[ Dr Keter Loya ]
Rabies is a fatal viral encephalitis that affects all warm-blooded animal. Dog is the most important reservoir, especially in developing countries like India.
Prevention is the primary approach to the disease. Rabies is caused by a bullet-shaped RNA virus of the family rhabdoviridae and genus lyssa virus. Once clinical signs appear, there is 100 percent chance of it becoming fatal.
Rabies is an untreatable disease; therefore the effort must be focused on preventing the disease.
As per the data presented by the union health & family welfare ministry in Parliament, dog bite cases increased from 21.8 lakhs to 27.5 lakhs between 2022 and 2023. Despite such an alarming situation and there being anti-rabies vaccine available, it still causes high numbers of human mortality in countries like Asia and Africa.
Some of the major challenges to be overcome to control rabies are:
- A low public health priority as a result of lack of awareness, information, and communication on rabies. Also, lack of knowledge about the disease transmitted. 99.8 percent rabies is transmitted by saliva (Acharya Anita, et al, 2012), and the rest can be by scratches, secretions that contaminate mucus membranes, aerosolized virus that enters the respiratory tract and organs and tissues transplants (Hankins, et al, 2004).
In a recent incident in Arunachal, one man died of rabies, after scratching an unvaccinated dog. Lack of information, despite the rising cases of rabies in India, people often look for a tribal or local healer for diagnosis and treatment of disease, without any medical treatment. Healthcare providers are also unaware of prescribed rabies immunoglobulin (RIG),along with anti-rabies vaccine for dog bite patients.
- High cost and unavailability of vaccine and rabies immunoglobulin to reach out every corner, mainly the rural part of india. Post-exposure prophylaxis (5 doses of vaccine and RIG) treatment is often unaffordable and faces less supply of vaccines.
- Existence of a large number of free- roaming stray dogs due to the lack of shelter, and lack of proper implementation of animal birth control programme. According to a State of Pet Homelessness report published in 2021, there are around 6.2 crore street dogs in India; therefore human interaction with this type of dog population is not uncommon.
- Limited resources to implement mass vaccination programmes annually.
- Diagnostic facilities are very limited. The most challenging part for veterinarians and doctors is to diagnose rabies, as the clinical signs of rabies are non-specific. Therefore it could be unable to be differentiated from other neurological diseases.
- Less strengthening of rabies surveillance. Surveillance is not rountinely carried out for rabies.
- Unavailability of doctors and veterinarians at government healthcare centres.
- Poor anti-rabies vaccine storage and temperature monitoring equipment. Most of the vaccines have to be maintained in low temperature – between 2? C and 8? C – due to poor infrastructure and storage capacity at government hospitals, resulting in the vaccine losing its potency.
- Economic challenges faced by the developing countries:
* Vaccine and rabies immunoglobulin cost.
* Not being able to conduct large-scale vaccination campaigns in every part of the country annually.
* Not being able to afford to conduct mass vaccination programmes in every part of the country annually.
* Dog-house cost. More cost effective to maintainfor the developing countries.
* Salaries of animal control officer and staff trainer, and requirement of expertise to carry out vaccination programmes.
* Laboratory diagnostic and storage equipment.
* Need to conduct surveillance programmes. (The contributor has a masters degree in veterinary medicine)
