Dr. Naresh Rakha, Dr. Naresh Rakha, Professor & HeadProfessor & Head Dept. of EpidemiologyDept. of Epidemiology& Preventive Medicine& Preventive MedicineCCS HAU Hisar.CCS HAU Hisar.

Epidemiology of Rabies and Epidemiology of Rabies and its strategic controlits strategic control

Rabies is a global problem

Don't fear, But prevent Rabies

Rabies is an acute, dreadful and Deadly viral Rabies is an acute, dreadful and Deadly viral infection of the central nervous system affecting all infection of the central nervous system affecting all

warm blooded animalswarm blooded animals

What is Rabies?What is Rabies?

Rabid dog will bite anything

EPIDEMIOLOGYEPIDEMIOLOGY

India has 27 million dogs

Dog : Human ratio 1 : 40 )

Stray dog population – 80%

Animal bite incidence – 17.5 million/ year - 66% children

Every 2 seconds a man is bitten by dog

Every ½ Hour a man dies of rabies

More than 20,000 human death every year

40% of people bitten by dogs don’t go for treatment

EPIDEMIOLOGY EPIDEMIOLOGY CONT.CONT.

India has highest incidence of rabies in the world (80%) 96% human rabies due to dog bite, out of which 11% due to pet dog bite Rest 4% due to contact with jackals, cats, monkeys, mongoose etc. For the last 10 years human death figure is constant. In army – 1 death per 6 lakh soldiers Death of one cattle per 1 lakh cattle ( 2830 )

Rabies in India: humanRabies in India: human

Each year about 7 million people undergo post exposure rabies treatment after a dog bite.

Association for Prevention and Control of Rabies in India (APCRI) reported in 2004 that there were 20,565 reported human deaths over the period of one year. Due to mis-diagnosis and under-reporting, the actual number of rabies deaths is believed to be higher.

About 70% of the victims are children younger than 15 years.

Global Epidemiology ScenarioGlobal Epidemiology Scenario

Estimates suggest that 1 person dies of

rabies every 10-15 minutes and about

1000 persons undergo post bite

prophylactic vaccination every hour in the world.

Rabies incidence in animalsRabies incidence in animals

Incidence more in summer months and particularly during the draught season

Incidence of rabies is uniform in all age groups of livestock.

More in cattle, buffaloes, sheep and goats compared to horse and swine,

Rabies in Haryana / IndiaRabies in Haryana / India Common in most parts of India and widely

prevalent in animal population of Haryana. Of about 25 to 30 million dogs in India (2003),

Haryana, estimated to have 1.5-1.9 million dogs

The situation of rabies in Haryana is no better, if not worse than national figures

Most of dogs in villages are ownerless, stray or at best termed as ‘common dogs’

These dogs play a major role in the spread of rabies.

Risk from common dogsRisk from common dogs

Common dogs are fed by local residents but their movements, although limited, are unregulated & daily activities are unmonitored.

Thus their contact with rabid animals and subsequent transmission to livestock gets ignored sometimes.

The dogs reared by farmers in rural and sub urban Haryana, while visiting fields, frequently come in contact with wild animals/ rabies reservoirs and thus bring the infection into the domestic animal population.

Increasing dog populationIncreasing dog population

Medical practitioners are recently advising ‘Pet therapy’ to the over stressed executives.

Because of nuclear structure of the families and mounting emotional stress, pets are being increasingly used as companions for children and old people.

This has made dog keeping more popular and thus has doubled the challenge of rabies control.

Treatment and controlTreatment and control

No treatment is effective in humans or animals once the symptoms of rabies are evident.

Control is possible through wound care & prophylactic vaccination only.

RABIES CONTROL PROGRAMME IN INDIA

No systematic programme Animal Birth Control ( ABC )

Catch, neuter, vaccinate and release – 1.4 lakh (0.52 %)

Neutering policies not well defined Vaccination of reservoir population –

Best choice India spends Rs 1500 crores ( US$ 375m)

for rabies vaccine in humans

Rabies control in animals in Haryana Animal welfare Board of India has envisaged a multi-

target rabies control program wherein stray dogs are sterlized, rehabilitated and orally immunized.

