“WORLD RABIES DAY 2023”: ALL FOR ONE AND ONE HEALTH FOR ALL 

“WORLD RABIES DAY 2023”: ALL FOR ONE AND ONE HEALTH FOR ALL 

 Submitted by-

Yukti Singh

4^th year B.V.S. C

COLLEGE OF VETERINARY SCIENCE AND ANIMAL HUSBANDRY, JABALPUR

NDVSU, JABALPUR (M.P.)

 Email- yukssss11@gmail.com

 

  ALL FOR ONE AND ONE HEALTH FOR ALL

Introduction

“Vitality of everything under the sun is entrusted upon the environs. “

The collaborative approach of the world as a whole towards any goal can generate a productive outcome. Rabies causes deleterious impact on economy, health, and social and also has ethical implications too. This year’s rabies day theme points towards accomplishment of one objective inculcating one health concept for a rabies free globe. Rabies is 99% fatal disease caused by Lisa virus but it is 100% preventable through vaccine. With a death rate of 9 deaths per minute it is havoc to mankind since treatment is still not available it can be better prevent

 

Environment has an overwhelming response on the human. Animal, plants and human are all the part of a chain of energy transmission and have interdependency over each other. If one link is broken whole chain will be adversely affected. The great physician Sir Hippocrates promoted the concept of public health relation with clean environment. In later years many researchers and scientist realized this vital concept. Sir James H Steele kept the founding stone of Veterinary Public Health Division at Centers of Disease Control and Prevention (CDC). Animal and human bond can be observed since ancient times when few animals where domesticated. This is an important determinant of animal welfare. If we beings are related to them we will naturally care for them. Negative human and animal relationship can impair animal productivity, health and so others. So, “One health “is an overall concept to understand the –Human, Animals and Environment. Animal flesh eating and raw eating of animals have been in practice since we humans were cave dwellers. This has passed on many diseases of animals to human. As per present data 65-70% infections are zoonoses.

HUMAN

MEDICAL PROFESSIONAL

ANIMLAS

This leads to an increased demand of veterinarians to research over these zoonotic diseases.

	VETERINARY

 

Concept of one health

Wildlife Conservation Society (WCS) introduced the term “One World-One Health “in 2007 along with 12 recommendations (the Manhattan Principles) that focused on establishing a more holistic approach to preventing epidemic disease and maintaining ecosystem integrity. Concurrent need of this concept is to fight against certain emerging viruses which can be fatal to humanity and further affecting the nature. International institutions promoting this concept -WHO – WORLD HEALTH ORGANISATION,FAO –FOOD and AGRICULTURAL ORGANISATION,CDC – CENTRE FOR DISEASES CONTROL AND PREVENTION.

Background

If we do not act Now 1, 000, 00 people will die of babies before 2030. The demand for post exposure profile axis will also grow because more people will be exposed and poor and rural population will continue to disproportionately affect by systematic inequality. Elimination of the dog mediated rabies will strengthen the health system. In 2019 Mexico became first country for eliminating rabies as public health problem. India accounts 36% of global death due to rabies nutritional rabies control program reported 6644 clinically cases and death of human within2012 and 2022

The three main objectives of “Zero by 30”

• Vaccine tools and technology to reduce the risk of human rabies
• Second generating major impact to promote reliable data and guidance
• Third sustain political and financial commitment

Rabies is a Latin word come from Sanskrit word rhabhas which means to do violence. Also, known by miscellaneous names like hydrophobia, lyssa, mad dog etc. It can occur in all warm blooded animal but recognized as natural disease of dog, cat, bat and wild carnivores. In human 999% cases of rabies are dog mediated. In this disease the characteristic sign is encephalomyelitis that is severe and fatal inflammation of brain and spinal cord. It is caused by the rabies virus belong to genus lyssa virus and family rhabdoviridae. This virus is large enveloped and bullet shaped sRNA,its envelope has some specific character – projection of glycoprotein –G which is important for its attachment to host cell and produce serum neutralizing antibody

Epidemiology :

Rabies is one of the oldest diseases, the dramatic growth in rabies came with famous work of sir LOUIS PASTURE. It is present in most of the countries but cause extensive morbidity and mortality in India. This is cause due to high population of unvaccinated dog. Rabies is not only urban but also a rural problem as cattle, buffalo, sheep, goat and equine are also moderately susceptible. Cattle, buffalo, equine and man are dead end host so not cause any problem to human. The Avian population rarely susceptible for this disease.

