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EDITORIAL
Year : 2017  |  Volume : 61  |  Issue : 1  |  Page : 1-2  

Vision 2030: Dog-mediated human rabies-free India: Action must begin now


Professor and Head, Rajiv Gandhi Institute of Public Health and Centre for Disease Control, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India; Member – Advisory Board of IJPH; Founder President/Mentor, APCRI; Member of the WHO and GAVI, Geneva, Switzerland, South Africa

Date of Web Publication16-Feb-2017

Correspondence Address:
M K Sudarshan
Professor and Head, Rajiv Gandhi Institute of Public Health and Centre for Disease Control, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India; Member – Advisory Board of IJPH; Founder President/Mentor, APCRI; Member of the WHO and GAVI, Geneva
South Africa
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_20_17

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How to cite this article:
Sudarshan M K. Vision 2030: Dog-mediated human rabies-free India: Action must begin now. Indian J Public Health 2017;61:1-2

How to cite this URL:
Sudarshan M K. Vision 2030: Dog-mediated human rabies-free India: Action must begin now. Indian J Public Health [serial online] 2017 [cited 2017 Jul 22];61:1-2. Available from: http://www.ijph.in/text.asp?2017/61/1/1/200249

Rabies is a zoonotic disease that is almost always fatal yet is practically 100% preventable. Worldwide, annually about 55,000–60,000 persons die of rabies,[1] of which 20,000, that is nearly one-third are from India alone.[2] About 99% (97% in India [2]) of these deaths are following bites/exposures to dogs, i.e., dog-mediated human rabies.[1] Till date, the disease is classified widely under the neglected tropical and zoonotic diseases. However, in December, 2015, the World Health Organization (WHO) at a global rabies conference held at Geneva, Switzerland, called for the elimination of dog-mediated human rabies by 2030 and recommended the strategy of “one health approach” that involves an effective coordination and cooperation of medical, veterinary, and other related sectors.[3] Consequently, as a responsible nation of the global community, India needs to drastically reduce its burden of human rabies. Hence, in July, 2016, at the 18th national conference of rabies organized by Association for Prevention and Control of Rabies in India (APCRI) at National Institute of Mental Health and Neurosciences, Bengaluru, it was resolved to support and work for accomplishing the global goal by ensuring a dog-mediated human rabies-free India by 2030.

The present estimate of human rabies burden of 20,000 per year is based on a WHO-APCRI national multicentric survey done in 2003 that is now redundant. Because at that time (of the survey), the rabies postexposure prophylaxis (PEP) mainly consisted of sheep brain (Semple) vaccine which was not only reactogenic but also less efficacious, and the use of lifesaving rabies immunoglobulins was negligible (≈2%).[2] However, in 2005, the Semple vaccine was discontinued and replaced by modern vaccines that are very safe and highly efficacious. In 2006, cost-effective intradermal rabies vaccination was introduced in the government hospitals in the country. Besides, in the last over a decade, the overall socioeconomic improvements have led to more literate masses and better rabies awareness, more/improved roads, transport and communications leading to better access, and utilization of vastly improved health-care facilities. The resultant better availability, access, and use of rabies biologicals have shown a remarkable reduction in the human rabies incidence in the isolation/infectious disease hospitals that serve as sentinel centers for disease surveillance in the country. Hence, it is time soon a reassessment of the burden of human rabies is done in the country, and in my opinion, the new guestimate may be around 5000!

The onus of reassessing the burden of rabies in India is now vested under the leadership of National Centre for Disease Control, Delhi, WHO collaborating center for rabies epidemiology that also serves as the WHO/national focal point for rabies in India. It is recommended that this activity is done in collaboration with APCRI, the organization that did the first rabies burden survey of India in 2003 and has the necessary expertise and experienced public health professionals in its fold. Incidentally, the APCRI in the first half of 2017 under a WHO project will be assembling new evidence in support of dog-mediated human rabies elimination in India considering cost-effectiveness, feasibility, and impact of improving access and coverage to rabies PEP and aspects of rabies vaccination policies. The results of this exercise are expected to provide the much needed information support, guide, and strengthen the initiatives of the government (personal communication).

It is important to immediately galvanize and relaunch the National Rabies Control Programme (NRCP, 2012–2017) by revising its strategy in consonance with the new global goal of the WHO by incorporating the “effective one health approach” and with the vision of achieving “dog-mediated human rabies-free India” by 2030. The revised NRCP shall have a clear action plan, road map, and a task force to drive it. It is ironical that when India can fire rockets of other countries into space and aspires to become a member of the global nuclear suppliers group but regretfully continues as a global hot spot of rabies.

It is time now to make “human rabies a notifiable disease” as it ensures a continuous surveillance of the disease. Initially, the disease may be made “reportable” based on clinico-epidemiological assessment (probable case/rabies) as sociocultural practices and practical feasibilities do not permit a postmortem (laboratory) diagnosis (confirmed case/rabies) in the humans. Nevertheless, this activity must begin soon under the Integrated Disease Surveillance Programme. The rabies biologicals, i.e., vaccines and immunoglobulins as lifesaving drugs must be exempted as applicable from the goods and services tax by the Central/State Governments.

At present, the single-handed approach to prevention of human rabies and the reduction of its burden by focusing mainly/mostly on medical interventions has not been fruitful. Hence, as an effective “one health approach,” it is recommended to target the source of infection, i.e., control the problem of rabies in dogs. Consequently, through well-organized communication campaigns and participatory approach, renewed efforts must be made to popularize and enforce (whenever and wherever needed) compulsory licensing of pet dogs in urban areas to begin with and later on to cover other areas; ensure accountability of Animal Birth Control programme for dogs in urban areas through periodic dog population surveys; and introduce annual mass dog vaccinations campaigns on the lines of the successful pulse polio vaccination. There is an urgent and immediate need for improving the availability, accessibility, and networking of rabies diagnostic laboratories in the veterinary sector.

The international support of UN agencies such as the WHO, UNICEF, OIE (World Organization for Animal Health), and others may be solicited for this marathon effort. The national and international nongovernmental organizations such as Rotary, Lions, Global Alliance for Vaccines and Immunization, APCRI, Indian Medical Association, Indian Veterinary Association, Indian Academy of Pediatrics, Indian Public Health Association, and others must be actively involved in the national action plan. To ensure a strong platform of information on one health, a network of all medical, veterinary, and other organizations working for the elimination of rabies in the country must be established through “RABINet,” the rabies network of India.

In the region of Asia, good progress in the control of rabies has been shown by Thailand, Sri Lanka, and the Philippines. If these countries have done it, then India must also do it. Finally, the freedom from dog-mediated human rabies in India by 2030 must be viewed by the Government of India as a public good, and India should occupy a place of pride in the WHO by achieving this goal successfully.

 
   References Top

1.
World Health Organization. Human Rabies. Geneva, Switzerland: World Health Organization; 2016. Available from: http://www.who.int/rabies/human/en/. [Last accessed on 2017 Jan 11].  Back to cited text no. 1
    
2.
Sudarshan MK, Madhusudana SN, Mahendra BJ, Rao NS, Ashwath Narayana DH, Abdul Rahman S, et al. Assessing the burden of human rabies in India: Results of a national multi-center epidemiological survey. Int J Infect Dis 2007;11:29-35.  Back to cited text no. 2
    
3.
World Health Organization. Weekly Epidemiological Record. Vol. 91. Geneva, Switzerland: World Health Organization; 2016. p. 13-20.  Back to cited text no. 3
    




 

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