature of the wound, doctors will give you antibiotics, analgesics, and tetanus vaccines.
PrEP: It is the administration of multiple doses of vaccines to prevent exposure to rabies. The rabies PrEP regimen involves the administration of two doses of rabies vaccine given intramuscularly on days 0 and 7. A person bitten by a dog who has previously received either pre- or post-exposure rabies prophylaxis does not require the administration of RIG. You should only receive two rabies booster vaccinations on days 0 and 3 after exposure.
Canine vaccination and bite prevention are keys to preventing the transmission of the rabies virus between and from dog to humans. The primary vaccination against rabies should be given at the age of 3 months and the booster vaccination should be given annually. The World Health Organization (WHO) mandates that at least 80% of dogs must be vaccinated annually to break the rabies transmission cycle. Government programs are required to set up free sterilization centers to reduce the dog population, public awareness campaigns, mass vaccinations for the entire dog population, and the provision of free drugs and / or vaccines to all rabies victims to prevent and eradicate rabies. A multi-pronged approach with a “one health program” coordinated at all levels would be a holistic solution to this threat. Among the Indian states, Sikkim in northeast India is an outlier, it is considered rabies-free after all of its strays have been neutered. To raise awareness of rabies prevention around the world, September 28th is celebrated as World Rabies Day. India recently launched its new National Action Plan to Eliminate Dog-Mediated Rabies (NAPRE) by 2030, with rabies now also being declared a reportable disease.
Adopt health, stop rabies.
Reference: Rabies website (https://www.who.int/india/health-topics/rabies)
Sangeeta Das1 *, Anu Malik1, Pankaj Deka2
1PhD Fellow, Department of Microbiology, LUVAS, Hisar, Haryana-125001
2 Assistant Professor, Department of Microbiology, CVSc, AAU, Khanapara, Guwahati-781022
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