Two epidemiological cycle Urban and Sylvatic spread the disease. The transmission of disease is through direct contact and bite injury. Rabies virion do not penetrate the intact skin but it may infect through mucous membrane. The presence of hyaluronidase enzyme in saliva of dog at time of attack increases permeability of skin to the virus. It is known that bats are reservoir host of rabies infection. Though not very prevalent in India may be seen other continents.Occurance of canine rabies is mainly seen in Asian and an African countries but occurence of wild life mediated rabies is also seen in other continenets.Classical rabies virus is not present in western Europe. South America is completely eliminated canine rabies.

Symptoms:

Animal  :-1. Manifest in furious or hyper excitable and dumb or paralytic form.

2. Change in voice of barking and anorectic, restlessness is observed.
3. An eating habit of abnormal object like stones, pipes may develop.
4. They may be increase tendency to bite later paralysis of limbs
5. Excessive salivation is one of characteristics sign which must also be properly diagnose from other diseases.

Human–

1. The initial symptoms after bite is of non- specific nature as we may get confuse with other infection [general body weakness, headache].
2. The first specific clinical sign is itching sensation at site of bite later cerebral dysfunction, anxiety, delirium etc
3. Remember once the clinical symptoms appear may occur within 2-3 weeks as no specific treatment is available.

 Community effort: to achieve the goal of zero by 30.

Principle of coexistence must be applied to achieve mass eradication of rabies. Strategy like reuniting and adoption of stray animal for betterment of both the animal and society at large maintaining a good sewage drainage system so that it could not attract the stray animal and be the cause of further pollution and enhance the spread of other zoonotic disease .As per this year theme all for one approach is focused on a multispectral cumulative approach to combat with the existing diseases. Daycare facilities, dog housing can be one of the successful measure.

 Diagnostic approach

OIE reference laboratory for Rabies diagnosis is in KVAFSU. Recent designation as OIE reference lab for rabies at KVAFSU is a millstone in improving surveillance in animal. Such other regional level strengthening of laboratories is prerequisite for rabies surveillance, various training  for assurance of quality and safety procedure, sample collection, submission , processing of the sample, antigen detection methods, various molecular diagnostic method , inter laboratory compulsion, processing testing and molecular epidemiology.

On the impact of training on brain sampling as become user friendly to trainee who do this in field basis. If we look upon the chain of diagnosis is start at various levels which start with the block level, we go for the collection of brain samples then it goes to the district level labs next is the state level labs where DRIT PCR is performed. Further molecular characterization is done at regional labs and at the level of national reference labs various analysis, documentation being done and finally reported to the government of India.

Rabies virus isolated from naturally infected host is called street virus in this kind of isolation virus does not undergo any modification  or changes in laboratory it has variable incubation period and invade salivary gland. There is another term called as fixed virus used for certain strains in laboratory animals by serial intra-cerebral passage.

Along with the clinical sign and history ante-mortem is another technique to diagnose the rabies and other zoonotic diseases. It is not routinely conducted, due to pack of necessary facilities. The most useful sample for diagnosis is obtained from nape skin biopsy and saliva. High viral titer can detect in saliva up to 10 days before the onset of clinical sign. Hair follicles, skin and saliva can be tested for viral RNA by RT-PCR.For post-mortem diagnostic testing brain tissue is first choice.

It is important that the minimum capacity of each laboratory to perform to perform at least direct fluorescent antibody test. Many risk posed by viruses risk posed by viruses risk posed by viruses focus on enhanced precautions for the handler of bio-safety lab of Level 3 must be developed keeping in mind all the safety protocols the personal protective equipments must be provided Working in these laboratories. Test for detection of viruses like mouse inoculation, tissue culture infection test. Advance antigen based techniques like antigenic typing of lyssavirus by monoclonal antibodies, use of flow cytometry etc.

Institutional policies

To, generate mass awareness, through various training, workshop, seminar, conference and webinar campaign. Conduction of surveys and census will also help to record and analyze data for estimating the resources required. Animal identification system through various markers is a new technology which should further help in the large scale surveillance program. International rule for export and important of various animal should be made more stringent so that spread of Trans boundaries diseases can be reduced by lenient policies to promote collaboration and partnership in veterinary care sector. Caught neutral vaccinate and return -tool has emerged to be effective. Euthanasia and its proper regulations can be made ethical for the betterment of the society.