Haryana Urban Development Authority at Gurgaon is arranging finances and an NGO volunteers will help catch the stray dogs, get them sterilized from qualified vets and rehabilitate them from wherever they were caught, along with feeding anti rabies baits

The model rabies program to be implemented in Gurgaon needs to be extended to cover the whole state of Haryana.

Stray monkeys and cats also need to be included in the program since even these can act as reservoir of rabies.

Vaccine for animals in Haryana Haryana Veterinary Vaccine Institute at Hisar

has been producing and supplying the pre and post bite vaccine.

WHO recommends that cell culture vaccines should replace brain tissue derived vaccines as soon as possible.

Tissue culture vaccine, available in the market, is economical and hence is being used for prophylaxis primarily.

Vaccine failure in animals

Despite reported use of post bite vaccine, several cases of rabies are reporting to Veterinary Institutions in Haryana & Veterinary Clinics HAU, Hisar. This might be due to failure of cold chain required for maintenance of adequate efficacy of the product.

Site of dog bite in ruminants is very close to brain. So, the incubation period in such bitten animals is quite short & thus proper vaccination is needed immediately.

Diagnosis of rabies in animalsDepartment of Veterinary Epidemiology and

Preventive Medicine has been getting requests from field vets as well as farmers to diagnose the suspected cases of rabies.

The experts have visited and confirmed the cases through laboratory examination.

It is important to note that sometimes it becomes difficult for farmers to identify the symptoms of rabies in ruminants as these are different than those exhibited by rabid dogs.

Rabies in ruminants of Haryana transmitted though bite of rabid dog

Year Place No. kept atFarm/village

No. bitten No. died confirmed by

1998-99 Ambala Not known 2 2 Symptoms

1999-2K

Ellanabad, Sirsa

1200 40 17Cattle=7Buffaloes=2Sheep=6Goats=2

FAT

2K-2K1 Karamsana,Sirsa

1000 37Cattle=22Buffaloes=12Goats=3

5 FAT

2001-02 Titoli,Rohtak

10000 30 15 FAT

2004-05 GLF Hisar 129 2 2 FAT

GaushalaBhiwani

200 2 1 Symptoms

Rabies control through vaccination

Availability of vaccines Nervous tissue vaccine – Discontinued in Nov. 2004 in most places including Haryana, on the recommendation of WHO, but used in some places Tissue culture vaccine - Limited supply Oral rabies vaccine – Not available

Vaccines

Introduction of oral vaccine ( SAG –2 )

Testing under Indian conditions - is essential

Annual requirement – 30 million doses

Available – 18 million dosesNet deficit – 12 million doses

SAFETY AND EFFICACY STUDIES ON ORAL VACCINE (SAG-2)

PREPARATIONS All the dogs were dewormed and

vaccinated against canine distemper, Rubarth hepatitis, parvo virus and leptospirosis.

Pre-vaccinated animals tested for antibody and virus.

Immunosupression with Vetalog-4 Inj. of 1.2 mg.

SAFETY AND EFFICACY STUDIES ON ORAL VACCINE (SAG-2)

Clinical observation

Safety trial – 219 days

Efficacy trial – 199 days Saliva collection- For excretion of

vaccine virus (D0 to D5) Neutralizing antibody detection after

vaccination : D0, D14, D28, D56

BAITING OF STRAY DOGS

PILOT PROJECT ON ORAL RABIES VACCINATION OF STRAY DOGS

PILOT PROJECT ON ORAL RABIES VACCINATION OF STRAY DOGS

Indian Govt. approved the project for

5 years No. of doses to be used – 0.8 million

1st year - 0.1 million doses 2nd year - 0.1 million doses 3rd year - 0.2 million doses 4th year - 0.2 million doses 5th year - 0.2 million doses

Indian Govt. approved the project for

5 years No. of doses to be used – 0.8 million

1st year - 0.1 million doses 2nd year - 0.1 million doses 3rd year - 0.2 million doses 4th year - 0.2 million doses 5th year - 0.2 million doses

