Rabies, a preventable yet fatal disease is still a problem, with dogs being the leading cause of human rabies deaths, accounting for up to 99 percent of all human rabies transmissions.
For the first time in six months, Bengaluru Urban area resident Hanumanth Raya went for a morning walk, but what he found instead of magnificent dawn was a four-legged innocent creature whose intentions were unknown. “The dog began barking at me and quickly began following me. He ran behind me and bit my leg as I picked up my speed,” said Hanumanth Raya.
Hanumanth Raya was quick enough to react to the situation, and on the same day, he went to the Isolation Hospital to get his anti-rabies vaccination. The Isolation Hospital receives between eight and ten dog bite cases every day, according to Dr. Dikhshita, an intern from Victoria Hospital. “Patients do not realize the severity of the situation and many patients come for vaccination after a week,” she said.
Only 70 percent of individuals in India had ever heard of rabies, according to a 2006 study published in the Journal of Communicable Diseases, and only 30 percent knew they should wash the wound after being bitten.
According to Reeta Mani, of NIMHANS, Bangalore who is an additional professor for the diagnostic and preventive aspects of Rabies, the severity of the condition of a dog bite is divided into three categories: one, two, and three. The third category is where the biggest fear arises. There are several bites and bleeding. As a result, the solution requires the administration of rabies vaccine as well as rabies immunoglobulin, which must be administered to the site of the wound. A modest exposure without bleeding is classified as category two. There are scratches and even bites. Category one is where there is minimal contact with the dog-like lick or touch.
There are two types of rabies one is called dumb rabies and other one is called furious rabies. In furious rabies, the patient experiences hydrophobia (fear of water). A fever with discomfort and an unusual or unexplained tingling, pricking, or burning sensation at the wound site are the first signs of rabies. Progressive and deadly inflammation of the brain and spinal cord develops as the virus travels to the central nervous system.
“Only after the symptoms appear, the diagnostic tests will be positive. Before that there is no test in the entire world anywhere which we predict and tell that the person is going to develop rabies,” said Mani.
Dr. Bhaskar, the Senior Specialist in Isolation Hospital, Indiranagar, said that the incubation period of a dog bite may vary from one week to one year and the patient can develop symptoms even after two to three months later.
They have one or two Rabies cases in a month, and the patient dies three to four days later. The patients are kept in an isolation ward with no light, where they suffer from a variety of problems such as ascending paralysis, hydrophobia, and cardio-respiratory difficulties.
According to Dr. NV Suresh, District Surgeon, even in the worst scenario, the people who are aware and take the vaccination immediately can be saved. “People do not come to the hospital and that is the main problem. They do not understand the severity of the situation. We provide vaccinations at a very minimal cost and for the people who hold BPL cards, it is free of cost,” he said.
Bengaluru, the city of canines
Men in parrot green T-shirts ran down the streets in Bengaluru, with long-handled nets in hand, heading for the garbage heaps where the dogs had staked their claim. Some dogs hid when they sensed or smelled danger, while others revolted by barking at the men carrying nets and vaccines.
Every NGO working with the BBMP is given two ARV\ABC (Anti-rabies vaccination\Anti-birth control) vans, which are used to catch dogs in various parts of the city. They have a target of vaccinating 35 dogs per day and once the dogs are captured, they are injected with the ARV. According to the volunteers, the target is different for every zone and they work 26 days a month. Further for the ABC surgery, the dogs are held for three days and are released on the fourth day.
Dr. Akshay Prakash, of Sarvodaya Foundation, Bengaluru, said that the BBMP only reimburses the money if certain requirements are met. NGOs must work with the regular team for at least 25 days every month and vaccinate at least 600 dogs per month. If the requirements are not met, they may be subject to various penalties.
According to ASRA Foundation’s Vinay Moray, even if the vaccination programme is taking place, there are other issues that are being overlooked. A volunteer from the ASRA foundation highlighted that the population of the dogs is increasing and one reason might be the migration of the dogs from the rural areas. “There is an increase in the eateries and there are piles of garbage on almost every corner of the streets. Dogs are migrating to the city in search of food and hence there is an influx in the number of dogs.”
Bruhat Bengaluru Mahanagara Palike (BBMP) undertook a census in 2019 and there are 3.09 lakh stray dogs in Bangalore and the number of dogs roaming freely ranged from 192 to 1888 per square kilometer. According to a census, 46 percent of the city’s free-ranging dogs had not been through the ABC programme. While various publications claim that the majority of dog bite incidents occur in rural areas, Dr. Bhaskar said that the majority of patients seeking treatment come from Bengaluru Urban.
The success of the vaccination drive, according to the joint head of the Animal Husbandry Department, Dr. Manjunath Shinde, is also dependent on herd immunity. He said that capturing all the dogs from a certain location in the time allotted is not possible. There was also an infrastructural limitation because the dogs undergoing ABC surgery require at least three days to heal and they are kept in NGOs and taken care of. With these limits in mind, the BBMP is collaborating with a number of NGOs to meet the targets for both the ABC and ARV, said Dr. Shinde. The ABC programme was initially launched in 2001 and is still running.
Will India eradicate Rabies by 2030?
For a decade, the incidence of rabies in India has remained unchanged and significantly under-reported, accounting for 35 percent of the global burden. The majority of these deaths (about 97 percent) are related to dog bites. Due to a lack of surveillance and reporting, data on animal attacks in the country is scarce, inconsistent, and contentious.
The World Health Organization (WHO), for Animal Health, the Food and Agriculture Organization, and the Global Alliance for Rabies Control have formed “United Against Rabies,” a global collaborative campaign aimed at eliminating human rabies deaths by 2030.
The Nationwide Center for Disease Control also produced a document that started the national rabies control. It was later documented to help with the implementation of rabies control initiatives. The fundamental issue was that for many years, rabies was not a notified condition.
Dr. Mani highlighted the fact that pediatricians also offer rabies vaccination as an optional vaccine because it is not free under the government’s universal immunization schedule and because three doses are necessary, it may not be economically viable. “If people take these three doses, in their entire life they are prevented from Rabies, and even if they get bitten by dogs they only have to take vaccine doses on day zero and day three, and they don’t have to take the rabies immunoglobulin.”
As said by Dr. Mani, human rabies was recently declared a notifiable disease by the Indian government in September 2021. As a result, there will likely be more awareness in the future, because once hospitals are aware that it is notifiable, they must notify the government. There is no way to determine the actual figures presently.
Others, in addition to Hanumanth Raya, were bitten on their regular morning walks. While just a few were aware of the procedures, others showed up three to four days later at the clinic.
Sujaya Jagdish, who runs a private NGO by the name “Save our animals” highlighted that it is important to build compassion as well as awareness among the people, especially in rural areas. “Our NGO runs health camps as well as awareness programmes in the rural and urban areas mainly to build compassion among the people.”
“Our aim is to educate people about Animal Birth Control and sensitization about animals and their needs. Also we create the awareness about the importance of participating in an adoption programme,” she said.