Promoting state level zoonoses committee for in acting various legislation. This issue comes under the aegis of various ministries directly or indirectly like ministry of family welfare and health, ministry of urban affairs, ministry of environment, ministry of animal husbandry. So it is important that various stakeholders join hands. Professional coexistence the medical, veterinary, agri-tech can jointly play the required roles. Combined training and research activity can improve both therapeutic and diagnostic approach .National one health mission efforts are been taken by the government private and global institution towards filling any left gap. In one such efforts office of principle scientific advisories approved to set up national one health mission. Various institution, councils ,public private body like  Indian council of medical research (ICMR) ,Department of biotechnology (DBT), Council of Scientific and Industrial Research (CSIR), National Centre for Disease Control (NCDC) etc will work together and achieving the goals of one health. National rabies control program was approved during 5 year plan as central sector scheme which comprised of animal health component and human health component .This aims at training providing technical support to state ,laboratory strengthening. National action plan for rabies elimination (dog mediated) has three key principle- prevention, promotion, and partnership.

Fund

Developing country Mostly require a large amount to sanction various policies  And to see their application on ground level. To maintain cold chain and regular supply of pre and post exposure prophylaxis. The development of large scale diagnostic labs and to promote research and development activities in the country. According to report put up by WHO the economic cost for dog mediated rabies is estimated at 8.6 billion US dollar per year.

A three phase approach has been proposed

• Phase 1- start-up, in this phase priority will be given to countries having great chance of curving rabies or such countries where pilot project successfully implemented.
• Phase 2 scale- up, this phase will involve most endemic countries.
• Phase 3 mop- up, will engage other remaining countries to aid will be provided and the countries which already achieve the goal.

The activities to be promoted through capital funding are ‘Global biological banks’, better monitoring program and good diagnostic facilities.

 One health and Veterinarians

Animal care and concern is of wide importance in present scenario. Veterinarians are one of the noblest professions as they deal with animals and their healthcare. This is vice-versa related to one health concept which amalgamates all the components of a healthy ecosystem. The Zoonotic diseases are prominent issue to deal with in upcoming years too. In the light, of this all the animal healthcare professionals are highly responsible and dedicated to combat and contribute in curbing zoonotic diseases worldwide.

• One health must be an important approach that will guide all veterinarians to be in one line with medical professionals and also our nature.
• Promoting one health is being now our prime duty.
• Developing more practical framework for implementation of this concept.
• Prevention, control and treatment of zoonotic diseases in animals
• Every veterinarian should consider it as a responsibility to protect themselves and others from zoonotic diseases at clinics, farms and hospitals.

Individual and society level

Among the many stakeholders the journal public is also included in country like India where diverse cultural population lived it even becomes difficult for the government to curve zoonotic diseases like rabies. The socio culture context influence rabies perception and dog keeping practices. Building awareness of dog mediated rabies as preventable global public health problem is important , practices like responsible dog ownership so that both human and animal end can be safeguarded. Proper educational program on bite prevention their management, first aid for both children and adult is required. This is high time to generate ,mass awareness  regarding the post exposure prophylaxis and various therapeutic and clinical approaches. The community can be engage in generating and creating awareness by celebrating various observance days like world Rabies day.

Cold chain :

Cold chain is a system of storing and transporting vaccine at recommended temperature from point of manufacture to the point of use. The key of cold chain element include the management of vaccine storage ,its distribution, equipments to store the vaccine and monitor the ambient temperature, procedure for utilization of equipment and ensuring vaccine store and transported safely. A various ice lined refrigerator, deep freezer, solar cold chain equipment, cold box, ice packs are used for maintain the vitality of vaccine. Proper testing of vaccine sensitivity must be done timely and also the vaccine is must be checked for its heat and cold damage.

Proper temperature monitoring from the manufacture site up to the destination as per required is important for the prevention of the disease. Primary health care centre must be well equipped to maintain these vaccines cold chain. Various insulated vans can also aid in easy transport.

                          “How beautiful is God’s creation under the shed of vaccination”

VACCINATION

Post exposure prophylaxis

In endemic country where there is sustained infection every animal bite is suspected to be a rabied animal bite follow the underlined protocol :-

• First observe the dog and cat and start post exposure prophylaxis simultaneously. If the dog remain healthy even after 10 days the post exposure prophylaxis can be altered the pr exposure vaccination by skipping vaccine dose on 14 day.
• Second Vaccination status of animal : generally unvaccinated animals likely to transmit rabies but vaccinated animal can also cause infection if vaccination was not effective.
• Vaccination is not always guarantee of protection if vaccine quality is poor, improper vaccination and poor health of animal at time of vaccination.

Wild animal bite : is third category vaccination protocol.

Anti rabies vaccine

Immunization program is made successful by administration of safe and potent cell culture vaccine or purified chicken embryo vaccine. One single intramuscular dose with potency of 2.5 IU should use. It is a minimum prescribed potency required for safety. All animal bite victims of category 2 and 3 of age and body weight require same number of vaccination. It is recommended that vaccine transported and maintain at 228 degree centigrade. Currently available anti rabies vaccine in India are RABIPUR, ABHYARAB.

