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Bite the dust

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Watch out for that friendly dog, it may be carrying rabies. With India accounting for 30 percent of these cases worldwide, it’s time to make it a notifiable disease

By Prakash Bhandari


ogs are considered man’s best friend. But few know about a disease they can pass on to humans with devastating consequences—rabies. In fact, it is the 10th biggest cause of infectious diseases, with Africa, Asia and South America being most affected by it. What’s more, worldwide, some $563 million is spent annually on measures to prevent rabies.

A study conducted by BP Poddar Hospital & Medical Research Institute, Kolkata, found that about 30 percent of the total deaths caused by rabies occur in India. According to WHO, around 205 billion people in 100 countries are at risk of contracting this disease, says Chinny Krishna, vice-chairman of Animal Welfare Board of India (AWBI), a Chennai-based government body.
Since 1985, India has reported an esti-mated 25,000 to 30,000 human deaths from rabies caused by dog bites. “The Central Bureau of Health Intelligence, in its last report in 2013, said that there were only 232 deaths due to dog bites. But our estimate is that more than 5,000 humans have lost their lives annually in India because of rabies. Since it is not a notifiable disease, this figure is likely to be underestimated. In order to get an authentic estimate, rabies should be made a notifiable disease,” says Krishna.

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A study found that 70 percent of people had never heard of rabies. Of those bitten, only 60 percent received a modern vaccine.

 

EASY ERADICATION

Incidentally, rabies was discovered in 2000 BC, when getting bitten by a dog was equated with death. The victim was isolated and left to die. Rabies means “rage or rave” and comes from the Sanskrit word “rhabas” which means “to do violence”. Rabies is a viral zoonotic disease, meaning it can be transmitted from animals to humans. Controlling the population of stray dogs by neutering and immunizing them annually can help eradicate the disease.

The chief executive of the world’s largest dog welfare charity, United Kingdom’s Dogs Trust, Clarissa Baldwin told India Legal that her Trust had cared for almost 17,000 dogs in the UK last year. In the last 20 years, the number of dogs euthanized by the UK
government has reduced dramatically from 30,000 to 6,500 each year.

In India too, there are various efforts to reduce rabies. Mission Rabies, a global welfare organization that works in Goa, hopes to eliminate rabies from the world by 2030. Its experts, Ilona Otter and Kate Sherveil, say that under a massive program undertaken in September 2013 in India, 60,000 dogs were vaccinated.

In Jaipur, Help in Suffering, another organization, vaccinated and sterilized 3,000 to 4,000 dogs, making Jaipur a rabies-free city. According to Dr Jack Raace, a vet here, the estimated population of stray dogs was over 25,000 in Jaipur and this was reduced through sterilization.

In Sikkim, Hollywood actress Brigitte Bardot’s Foundation is supporting a program to make it the first rabies-free state in India. “Since 2006, we have been funding a care program of sterilization and vaccination that has curbed the proliferation of dogs and cats. More than 80,000 dogs have already bene-fited,” says Brigitte Auloy, project coordinator of this Foundation. It is also working in Dharamshala, Ladakh and Bodh Gaya.

NO DECLINE

Though this disease is preventable, in south-east Asian countries, it is still a public health problem that eats into their resources. In India, the incidence of rabies has been constant for a decade, without any obvious decline. It mainly affects people from the lower socio-economic strata and children between 5-15 years.

In the study done by Poddar Hospital, many children who were attacked by dogs were unaware of having been bitten and their parents often ignored the attacks or simply treated the wounds by applying indigenous products such as hot pepper or turmeric. “Very few parents sought medical advice, and immediately,” said the study.
Another study shockingly found that 70 percent of people had never heard of rabies, while only 30 percent knew how to wash the wound after an animal bite. Of those bitten, only 60 percent received a modern vaccine. Ironically, in this era of mass communication and advanced health systems, even physicians seemed to know little about proper measures following animal bites.

 

It is only recently that intradermal vaccination, recommended by WHO in low-resource settings, has been practiced because of lower cost and high immunogenicity. However, it requires special training to reduce the risk of insufficient dosing. Some-times, patients are advised to watch the offending animal for abnormal behaviour for 10 days after a bite before seeking treatment, but because animals can be asymptomatic carriers, such delay can be risky. It would be safer to administer the complete course of anti-rabies vaccination for such a victim.

Sadly, though the government has appro-ved a National Rabies Control Pilot Project, due to dearth of funds, dog sterilization has not been successful, says Krishna. “NGOs and animal welfare groups found that the funding was not adequate and was the same as was a decade ago.” Dr RM Kharab, chairperson of AWBI, says that while the cost of sterilizing a dog is more than Rs. 770, the government has been giving only `445. Thus, NGOs are no more interested in carrying on this work, throwing a spanner in the works.

Watch Out!

These are the symptoms of rabies:

  • Feverish feeling
  • Weakness, body ache, loss of appetite, headache, nausea, vomiting, stomach cramps and diarrhoea
  • Numbness, burning, itching where the bite took place
  • As the patient gets worse, there is irregular breathing and heart rhythm
  • Hydrophobia—the patient is unable to swallow liquids due to paralysis of neck muscles. As he tries to drink water, it enters the trachea instead of the esophagus and then, is coughed out through the nose. Even the sight of water can trigger a spasm in the body
  •  

    Meanwhile, the health ministry has started a pilot project in Haryana for sterilization and vaccination of street dogs. If this experiment is successful, it will be taken to other states. Under these circumstances, public education campaigns need to be conducted to make people aware of rabies, especially in remote areas, and of seeking medical care immediately after a bite. Steps must be taken to ensure uninterrupted availability of vaccines in all hospitals and primary healthcare centers. Personnel should be trained in these centers to administer proper vaccinations. School curriculum should include information on rabies.
    Dr Kharab says that all dogs should be given oral vaccine against rabies and stray animals sterilized. “Rabies should be declared a notifiable disease and incorpo-rated into a health programme in a coordinated manner,” he says.

    Is anyone listening?

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