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Feature Zoonotic disease

Rabies: beware of the dog

BMJ 2013; 347 doi: (Published 01 October 2013) Cite this as: BMJ 2013;347:f5912
  1. Subhankar Chatterjee, seventh semester MBBS student, R G Kar Medical College and Hospital, Kolkata, India,
  2. Haris Riaz, researcher, Dow University of Health Sciences, Karachi, Pakistan
  1. Correspondence to: S Chatterjee chatterjeeaspiresubhankar.92{at}

India’s least populous state, Sikkim, has made great progress toward eliminating rabies. Can the rest of the country follow its lead and reduce the huge burden of this universally fatal disease? Subhankar Chatterjee and Haris Riaz report

Sikkim is about to be certified as the first rabies-free state in India.1 This is thanks to a innovative state-wide campaign to vaccinate dogs. This was carried out by Vets Beyond Borders, an Australian non-profit organisation, with the support of the Sikkim government and the National Centre for Disease Control.

India is estimated to have the highest incidence of rabies globally, with 30 000 of the world’s 50 000 cases reported each year.2 India has 36% of the global and 65% of the Asian rabies burden in terms of cases.3 Control of rabies is a priority for the Indian government, according to its 12th five year plan (2012-17), but the population remains vulnerable because of shortages of anti-rabies vaccine,4 and once symptoms appear, dog rabies virus is universally fatal in humans.

In contrast to the West, where other mammals such as bats and racoons are implicated in transmission, stray dogs comprise the predominant reservoir for the rabies virus in the developing world. In Mumbai, 82 247 cases of dog bites were reported in 2012.5 Someone is bitten by a dog every two seconds in India and someone dies from rabies every 30 minutes on average.6 But because rabies is not a notifiable disease here the actual burden is likely to be even greater.

This makes rabies an endemic public health nuisance to visitors as well as the local population, and the disease is spreading to neighbouring countries where it is not yet endemic.7

100% fatal and 100% preventable

“A disease that is 100% fatal and also 100% preventable should be taken with utmost seriousness, …

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