Intradermal  technique: it is cost effective technique as compare to intramuscular technique .if followed on wide scale it will pose less burden on country economics. There are occasional and rare incidences of vaccine failure mainly due to incomplete course of vaccination or in case of immune compromised status of the subject.

Animal immunization: vaccine is always economical than treatment ,pet animal can easily be vaccinated their records can be maintain. The mass vaccination camping at village ,block and at district level must be conducted time to time. Precaution taken are as follows

1^st– re-vaccinate :vaccine for rabied and some others fatal diseases are to be given boosters and annual dose. It is the individual responsibilities to bring their dog for vaccination.

2^nd health status: it is ideally recommended not to vaccinate a weak and feverish dog. Success of vaccine depend show healthy is the animal.

3^rd After care: sli8ght dullness, in-appetance even after 24 hours of vaccination and increasing lump at the site of injection beyond 2-3 months false for the veterinarians attention.

4^th De-worming: it is an important to abide by the de-worming schedule for the prevention of  harmful parasite which can cause complication  and effect efficacy of vaccination.

Vaccines used are raksha-rab, defensor, nobivac rabies.

Vaccination schedule for post rabies

Pre-immunized individuals

Regimen	Route of administration	Days of visits	Regimen details
Booster	Intradermal or intramuscular	.      0 and 3	dose each day

 

.     Unvaccinated individuals

Essen	Intramuscular	0, 3, 7 and 14,28	1 dose each day
Modified Essen	intramuscular.	0, 3, 7 and 14	1 dose each day
Zagreb(2-1-1)	intramuscular	0,7,21	2 dose at 0thday 1 dose at 7th and 21st
Thai Red Cross	Intradermal	0, 3, 7,28	2 dose at different site

.

Surveillance

In the human sector integrated disease surveillance program was focused to increase government funding for surveillance strengthen laboratory facility and having trained expert at every stages. The information technology advancement  has taken digital program set at higher level. National digital livestock mission encompasses unique identification of animals enhance ideal application use of artificial intelligence .Purpose is to integrate data from multiple source like outbreak and incidence diagnostic data, vaccination update etc New feature like tele-health care and tele medicine services will require routine surveillance and monitoring.

RESQ charitable trust setup a response unit which receive reports of animal emergency and potential rabies animal through helpline of web line based on the information provided the response unit ambulance sent to the suspected area later the information of location was record analyze through geographical mapping and determine as rabies Hotspot.

Surveillance of human population in rabies infected areas any case of animal scratch bite should be immediately investigated. The aggregated data must be reported to the committed rabies team rapid exchange of information is required for epidemiological investigation at all focal spots. Surveillance of animal population .There should be an integrated approach at human and animal exposure data to provide better facilities.

Rabies Immuno Globulin

It provides passive immunity in form of ready-made antibodies, it forms effective way to locally neutralize the virus.

The types of rabies immunoglobulin available are equine rabies immunoglobulin is of heterologus origin. Its use has a small risk associated with it which is anaphylaxis. The second type of immunoglobulin is Human Rabies Immunoglobulin Virus (HRIG). It has no adverse effects as it is of homologous origin.

It is mainly done in category 2 type of exposure.

Rabies immunoglobulin for passive immunization is administered only once, Preferably within 24 hours after the exposure (on day 0 along with the first dose of anti-rabies vaccine)

Precautions to be taken are:

1. Proper dose must be calculated and infiltrated or it will slow down the vaccines antibody production.
2. Infected bite wound can also be infiltrated without any complications.

Wound Management

Since the rabies virus enters the human body through bite or scratch so it is important to remove the saliva as soon as possible. Precautions taken are as follows

• Never applied chilly , mustard oil or any other irritant on bite wounds as it may cause further irritation and aggravated the condition.
• Never apply dressing or get suture until any emergency.
• Dettol or sevlon in concentrated form can cause severe irritation.
• Never rely on superstitious methods.
• Cauteristaion is not recommended in anymore as it leaves scar around the wound and is moreover not helpful.

Steps to be followed are

• Immediate washing with running water for mechanical removal of virus for the wound, maneuver dip your hands in stagnant water.
• Apply soap preferably alkali soap if available can kill the virus through continuous washing for 15 minutes.
• After washing dry the wound and Apply antiseptic lotion like povidone iodine .
• In category 3^rd exposure infiltration of immunoglobulin is preferred to neutralize the virus around the wound.
• Suturing If required should be done after adequate cleaning and immunoglobulin infiltration.
• Tetanus toxoid injection to prevent sepsis in the wound.