Issues at a glanceIssues at a glance In India with 27 million dogs, animal In India with 27 million dogs, animal birth control looks difficult.birth control looks difficult. Vaccination is the practical choice parenteral Vaccination is the practical choice parenteral for accessible dogs and oral vaccination forfor accessible dogs and oral vaccination for non-accessible dogsnon-accessible dogs Birth control coupled with parentral and oral Birth control coupled with parentral and oral immunization may be holding the answer to thisimmunization may be holding the answer to this mega problem.mega problem. Shortage of conventional vaccinesShortage of conventional vaccines ORV (SAG-2) is convenient in immunization ORV (SAG-2) is convenient in immunization of stray dogsof stray dogs Bait acceptance is 92 % Bait acceptance is 92 % ORV is safe for dogs as no adverse clinical ORV is safe for dogs as no adverse clinical signs and no replication of virussigns and no replication of virus

Suggestions to be considered to implement Suggestions to be considered to implement rabies control program in Haryanarabies control program in Haryana

1.1. All the dogs kept by owners All the dogs kept by owners should be licensed by competent should be licensed by competent authorities. In villages, dogs be authorities. In villages, dogs be registered with Panchayats like registered with Panchayats like Municipal Committees in cities Municipal Committees in cities are authorized to register and issue are authorized to register and issue licenses. licenses.

2.2. All licensed dogs should be All licensed dogs should be vaccinated against rabies as per vaccinated against rabies as per recommended schedule from a recommended schedule from a qualified Vet. A certificate of qualified Vet. A certificate of Vaccination of the pet should be Vaccination of the pet should be maintained by owner along with maintained by owner along with documentary proof of purchase of documentary proof of purchase of anti rabies vaccine dose.anti rabies vaccine dose.

Two more suggestionTwo more suggestion

3. Village Panchyats through the Block Development 3. Village Panchyats through the Block Development Officer and Municipal Committees through District Officer and Municipal Committees through District administration should be provided with adequate administration should be provided with adequate funds to ensure free vaccination for common dogs. funds to ensure free vaccination for common dogs.

4. Pet practitioners whether in Govt. jobs or in the private sectors should be instructed to treat the dogs which is licensed and has been properly vaccinated against rabies as evident from the certificate. This will encourage people to get their pets vaccinated regularly.

Last three suggestions

5. Vaccination should preferably be done in the winter season.

6. Thermo sensitive additives should be attached with the vaccine to reduce the problem of failure of cold chain.

6. Damage caused by the rabid dog to the third party (victim of bite) should be duly compensated by its negligent owners and a suitable legislation in this respect be brought in, on the pattern of negligence under Motor Vehicles Act.

AppealAppeal

Public awareness and education through extension Public awareness and education through extension activities & popular media will help in combating activities & popular media will help in combating the disease. the disease.

Animals Welfare Board of India has already Animals Welfare Board of India has already undertaken programs to curb the rabies menace. undertaken programs to curb the rabies menace. Govt. and Non Govt. Institutions along with some Govt. and Non Govt. Institutions along with some dedicated volunteers need to come at a common dedicated volunteers need to come at a common platform to take initiative to shoulder the platform to take initiative to shoulder the responsibility since rabies eradication is a responsibility since rabies eradication is a Herculean task.Herculean task.

Tell the ChildrenTell the Children

Donot try to pat wild, captive or stray animal even if they Donot try to pat wild, captive or stray animal even if they are dead, Pat only the Pet.are dead, Pat only the Pet.

Regular vaccination of Pets.Regular vaccination of Pets. In case the behavior of animal is changed, stay away.In case the behavior of animal is changed, stay away. Upon bite of dog, monkey, mongoose or any other warm Upon bite of dog, monkey, mongoose or any other warm

blooded animal with aberrant behaviour, wash the wound blooded animal with aberrant behaviour, wash the wound with soap and lot of water then consult the doctor with soap and lot of water then consult the doctor immediately.immediately.

Donot tie or cover the wound.Donot tie or cover the wound. Donot apply irritants like Lal Mirch at the woundDonot apply irritants like Lal Mirch at the wound Post exposure vaccine can save lifePost exposure vaccine can save life

  

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