Rabies Elimination in India – Challenges, Innovations and Community Engagement

Rabies Elimination in India – Challenges, Innovations and Community Engagement

Lalrinkima

Assistant Professor

Department of Veterinary Pathology

Institute of Veterinary Science and Animal Husbandry

SOA (Deemed to be University), Odisha

The Latin word rabere, which means to lose one’s sanity is the root of the English word rabies. Louis Pasteur discovered this infectious disease for the first time in the year 1880s. A viral zoonotic disease primarily affecting the central nervous system. The disease is caused by a member of Lyssavirus under the genus Rhabdoviridae negative sense, non-segmented, single stranded RNA virus. It is estimated that 55,000 individuals worldwide pass away from rabies ever year. About 40% of cases involved children under the age of 15 with the majority occurring within poor populations in Asia and Africa and around 96% of mortality and morbidity associated with rabies in India reported from dog bites. Rabies is an endemic disease in India and it is common throughout all of the states and union territories with the exception of the Andaman and Nicobar and Lakshadweep Islands.  India’s National Action Plan for Rabies Elimination (NAPRE) launched in 2021 promotes a “One Health” approach, emphasizing inter-sectoral coordination between human and animal health authorities, mass dog vaccinations and public education.

CHALLENGES IN RABIES ELIMINATION

1. a) Vaccine and immunoglobulin availability
2. i) Insufficient stock:There is widely available of anti-rabies vaccine (ARV) in many public health facilities whereas studies have found inconsistent supplies of vaccine particularly in primary health centers and rural areas.
3. ii) Severe shortage of immunoglobulin:The most significant challenge is the shortage of Rabies Immunoglobulin (RIG) which is critical for treating severe (Category III) bites alongside the vaccine. A recent survey found that rabies immunoglobulin was available in only about 20% of public health facilities.

iii) Geographic and facility disparities: Access varies widely throughout the nation. Compared to hospitals in urban areas anti-rabies vaccine and rabies immunoglobulin are far less readily available in primary care settings and in some areas like the Northeastern states.

1. iv) Cost and affordability:Though anti-rabies vaccine and rabies immunoglobulin are provided for free at public facilities whereas patients often face costs in private clinics. Rabies immunoglobulin is particularly expensive which can lead to delayed or incomplete treatment especially for the poor.
2. b) Challenges with the administration and protocols
3. i) Incorrect injection sites: Improper intramuscular injections including forbidden administration in the gluteal region have been reported.
4. ii) Incorrect Rabies immunoglobulin infiltration: Rabies immunoglobulin must be infiltrated properly around and into the wound. Some healthcare workers may lack the expertise to perform this complex procedure correctly especially in difficult cases like children or multiple bite wounds.

India, which has one of the highest rates of rabies mortality worldwide must significantly innovate in a number of areas in order to meet its 2030 rabies elimination target. Although the National Action Plan for Dog-Mediated Rabies Elimination (NAPRE) offers a framework, systemic problems with dog vaccination, surveillance, medical care and public awareness must be resolved through innovative methods.

DOG VACCINATION AND POPULATION CONTROL

Since almost all human rabies cases in India result from dog bites effective vaccination of the canine population is the most critical component of elimination.

1. i) Oral Rabies Vaccines (ORVs):The necessary 70% vaccination coverage is difficult to attain with traditional catch vaccinate release techniques particularly when dealing with elusive free-roaming dogs. Because they are more affordable and easier to give to large populations, oral vaccinations embedded in traps have the potential to transform healthcare.
2. ii) Digital tracking:Innovative mobile applications equipped with GPS tracking have been successfully piloted by organizations like Mission Rabies in Indian cities like Ranchi and Goa. These applications allow teams to map vaccinated dogs in real time identify coverage gaps and guide field teams back to under vaccinated areas.

iii) Sustainable population management: Beyond vaccination, innovations are needed for more effective Animal Birth Control (ABC) programs. This includes developing partnerships with local communities and animal welfare organizations to promote responsible pet ownership and manage stray populations more humanely and systematically.

INTEGRATED SURVEILLANCE AND DATA MANAGEMENT

Innovation is vital for improving India’s fragmented rabies surveillance and reporting systems.

1. i) One Health integration:In order to create an effective “One Health” network for real-time data sharing, veterinarians and India’s Integrated Health Information Platform (IHIP) need to be more closely connected. This would provide a better understanding of the illness load and enable a quicker response to suspected cases.
2. ii) Rapid diagnostics: Rapid, point-of-care diagnostic kits for animals may be developed and made publicly available to enable field teams to promptly confirm suspected rabies cases giving them useful information to guide focused vaccination campaigns.

iii) Molecular epidemiology: Expanding the capacity for molecular sequencing of rabies viruses as implemented in Goa can help scientists understand transmission dynamics and track the virus spread.

PUBLIC AWARENESS AND COMMUNITY ENGAGEMENT

1. i) Behavioral science:Cultural misunderstandings frequently render traditional awareness efforts ineffective. To challenge ingrained attitudes and encourage prompt wound care and medical attention, creative campaigns founded in behavioral science concepts are required.
2. ii) Targeted digital media:More efficient distribution of instructional messages can be achieved by utilizing mobile and social media platforms. This might include a centralized toll-free helpline to assist victims of animal bites as well as content targeted to various linguistic and demographic groups.

iii) School-based education: Integrating bite prevention and rabies awareness into school curricula can create a more informed younger generation who can then educate their families and communities.

1. iv) Using multiple channels:Information, education and communication materials can be distributed via rallies, street plays, pamphlets and mass media like television.
2. v) Report incidence: They can quickly report animal bites and are frequently the first to learn about possible rabies exposures ensuring that victims receive fast medical attention.
3. vi) Following post-exposure care: People with higher levels of education are more likely to seek medical help and properly cleanse wounds with soap and water—two life-saving measures that are frequently disregarded because of ignorance.

vii) Supporting animal welfare: Instead of making people afraid of stray dogs, community involvement can create a welcoming, dog-friendly atmosphere that promotes involvement in vaccination and animal birth control campaigns.

viii) NGO and animal welfare organization: These groups often have the trust of the community and play a crucial role in implementing sterilization and vaccination programs.

HUMAN PROPHYLAXIS AND TREATMENT

1. i) Monoclonal antibodies: Innovations in locally made reasonably priced Rabies Monoclonal Antibodies (RmAbs) are required as a substitute for the expensive and rare Rabies Immunoglobulin (RIG). These are more adaptable, safer and simpler to manage.
2. ii) Intradermal vaccine delivery:Accessibility and affordability would be increased by promoting and standardizing the use of intradermal vaccination, which utilizes a lot less antigen and is more economical. Innovations such as intradermal micro needle patches have the potential to enhance safety and streamline administration.

iii) Universal Pre-Exposure Prophylaxis (PrEP): Incorporating Prophylaxis into the national immunization schedule is a viable long-term strategy for high-risk groups, especially children in endemic areas. This would lessen the need for urgent post-exposure care.

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