Animal Birth Control

India is endemic for this disease and 36 percent of world’s rabies death. Most cases reported are under age of 12-15 years. Scheme is meant for controlling the population of stray dog by sterilization. The animal welfare board of India provides grant to non government organization, society to prevention of causality of animal and local bodies for immunization, catching and relocation of animal. This is given in the name of animal Birth Control grant. In this scheme rupees 370 per dog is given as financial aid for pre and post operative care which can also include medicine if required.

Also for catching and relocation of dog 75 rupees per dog is given. Key features of success ABC program include identification of stray dog, record keeping and further monitoring of program effectiveness. The sterilization surgery is done under proper anesthetic and surgical protocols with use of analgesics and antibiotics.

One health economics

This is a broader concept as it inculcate at level of human-animal-environment interface. The World  Bank has made various financial estimates regarding zoonotic infections and their control measures. If the cost of the eliminating the disease is even more then also we should focus to curve the particular disease instead of spending in prevention and control measures. For economic understanding we can start by taking the parameters of resources, scarcity and its utilization. For the improvement of monitoring of facilitating environment estimates the cost both direct and institutional. Doing the cross sector assessment widen the perspective.

Research and development–

In every sector research and development is mandatory for improvisation, lowering the cost ,enhancing vaccination efficacy,  faster cure research is always required as the organism might show mutation causing the existing program of immunization and prevention become futile. So we have to enhance our research according to the mutational changes in an organism. The availability of vaccine in low cost will help faster elimination of disease. Also facilities and strategic partnership must be done for clinical investigation of new drugs.

Ecological factor

Various environmental parameters including temperature, longitude, water bodies, forest are pivotal in determining prevalence of rabies. Like vampire bat is the important reservoir of rabies in western hemisphere, their distribution is affected by altitude, climate change. Though oral rabies vaccination is being done in wild life like fox but is still not popular in Indian subcontinent. The waste management is to be done by following a systematic approach as this will reduce the number of stray dog, roaming, causing nuisance and become troublesome for the society.

Issues Ahead

1. The proper resource utilization is not done in any sector which causes wastage of resources
2. The laws and regulations are either not strictly implemented or followed
3. Research activity has so much vacuum but due to lack of fund researchers are coming forward
4. Poor surveillance and reporting of rabies of both animal and human and lack of any mechanism to share data among various stakeholders.
5. Even after animal Birth Control program of very large number of stray dog population is found in India.
6. Lack of awareness and improper training thus further deteriorate the condition.
7. Negligence of owner for their Pet vaccination.
8. Lack of collaboration amongst various institutes for research and development activities.
9. Public private partnership we also not promoted.
10. Avoiding mass awareness campaign and ignorant in following the rules.
11. Deforestation is also a thread as it may cause spill over or inter mixing of Sylvatic and urban cycle
12. No such nidus should be maintain but unhygienic practices keep on enhancing the risk of diseases
13. Improper functioning of local self government leads to leniency in implementation of laws.
14. Lesser dog ownership Or adoption policies leads to increasing stray animal.
15. People who belongs to the poverty line , due to lack of awareness and knowledge about the dog bite cause burdensome situation

GOA: SUCCESS STORY

GOA an Indian state is almost on verge of eliminating Rabies through one health approach. GOA has achieved this feat through vaccination camp. They made various response team for towns ,villages and urban area. They followed catching of the street dogs, then marking with non toxic paint and lastly free them. They used various digital technologies like mobile application for collating data. They have not only overcome this issue but also utilized lesser fund this saving the government money. They also choose education to generate awareness amongst children about the bite management and importance vaccination amongst the high risk profession

Contribution of veterinarians

All the human and animal healthcare professionals need to join hands to win over these zoonotic diseases.

• Promoting research of diseases of animals worldwide
• Proper study and analysis of epidemiology, etiology of diseases
• Early treatment by veterinary doctors for rabies infected and brucellosis infected animals and so for other zoonoses
• Development of proper infrastructure for veterinary department all across the globe to be interconnected for sharing of ideas of research based studies.
• Disease Surveillance
• Developing best-practice guidelines for informal market and
• slaughterhouse operation (e.g., inspections, disease prevalence assessments
• Holistic contribution

Conclusion

Now with observing trends of diseases it is very appropriate time to understand that zoonotic diseases capture the major human population. The scientific, infrastructural, research and development each sphere of veterinary should hold on to the concept of “one health”.

 

                             “Being a proud veterinarian we are a great humanitarian”

 All For 1 : One Health for All