Cases of Rabies are invariably fatal once symptoms manifest. More than 20,000 people die of rabies every year in India, three-quarters of them in rural areas.
Incidence of rabies in India has been constant for the last few years, without any declining trend.
Every animal bite is potentially suspected as rabid exposure as rabies is endemic in India. The exposed individuals should seek early health care and prophylaxis (PEP) should be started immediately at the healthcare facility as it is lifesaving.
Unfortunately, availability, accessibility, and usage of PEP are limited in India.
There are many primary healthcare centres in Karnataka where the staff lacks knowledge on how to administer the vaccine, even if it is available, say doctors.
A study in 2019 showed that in over half of the anti-rabies clinics surveyed in Bengal, Bihar, Gujarat, Himachal Pradesh, Kerala, Madhya Pradesh and Manipur, even facilities for washing wounds and antiseptics -- a critical first step in treating animal bites -- were inadequate.
Over half the clinics did not have Immunoglobulin which could be critical in preventing rabies if there was blood from the bite wounds, especially on the neck, face or head.
Two studies carried out in New Delhi and Jodhpur showed many disparities in the knowledge and practices of doctors in regard to rabies. Less than half of them were unaware of the intradermal rabies prophylaxis schedule, and only 45% of them knew about HRIG (immunoglobulin). 81% of them knew of the prophylaxis in unimmunized patients, but only 40% were familiar with the guidelines for previously immunized patients.
More importantly, public doctors had markedly better knowledge than private doctors in regards to the prophylaxis. This is very concerning, when taken into account that India has the biggest private sector of doctors in the world, accounting for 93% of the hospitals and 85% of doctors.
Post-exposure treatment (HRIG) is simply unaffordable, costing around 30,000 rupees ($447) for an average person.
Moreover, India notoriously experiences local and national shortages of HRIG, causing the patients who are willing to pay, to wait for it, for weeks or even months, which can eventually lead to death.
A 2018 WHO report said that dog-mediated rabies has been eliminated from western Europe, Canada, the USA, and Japan. 28 of the 35 Latin American countries report no human deaths from dog transmitted rabies.
Great strides have been made in reducing rabies deaths in countries such as Bangladesh, the Philippines, Sri Lanka, Tanzania, Vietnam, and South Africa.
Bangladesh, with almost 10.000 deaths per year and less than six % dog vaccination coverage, has adopted a very successful national strategic plan for the elimination of rabies by 2020. Through the establishment of the District Rabies Prevention Control Centres in almost every district, they provided facilities for mass dog vaccination, dog population management, care of bitten patients, all of whom receive anti-rabies vaccine and immunoglobulin for free.
Furthermore, local champions were appointed to convince political leaders, policymakers and stakeholders for political commitment and technical leadership and partnership for this assignment. As a result, rabies deaths have reduced by 50% between 2010 and 2013.
Such an outcome contrasts with the slow progress made in India.
It has been demonstrated in multiple research studies that India’s poor position in rabies elimination is rooted in a lack of knowledge about the disease, uncontrolled canine population, the insufficient vaccination programme, irregular supply of vaccines and inadequate training of healthcare professionals.
The WHO estimates that investing in rabies elimination globally will eventually free up an estimated US$8.6 billion in economic resources each year. Since over a third of the rabies burden is in India, it should save about US$3 Billion a year by eliminating rabies.
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