Intended for healthcare professionals

Letters Risks and benefits of dog ownership

Collaboration between medical and veterinary professions on the problem of dog bites

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5083 (Published 13 August 2014) Cite this as: BMJ 2014;349:g5083

Concerns about prevention and control of animal bites in India

Rabies is a disease of terrestrial and airborne mammals, including dogs, wolves, foxes, coyotes, jackals, cats, bobcats, lions, mongooses, skunks, badgers, bats, monkeys and humans. The dog is the main reservoir of rabies in India. However, the number of cases involving monkey bites has been increasing over the years. Monkeys are susceptible to rabies, and their bites necessitate post-exposure prophylaxis (1).

Human rabies is at low risk in some developed countries such as in North America, Canada, Western Europe, Australia, but it is still present in many others, including those in Southeast Asia (2). Animal bites leading to rabies is of public health importance needing close surveillance, preventive and control measures more so in developing countries. It is unfortunate that no authentic data is available globally on the extent of the problem of animal bites and associated rabies. There are few available reports based on which the problem is extrapolated in the population. The problem of reporting animal bites and rabies in India is all the more grave. It is estimated that roughly 36% of world’s rabies deaths occur in India, and mostly children (3). In absolute terms, about 15 million people are bitten by animals, mostly dogs in India annually. The figure projected from the National Multicentric Rabies Survey, conducted in 2004 by the Association for Prevention and Control of Rabies in India in collaboration with the World Health Organization, is 20 565 deaths from rabies per year. India has approximately 25 million dogs, with an estimated dog : man ratio of 1:36 (4). This is impossible to judge how many persons are infected by rabid dogs every year.

The currently ongoing Million Death Study, based on verbal autopsy on a representative survey of 1, 22,000 deaths in India, reported that in 2005, there were 12,700 (99% CI 10,000 to 15,500) symptomatically identifiable furious rabies deaths in India. The overall rabies mortality rate was 1.1 deaths per 100,000 population (99% CI 0.9 to 1.4) (5). The findings reveal that the widely accepted data of 20,000 deaths due to rabies is an overestimate. The data from the Million death study has its own limitations in terms of data collection, analysis regarding rabies deaths and estimating rabies cases. However, the report is based on population based enquiry and it is a better method than the presently available reports of rabies deaths in India.

There is speculation about the estimated data on rabies in India. A report (6) shows conflict in the number reported by Government of India and the earlier accepted figures. The older reported figure of 25,000-3000 appears to have been based on 101 year old research. The report pointed out that Central Bureau of Health Intelligence (CBHI) has shown the average figure of rabies as 238 Indians per year during the past nine years, within a range of 162 to 361 (6 ) which is at a much lower side. The CBHI figure is based on the reported figures from the participating Government hospitals, which may not reflect the true incidence of rabies in the country. Patients reporting to private hospitals are not accounted in the figure. In absence of a proper reporting based on surveillance from both public and private hospitals, health care providers, the true figure on rabies cannot be derived at with accuracy. Absence of such a reliable data makes it a weak case to propose a nationwide programme on prevention and control of rabies in India. Under such circumstances, it is imperative to document rabies cases. This is possible if a system of recording rabies is established by way of having a dedicated rabies clinic with proper documentation about the cases in terms of socio-economic demographic characteristics, nature of animal bite, circumstances of bite, and management in the form of ‘Rabies registry’ in all the government and private hospitals and mandatory periodic reporting to the health authorities.

Shortcomings prevail in the Government action on the prevention and control of rabies in India. There are facilities in few Government hospitals about management of cases of animal bites in India. Concerted efforts regarding authentic reporting, awareness generation among the people is lacking. Collaboration with municipal corporations, health, and animal husbandry departments are needed for control of dog population, vaccination and rabies control in India. The problem is still worse in rural areas where facilities for treatment of animal bites, vaccination of dogs etc are lacking or not at all available in the neighbourhood.

‘Mission rabies’, a programme for dog vaccination, pioneered by British veterinarian Luke Gamble, founder of World Veterinary Service, a nonprofit organization to improve animal welfare, with 500 volunteers including veterinarians, vet nurses, dog catchers in 12 Indian cities accomplished vaccination of 50,000 dogs within a short span of about a month. The mission led Chennai to pledge vaccination of 1,50,000 dogs every year. Such a programme needs to be sustained with active support from the Government and civil society (7).

References

1. Ghosh TK. Rabies. Proceedings of the IX National Conference of Pediatric Infectious Diseases; 2006; Chennai, India.

2. Presence/absence of rabies worldwide — 2006. Geneva: Department of Food Safety, Zoonoses and Foodborne diseases, World Health Organization; 2008. Available at:www.who.int/rabies/rabies_maps/en/index.html (accessed on 20th August 2014).

3. Chatterjee P. India’s ongoing war against rabies. Available at: http://www.who.int/bulletin/volumes/87/12/09-021209/en/ (accessed on 20th August 2014).

4. Sudarshan MK. Assessing burden of rabies in India. WHO sponsored national multi-centric rabies survey (May 2004). Assoc Prev Control Rabies India J 2004;6:44-5.

5. Suraweera W, Morris SK, Kumar R et al. PLOS Neglected Tropical Diseases Deaths from Symptomatically Identifiable Furious Rabies in India A Nationally Representative Mortality Survey. PLoS Negl Trop Dis [Internet]. 2012;6(10):e1847. Available from: http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001847.

6. Merritt Clifton. Official Indian human rabies death toll of 20,000 ignored government’s own data. http://abcindia.org.in/?p=703 (accessed on 20th August 2014).

7. Ball AL. Mission Rabies Leads the Pack in Dog Vaccinations in India. http://news.nationalgeographic.com/news/2013/10/131027-mission-rabies-do... (accessed on 19th August 2014).

Competing interests: No competing interests

24 August 2014
Mongjam Meghachandra Singh
Professor,
Reeta Devi
Maulana Azad Medical College, New Delhi; co-author-Indira Gandhi National Open University, New Delhi
Department of Community Medicine, MAMC, New Delhi and School of Health Sciences, IGNOU, New Delhi