What is Rabies and How does it Occur?
Rabies is a disease caused by a virus that is transmitted to humans through the infected saliva of a range of animals (most commonly dogs, but also monkeys, horses, or cats, and sometimes wild animals such as bats, raccoons, skunks, and foxes). Most human deaths follow a bite by, or exposure to, an infected dog, with the majority of human deaths caused by rabies attributed to dog bites, especially stray dogs, accounting for over 99% of fatalities.
What are the Symptoms and Prognosis of Rabies?
Initial symptoms are often flu-like, such as fever, headache, and fatigue, but as the disease progresses, neurological symptoms like confusion, anxiety, and the horrific hydrophobia (difficulty in swallowing water) develop. Ultimately, rabies can lead to paralysis, seizures, and death. Rabies is almost always fatal.
How can Rabies be prevented or treated?
There is no treatment or cure for rabies. But it can be prevented by giving what is called ‘post-exposure prophylaxis’ (PEP), which involves taking preventive steps immediately after the animal bite. Depending on the category of the bite, anti-rabies vaccine (ARV) and human rabies immunoglobulin (HRIG/RIG) are administered as soon as possible. One should not wait or base any decision on the status of the dog.
Standard wound care involves immediate and thorough washing of the animal bite wound with soap and water for at least 15 minutes, which is crucial for preventing rabies infection. This should be followed by disinfection with an antiseptic like povidone-iodine or chlorhexidine.
Anti-rabies vaccines and human rabies immunogbulin are available at public and private hospitals, and healthcare facilities across most countries, including India, as well as in primary and secondary care centers, medical colleges, and private clinics and pharmacies. In big cities, one can even find home vaccination services.
Is there any preventive treatment for those working regularly with animals?
Pre-exposure prophylaxis (PrEP) vaccination is recommended for people who work directly with animals that could have rabies, or those who travel to parts of the world where rabies is common and access to medical care is limited. Primary series of two doses on days 0 and 7, or 0 and 21/28, is given intramuscularly. For individuals with ongoing risk, booster doses after a titre check or a one-time booster dose within 3 years of the primary series, especially if titres fall below 0.5 IU/mL, is given.
How can Rabies spread and Dog bites be prevented in the Community?
The World Health Organization (WHO) and the Global Alliance for Rabies Control (GARC) have emphasized the importance of vaccination and sterilization of dogs, as the only proven and effective method of achieving zero-rabies deaths and controlling the stray dog population. The WHO and GARC, along with the World Organization for Animal Health and the Food and Agriculture Organization of the United Nations (FAO), have established a global goal for the elimination of dog-mediated human rabies deaths by 2030. However, this would involve a holistic and coordinated approach at multiple levels:
1) Meticulous Reporting: Rabies is now a notifiable disease in 20 states of India and also in many other countries. Many countries also include rabies prevention and tracking in their national health policy and run nationwide programs (National Rabies Control Programme in India and the ABC-AR Animal Birth Control-Anti Rabies rules). These need to be supported by a high-level task force empowered to track, audit, and supervise the implementation of collecting real-time data: city-wise dog bite cases, stray dog population, sterilization and vaccination coverage, vaccine availability by district, bite-to-death ratios, and lapses in reporting for corrective action.
2) Funding and Infrastructure: Municipalities should receive adequate budgets for sterilization, deploy trained teams, and expand access to mobile ABC units, a consistent supply of medicines, staffing, and logistical support. Activists, NGOs, and individuals voicing the cause of protecting stray dogs, can come forward to contribute through funds, time, and assistance for appropriate dog shelters, sterilization and vaccination, along with adoption wherever feasible.
3) Knowledge and Awareness: These include important points for the public like washing the wounds after animal bites, seeking immediate medical attention for ARV and RIG. It also involves familiarity of Medical College interns with proper post-exposure prophylaxis and anti-rabies immunoglobulin immediately after a bite is categorized. Any delay can be risky, and it would be safer to administer the complete course of anti-rabies vaccination to anyone who gets bitten by a dog.
4) Garbage disposal and Sanitation: Stray dogs are an integral part of both rural and urban ecosystems, feeding off garbage, defending territory, and responding to human behaviours, and their aggression and distribution are influenced by food availability and human interaction. Therefore, maintaining hygeine, proper garbage disposal, and reforming waste management are important.
5) Stray dog feeding: Dog feeding should not be on streets, but only in designated areas indicated by a notice board, with a hefty fine and legal action imposed on any obstructing official or person. Such designated feeding areas can also reduce the incidents of aggression and attack by dogs on people in the streets, especially children and riders.
6) Community dog norms: Individuals and organizations who love to or engage in care for stray dogs or want to keep ‘community dogs’ should ensure the dogs are collared, and kept under a roof. While areas where dogs can be kept off a leash and be allowed to play must be created wherever possible, in public, but safety of human beings should not be compromised in such places.
7) Dog shelters: There is a severe current shortage of dog shelters, and till adequate and appropriate dog shelters are available, vaccinated and sterilized dogs may have to be released back to their streets of origin. However, these released dogs should be tagged and tracked. Dogs with suspected or confirmed rabies or of aggressive potential should be kept sheltered and not released back into the community. Also, shelters are not dumping grounds but should be well-regulated and cared-for facilities.
8) Legal frameworks: While the ABC Rules rightly prohibit mass culling, they do allow for the euthanasia of diagnosed rabid or dangerous animals. But such powers should only be exercised under clear protocols with judicial oversight.
Also read:
Overview of 10 Zoonotic Diseases: Infections that spread from Animals to Humans