World Rabies Day 2020: India accounts for 36% of all rabies deaths; poor awareness, insufficient dog vaccination complicate fight

A viral infection that’s zoonotic in nature, targets the central nervous system and then the brain, and is fatal unless post-exposure prophylaxis (PEP) is provided – that’s what rabies is. The rabies virus is one of the deadliest out there and spreads to humans via animal bites. Once the infection is contracted and the symptoms appear, the progression of this disease cannot be stopped and death is almost always inevitable. On World Rabies Day, observed every year on 28 September, international organisations and governments join hands to spread awareness globally about this deadly but preventable disease. This mission is vital and highly relevant for India; as the World Health Organisation (WHO) points out, roughly 36 percent of the global deaths due to rabies can be attributed to India alone. India’s war against rabies An editorial published in the Bulletin of the World Health Organization in 2014 points out that this high incidence of rabies has been a constant in India for a decade without any obvious sign of decline. This grave situation is owed to a general lack of awareness about rabies prevention measures as well as proper PEP, an uncontrolled canine population, insufficient dog vaccination and an irregular supply of anti-rabies vaccine and immunoglobulin in primary healthcare facilities. A 2006 study published in the Journal of Communicable Diseases throws light on just how widespread this lack of awareness about rabies in India is. This study’s results state that only 70 percent of people in India have ever heard of rabies, just 30 percent know that you need to wash the wounds thoroughly after animal bites and only 60 percent of the people who get bitten receive proper prophylaxis and a modern cell-culture-derived vaccine. The study also found that instead of following proper first aid and PEP for rabies, most people who participated in the study proposed the application of indigenous products like chillies, turmeric, lime, kerosene oil or a herbal paste on the bite. The Indian National Centre for Disease Control (NCDC) while stating that rabies is a year-round endemic throughout India with the exception of Andaman and Nicobar and the Lakshadweep Islands also mentions the fact that 96 percent of the mortality and morbidity in human cases are associated with dog bites. Evidence of animal to human transmission via the bites or scratches of cats, wolves, jackals, mongoose and monkeys have been found in the country but bat rabies has not been conclusively reported. To meet this immense disease burden posed by rabies, the NCDC and the WHO instituted the National Rabies Control Programme (NRCP) in 2013. The National Rabies Control Programme and rabies prophylaxisAs a study published in the journal Tropical Medicine and Infectious Disease points out, the only way to completely prevent canine rabies — the biggest cause of human rabies cases in India — is by mass vaccination of the dog population. The National Health Portal mentions that such mass vaccination, a population survey and surveillance of dogs and proper management of this population are key parts of the animal component of the NRCP’s strategy. When it comes to the human component, the NRCP’s strategy includes strengthening the surveillance on human rabies incidence, spreading better awareness about the disease and its prophylaxis, training of health professionals and proper administration of rabies immunoglobulin. In its National Guidelines on Rabies Prophylaxis, the NRCP recommends the following first aid and prophylaxis steps:

• Proper post-exposure prophylaxis or PEP should start immediately after getting bitten or scratched by any warm-blooded animal, including dogs, cats, wolves, jackals, etc. If the bite is by a dog or cat, the animal should be kept under observation for 10 days, whether it has received previous vaccination or not.
• Since the rabies virus enters the human body through bites or scratches, it’s vital to remove all the saliva (and thereby, hopefully, the virus) from the wounds by flushing and washing it thoroughly for a minimum of 15 minutes with soap and water, povidone-iodine or other such substances. This step is crucial in removing and killing the rabies virus.
• The application of irritants like chillies, turmeric, lime, etc is unnecessary and can be damaging. It should be avoided.
• After the wound is thoroughly washed and dried, antiseptic agents like povidone-iodine may be applied. 
• Cauterizing the wound is no longer recommended and suturing should be avoided unless absolutely necessary. 
• The rabies immunoglobulin should be administered as soon as possible in the depth and around the bite wound to neutralise the locally present virus. A tetanus injection and a course of antibiotic should also be taken to prevent sepsis in the wound.

For more information, read our article on Rabies.

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