Goa has become the first state in India to eliminate rabies in humans

Goa has become the first state in India to eliminate rabies in humans, with no cases since 2018. The project, led by the NGO Mission Rabies, began in 2014. 

The NGO's approach consists of remote teams of dog vaccinators, who systematically work their way through towns and villages vaccinating dogs.

Vaccination teams rotated through the talukas of Goa, re-starting the state campaign cycle on an approximately annual basis. A combination of door-to-door and capture-vaccinate-release (CVR) methods were used to access dogs for vaccination. 

CVR involves catching street dogs in large nets, before vaccinating them and marking them in non-toxic green paint, and then releasing them again.

Their progress was recorded in a smartphone app, which collects data on dog sightings, geographical areas covered by the team, and the details of the vaccinated dogs. 

The annual vaccination output increased, both in terms of geographic extent and a total number of dog vaccinations, through program refinement from 2013 to 2017. Intensive state-wide vaccination was achieved for the first time in 2017, vaccinating 97,277 dogs in an estimated total population of 137,353 dogs. Thus, a 70% dog vaccination coverage rate was achieved for the first time in 2017 using this method. This output was sustained through 2018 and 2019.

Both ownership and confinement data were available for over 90% of dog vaccination records. 52% were owned dogs and 48% were unowned dogs. Unowned dogs were inherently always roaming, while owned dogs were either always roaming (17.9%), allowed to roam for some of the time (50.3%) or always confined (never roaming) (31.7%). Consequently, most dogs vaccinated (83.5%) were among the roaming dog population for some or all of the time.

Smaller two-person vaccination teams were introduced in 2018 to more efficiently vaccinate dogs that could be restrained by hand, which was the case for 64.2% of all dogs vaccinated.

Nevertheless, specialist equipment was still needed to access a considerable proportion of dogs, with 16.3% of owned dogs and 56.5% of unowned dogs being restrained by a net.

Mission Rabies spends about $300,000 a year and has vaccinated 100,000 dogs a year since 2017, about 50,000 a year before that. Deaths of people from rabies in Goa fell to zero in 2018, from 15 in 2014, when the campaign started. 

Mission Rabies estimates the vaccination cost per dog, including salaries and other costs, at $2.50, far lower than the cost of treating humans, which involves not only a more expensive vaccine, but also potential hospital stays. By that accounting, every dog in India could theoretically be vaccinated for under $90 million. India now spends $490 million a year on post-bite treatment.

The Goa program for human rabies elimination consisted of three core areas of activity: dog vaccination; rabies education; and intensified human and animal rabies surveillance.

The second pillar of the program was an education initiative whose primary focus was on teaching school children about rabies, how to avoid dog bites and what to do if bitten. The program also emphasized the importance and social value of ensuring as many dogs as possible were vaccinated against rabies each year. 

In total, school-based rabies education classes were delivered to 694,271 school children and 31,251 teachers between 2014 and 2019. 

Activities to distribute rabies educational messages throughout communities intensified with a similar timeframe which resulted in the delivery of rabies lessons to 155,079 people through community groups, local authorities, and public events.

Seventy-three canine rabies cases were confirmed in the first 6 months of surveillance in 2014. The mean state-wide occurrence of canine rabies cases decreased from 10.6 cases per month in 2014 to 0.8 in 2019, a decrease of 92%.

Thus the Mission Rabies project in Goa was "very cost effective", not only saving the state government money on healthcare-associated costs, but also reducing economic loss from death.

As well as vaccinating dogs, the methodology emphasizes ramping up disease awareness in society, such as running education programs in schools across Goa. 

Children are taught how to avoid dog bites, as well as what to do if bitten. Currently, many rabies deaths occur due to incorrect post-bite treatment. 

The Kerala state government now plans to partner with Mission Rabies to replicate the Goa program. 

Applying the Goa project’s methods on a larger scale would require at least one technical piece that is missing — an oral vaccine. Western Europe eradicated rabies in foxes by dropping baits with oral vaccines, beginning in 1990 when rabies was widespread and lasting more than 20 years.

WHO AND CDC Guidelines for Bites

WHO Document

WHO Document

WHO Document

WHO Document

WHO Document

WHO Document

WHO Document

Postexposure prophylaxis consists of a dose of human rabies immune globulin (HRIG) and rabies vaccine given on the day of the rabies exposure, and then a dose of vaccine given again on days 3, 7, and 14. For people who have never been vaccinated against rabies previously, postexposure prophylaxis (PEP) should always include administration of both HRIG and rabies vaccine. The combination of HRIG and vaccine is recommended for both bite and non-bite exposures, regardless of the interval between exposure and initiation of treatment.

People who have been previously vaccinated or are receiving pre-exposure vaccination for rabies should receive only vaccine.

For many types of bite wounds, immediate gentle irrigation with water or a dilute water povidone-iodine solution has been shown to markedly decrease the risk of bacterial infection.

Wound cleansing is especially important in rabies prevention since, in animal studies, thorough wound cleansing alone without other postexposure prophylaxis has been shown to markedly reduce the likelihood of rabies.

You should receive a tetanus shot if you have not been immunized in ten years. 

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.