Studies on Rabies in Punjab

 A study in Punjab India, showed that the proportion of confirmed rabid dog cases was consistent throughout the study period (2004-2014).

It is likely that rabies is maintained in dogs in an urban transmission cycle. Reports of dog- bites demonstrated increased incidence in humans over the years. Another study in 2016-'17 showed that the annual incidence of rabies in dogs in Punjab would be in the region of 190 cases. The incidence in pet dogs would be double that of stray dogs. But Stray dogs are responsible for most of the human bite cases in India (60 %).

Of rabid animals in which the biting history was known, there was no significant difference between the proportion of dogs that had a history of biting behaviour and those that had not. 

It is accepted that vaccination of dogs for canine rabies needs to consistently achieve high coverage to reduce incidence and potentially eliminate rabies in dogs. However, this is difficult to achieve even in well- resourced environments.

Some municipalities in Punjab try to control stray dog populations through Animal Birth Control- Anti- Rabies programmes but are unsuccessful due to insufficient resources. 

There are increased cases of rabies in dogs in Punjab in March and August. It is not known if this is due to an increased seasonal breeding. Regardless of the reason —either increased exposure of the general public to dogs, or increased incidence in dogs—rabies elimination campaigns in the Punjab can gain more efficient resource allocation by targeting dog vaccination prior to March and August and rabies- awareness messaging during March and August.

Surveillance for rabies in animals in Punjab relies solely on passive data collection. There is no coordinated approach to surveillance such as a state sponsored testing scheme.

Factors such as poor dog population management and low standards of dog care (including infrequent veterinary consultation) are considered responsible for high endemicity of canine rabies in India. 

Some of the rabies-infected domestic and pet animals in the study (16%) had received rabies vaccination previously, but the recommended annual vaccination schedules were not subsequently followed. In 56% of the rabies cases, the animal owner noticed a bite wound on the animal’s body but only 31 % of the owners requested veterinary treatment or vaccination of the animal. All of these animals died before completing the course of post-exposure rabies prophylaxis vaccination.

Of the 16 rabid dogs reported in 2016-'17 in 4 sub-districts of Punjab, all had developed rabies after being bitten by other rabid dogs. A total of 20 humans were exposed to rabid cases sufficiently for potential rabies virus transmission. All of them received post-exposure prophylaxis, and were alive at the time of completion of the study.

But in an earlier study decades ago, 177 cases of clinically diagnosed rabies were reported from hospitals in Amritsar city over 6.5 years. 87 % of the patients had been bitten without any provocation.

All the patients died with varied symptomatology: hydrophobia, aerophobia and restlessness was observed in 100% of cases. Almost all the patients applied red chillies; only 18% had antiseptic dressing. 87 % of the deceased had not taken anti-rabid vaccine treatment.

A total of 18 cases, who also died, were given post-exposure treatment with anti-rabic vaccine but only 12 received 11 or more injections. They started the treatment from 1-35 days after exposure.