INTRODUCTION TO THE RABIES AND DOG BITE ISSUE IN INDIA

 Introduction

• Rabies negatively affects the poor living in remote rural areas and slum-dwellers of developing countries.
• Rabies is the deadliest virus-caused disease, where nearly 100 % of the patients die after developing symptoms - but it isnt even notifiable in India. 
• An estimated 17.4 million animal bites occur in India annually.
• Dogs are the source of the vast majority of human rabies deaths, contributing up to 99% of all rabies transmissions to humans.
• By 2010 India had vaccinated just 15% of its dogs. 
• A large number of reported rabies cases and deaths in India occur in children under the age of 15 years.
•  Rabies immunoglobulin is undergoing a critical shortage worldwide. It is also prohibitively expensive for many victims in a country where 60% of the population lives on under US$2 a day: In India it costs about US$7, for each vial. Only three companies produce it, with relatively high manufacturing costs.
• Less than a third of the animal bite cases in India recieve post-exposure rabies prophylaxis.
• A mere 0.33 % of the dog population of India is sterilized every year. An unsterilized female dog can result in 67,000 pups in seven years. 
• In fact, India has not implemented any of the rabies-prevention strategies successfully, be it vaccination, sterilisation of dogs, or providing free medicines to all rabies victims.
• If the level of vaccination in the dog population can be kept at 70 percent over a period of seven years, the variant of the rabies virus that thrives in dog populations will disappear.

The 2020 New Year did not start on a good note for young Praveen and his family at Ballari : The twenty-six-year-old’s eyes are feverish and wild as he hyperventilates on a hospital bed. As his words tumble out in a breathless babble, he explains to a doctor that months earlier, a three-month-old puppy had bitten his leg. Showing the scars, the youth says he was given injections at that time by a local doctor. 

He tries hard to drink water, but screams at the very sight of it. Tormented by thirst, he brings it to his lips again and again, only to convulse and gag at the last moment. Lying alone in a dark room of Isolation Hospital in Bengaluru, Praveen pleads for the lights to be switched off, as they hurt his eyes. It’s a horrible sight for his family, as they watch him suffer. The hospital staff knows there is nothing they can do now. A few hours later, Praveen passes away.

Many countries have gained an efficacious governmental control over rabies, mainly by vaccinating a wide number of human and dog populations, and by implementing other interventions and policies. Only a few countries have managed to completely eradicate the disease. Unfortunately, this is not the case with India. Here the situation has not changed for a decade.

Rabies is a neglected disease, which is insufficiently addressed by the national and international community. Rabies negatively affects the poor living in remote rural areas and slum-dwellers of developing countries. 

Once clinical symptoms appear, rabies is virtually 100% fatal. It spreads to people and animals via saliva, usually through bites, scratches or direct contact with mucosa (e.g. eyes, mouth or open wounds).

Managing a rabies exposure, where the average cost of rabies post-exposure prophylaxis is currently estimated at an average of US$ 108 (along with travel costs and loss of income) can be a catastrophic financial burden on affected families whose average daily income may be as low as US$ 1–2 per person.

Vaccinating dogs, including puppies, is the most cost-effective strategy for preventing rabies in people because it stops the transmission at its source.

India has more than 30 million stray dogs (this figure mentioned in this article also). By 2010 India had vaccinated just 15% of its dogs. The Animal Welfare Board of India was quoted in 2016 as stating that 'Over one lakh stray dogs are sterilized and vaccinated against rabies every year.' - that would be a mere 0.33 % of the dog population of India. 

An article states : 'If a female dog is sterilized, effectively it prevents 67,000 births over seven years.' But since the effort at sterilization is so small, we are adding these dog numbers endlessly to india. 

Once given a vaccination shot, a dog should be safe from catching or spreading Rabies for at least a year. The consensus among rabies experts is that if the level of vaccination in the dog population can be kept at 70 percent over a period of seven years, the variant of the rabies virus that thrives in dog populations will disappear.

In fact, India has not implemented any of the rabies-prevention strategies successfully, be it vaccination, sterilisation of dogs, or providing free medicines to all rabies victims.

An estimated 17.4 million animal bites occur annually (the figure in 2012 was 15 million annual bites a year), and about 5 million post-exposure rabies prophylaxis (PEP) are provided. 

Over the years, India’s stray dog population has grown.

For example, stray dog population has gone up by 65% within seven years in Chandigarh. This was revealed in the 2019 animal census conducted by the UT animal husbandry and fisheries department. 

Between January and March 2015, Chandigarh registered 1,200 cases of dog bite. 

On an average, nearly 6,000 cases of dog bites are being reported in Ahmedabad every month. This means roughly 200 people are bitten by dogs every day in the city.

A study showed that dog sterilizations in Ahmedabad reduced bites by only 8.5 %. 

Statistics from Pune Municipal Corporation reveal that, “at least 28 citizens were bitten every day by stray dogs making for an average of 10,000 dog bite cases in 2017. 

Nearly 50 per cent of those bitten by a dog in India do not receive rabies vaccine.