World Rabies Day is observed every year on 28th September where international organizations and governments unite to spread awareness globally about this deadly yet preventable disease.
Rabies is a viral infection that is zoonotic I nature. It targets the central nervous system (CNS) followed by the brain. The disease is curable; however, it can prove to be fatal if appropriate post-exposure prophylaxis (PEP) is not conducted.
Rabies virus belongs to Rhabdoviridae family and spreads among humans via animal bites. Once the infection is contracted and the symptoms appear, the progression of the disease is exponential and death is almost always inevitable.
On this day, global efforts are made by various governments and organizations to spread awareness about this deadly disease. And this mission is vital and highly relevant to India; World Health Organization (WHO) has estimated that roughly 36% of the global deaths due to rabies occurs in India.
India’s battle against rabies
An article published in 2014 in the “Bulletin of the World Health Organization” states that the high incidence of rabies in India has been constant for a decade without any signs of decline. This grave situation can be attributed to a general lack of awareness about rabies prevention measure as well as proper PEP, uncontrolled canine population, insufficient dog vaccination and irregular supply of rabies vaccine in primary healthcare facilities.
While a 2006 study, published in “Journal of Communicable Diseases” throws light on just how widespread this lack of awareness about rabies in India is. The study concludes that only 70% of people in India have ever heard of rabies, of which only 30% know that one needs to wash the wounds thoroughly after the animal bites while only 60% of the people bitten receive proper treatment and a modern cell culture derived vaccine. The study also reported that instead of following proper first-aid and PEP for rabies, most people participated in home remedies and unscientific practices to treat the wound from the bite.
The National Centre for Disease Control (NCDC), India’s healthcare administrator, stated that rabies is a year-round endemic with the exception of Andaman and Nicobar Islands and Lakshadweep Islands. It also mentioned that 96% of the mortality and morbidity in human cases are associated with dog bites.
Evidence of animal to human transmission via the bites or scratches of cats, wolves, jackals, mongoose and monkeys have been found in the country but bat rabies has not been conclusively reported yet. To meet this immense disease burden posed by rabies, the NCDC and the WHO incepted the National Rabies Control Programme (NRCP) in 2013.
The National Rabies Control Programme and rabies prophylaxis
As a study published in the journal of “Tropical Medicine and Infectious Disease” points out, the only way to completely prevent canine rabies — the biggest cause of human rabies cases in India — is by mass vaccination of the dog population.
The National Health Portal mentions that such mass vaccination, requires an efficient population survey along with surveillance of dogs followed by proper management of this population. These are the key parts of the animal component of the NRCP strategy.
When it comes to the human component, the NRCP’s strategy includes strengthening the surveillance on human rabies incidence, spreading better awareness about the disease and its prophylaxis, training of health professionals and proper administration of rabies immunoglobulin.
In its National Guidelines on Rabies prophylaxis, the NRCP recommends following first aid and treatment steps:
- Proper post-exposure prophylaxis or PEP should start immediately after getting bitten or scratched by any warm-blooded animal, including dogs, cats, wolves, jackals, etc. If the bite is by a dog or cat, the animal should be kept under observation for 10 days, whether it has received previous vaccination or not.
- Since the rabies virus enters the human body through bites or scratches, it’s vital to remove all the saliva (and thereby, hopefully, the virus) from the wounds by flushing and washing it thoroughly for a minimum of 15 minutes with soap and water, povidone-iodine or other such substances. This step is crucial in removing and killing the rabies virus.
- The application of irritants like chillies, turmeric, lime, etc is unnecessary and can be damaging. It should be avoided.
- After the wound is thoroughly washed and dried, antiseptic agents like povidone-iodine may be applied.
- Cauterizing the wound is no longer recommended and suturing should be avoided unless absolutely necessary.
- The rabies immunoglobulin should be administered as soon as possible in the depth and around the bite wound to neutralise the locally present virus. A tetanus injection and a course of antibiotic should also be taken to prevent sepsis in the wound.