ALL FOR ONE- ONE HEALTH FOR ALL: RABIES CONTROL IN INDIA AND WORLD
K.P. Singh*1 and Praneeta Singh2
Government Veterinary Hospital, Deoranian, Bareilly,
Department of Animal Husbandry, Uttar Pradesh, India
1: Veterinary Officer, Government Veterinary Hospital, Deoranian, Bareilly, Uttar Pradesh Email: drkpsvet@rediffmail.com
2: Assistant Professor, Department of Livestock Products Technology, C.V.A.Sc., GBPUAT, Pantnagar, U.S.Nagar, Uttrakhand Email: vet_praneeta12@rediffmail.com
*Corresponding Author: Veterinary Officer, Government Veterinary Hospital, Deoranian, Bareilly, Uttar Pradesh Email: drkpsvet@rediffmail.com
Abstract
Rabies is a vaccine-preventable viral disease present in more than 150 countries around the world. Globally, almost 60,000 people die each year from rabies, of which more than 58% are in Asia and around 45% in South Asia with especially high incidence in India, Pakistan and Bangladesh. Rabies imposes a substantial burden to about half of the world population. The World Health Organization (WHO), World Organization for Animal Health, and the Food and Agriculture Organization have set the goal of eliminating dog-mediated human rabies deaths by 2030. This could be achieved largely by massive administration of post-exposure prophylaxis through elimination of dog rabies, or combining both. Here, we focused on the resources needed for the elimination of dog rabies virus by 2030.Vaccination coverage of both people and stray dogs is low in the region. In general people are not given enough protection and information about pre- and post-exposure prophylaxis. Engagement of multiple sectors and One Health collaboration including community education, awareness programmes and vaccination campaigns are critical to control and elimination of rabies.
Key Words: One health; rabies control; India
Introduction
About 35% of all human deaths from rabies occur in India which also accounts 60% of rabies deaths in Asia. The One-Health nature of rabies—requiring the integration of medical and veterinary sectors—has challenged how animal control and rabies prevention efforts are designed and implemented. Animal control has posed a challenge for centuries as suggested by the epigraph, which continues to resemble many urban and peri-urban settings today. Rabies is a zoonotic disease that kills an estimated 59,000 people and hundreds of thousands of animals annually, with most of the burden falling in low- and middle-income countries, particularly among children and poor urban and rural communities. About 99% of rabies human cases originate by rabid domestic dogs. It is estimated that there are about 60 million stray/free-ranging dogs in the country and more than one million people receive PEP each year. Despite these figures, there is no coordinated and structured surveillance system for rabies which is not included in the list of regular surveillance diseases under the Integrated Disease Surveillance Project of the Indian Ministry of Health and Family Welfare. This results in the underestimation of actual cases and deaths due to rabies. The National Rabies Control Programme of the Twelfth 5-year plan (2012–2017), administered by the National Centre for Disease Control and the Animal Welfare Board, aimed to halve human deaths by 2017 but there is no evidence that this target was achieved. The Assistance to States for Control of Animal Diseases (ASCAD) and the Scheme for Birth Control and Immunization of Stray Dogs of the Animal Welfare Board, the Prevention and Control of Infectious and Contagious Diseases in the Animals Act, 2009, and the Laboratory Diagnosis Facilities (One CDDL, 5 RDDL and 256 State laboratories) execute various rabies control and prevention programmes. Tamil Nadu was the first one to establish a multisectoral, coordinated One Health committee to control rabies. Rabies not being a notifiable disease, absence of a national rabies control programme, a focus by Ministry of Health only on PEP, absence of nationwide dog vaccination and an unsystematic reporting system are the major blocks to control and elimination of rabies in India.
The One Health approach
The One Health (OH) approach is growing but could not progress towards institutionalization in much of South Asia in spite of funding and advice from the international community. The principal reasons are limited political support, an inappropriate legal framework, a dearth of technical expertise, budgetary constraints, limited data sharing mechanisms and lack of coordination among the various components that should be promoting and implementing OH activities. India, Pakistan and Bangladesh – are among the world’s top five rabies endemic countries. The one health approach has been found helpful in controlling zoonoses and has been practised effectively in some countries over several years Bhutan, Sri Lanka and Bangladesh have successfully reduced deaths from rabies over time using the OH approach. A multi-sectoral OH approach would facilitate the promotion of actions for all sectors but would impose only one cost (mass dog vaccination costs are borne by the animal health sector but provide important benefits to public health) [38]. The World Health Organization (WHO), the Food and Agriculture Organization (FAO) and the South Asian Association for Regional Co-operation (SAARC)) independently help to strengthen the OH approach for rabies prevention in the region. The main animal and human health concerns have been identified as zoonotic influenza, canine mediated human rabies and antimicrobial resistance. Each problem has an impact or effect on animal, human and environmental health in some cases and is most likely to be overcome by working in collaboration or providing information to multiple sectors. A Regional Capacity Building project under Eco-Health (OHASA) addresses training of trainers, holds health days for public awareness and mass vaccination of dogs.
The number of people bitten by dogs is increasing in much of the region Asia. Control has been ineffective due to a general lack of awareness for pre-exposure and post-exposure prophylaxis. Low vaccine efficacy due to a failure to follow the proper cold chain procedures and possibly poor vaccine quality are further problems. Rabies is incurable but is preventable. Active participation and collaboration with and among farmers, animal health workers, veterinary professionals, medical professionals, politicians and a range of other stakeholders in an OH approach is required. Achieving this type of action is compounded in the South Asian region due to diverse cultures and traditions and to political instability.
Actions required for the control and elimination of rabies in India and South Asia
- Data sharing and co-ordination among human, animal, plant and environmental health sectors
- Efficient risk analysis and surveillance system to capture both clinical and non-clinical cases of rabies in both domestic and wild animals
- Strengthening of the laboratory capacities
- Increased vaccination coverage and improved vaccination efficiency
- Effective awareness campaigns
- Comprehensive reduction of risk measure
- Investigations of the various bio-social conditions
Conclusions
The best pathway to rabies control and elimination appears to be the one health. One health requires coordination and exchange of actions and data among all parties and across all disciplines and countries. It is also important to provide educational programmes for young people that highlight the importance of wound treatment and the need for post-exposure prophylaxis (PEP). Achieving global dog rabies elimination will require unique regional and national strategies. Funding, vaccination methods, personnel, and technological advances will be utilized differently. Countries will progress at the pace set by their governments and with assistance by international supporters, not at the predicted pace of the 13-year elimination program utilized in this analysis. Natural disasters, human-made disasters, competing needs, political processes, economic stagnation, and other unpredictable events will undoubtedly derail rabies elimination efforts in some countries.
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