Rabies is one of the fatal zoonotic diseases which has tormented humans since antiquity.
As per WHO estimates, globally, there are 59,000 human deaths annually due to dog-mediated rabies. India contributes to one-third of the total global burden due to rabies and two-thirds of the rabies burden in the South East Asia Region.
In India, Rabies is transmitted commonly by dogs and cats (97%), followed by wild animals (2%) such as mongoose, foxes, jackals, and wild dogs, and occasionally by horses, donkeys, monkeys, cows, goats, sheep, and pigs.
People are usually infected following a bite or scratch from an animal with Rabies. It is also possible, but rare, for people to get Rabies from non-bite exposures, which can include scratches, abrasions, or open wounds that are exposed to saliva or other potentially infectious material from a rabid animal.
According to various research conducted by the Department of Community Medicine, Government Medical College Srinagar, about 98 % of the animal bites are contributed by stray dogs in Kashmir.
Although nearly 100% fatal, rabies is also nearly 100% preventable through prompt and proper management of the wound and administration of modern Anti-Rabies Vaccine (ARV) and Rabies Immunoglobulin (RIG) or monoclonal antibodies.
Globally various efforts have been taken from time to time to focus on the issue of eliminating Rabies.
Successful Rabies control programs have been implemented throughout the world, demonstrating that elimination is technically feasible.
The current is that rabies is included in WHO’s new 2021-2030 road map. It advocates the ‘One Health Approach’ through cross-sectoral coordination by forming ‘United Against Rabies Forum’ (UAR). It prioritizes investment in Rabies control and coordinates the global rabies elimination affords to achieve ‘Zero Human Deaths’ from dog-mediated human rabies by 2030.
India has already rolled out the National Rabies Control Program (NRCP) to address the issue of rabies in the country.
The National Action Plan for the Elimination of dog-mediated Rabies (NAPRE) in India provides a broad framework for combating Rabies. The NAPRE is a guidance document for the states /UT stakeholders to develop their own action plan, specific to their needs and aims at systematic reduction of Rabies risk through sustained mass dog vaccinations, pre- and post-exposure prophylaxis, and public education until the country is completely free of dog-mediated Rabies.
The anti-Rabies Clinic (ARC) in SMHS hospital, run by the Department of Community Medicine, Government Medical College Srinagar was established in 2003in SMHS Hospital, Srinagar and is situated on the ground floor of Block-F. The clinic remains open all days of the week including holidays and Sundays from 9.30 AM to 6.00 PM. We receive animal bite cases from all the districts of the valley but mostly from Srinagar and neighbouring districts.
The incidence of animal bites cases shows an increasing trend year by year. In the year 2020-21, more than 4500 cases of animal bites were reported. In 2021-22 the number increased to more than 5300 and during the current year till date about 3000 patients were managed. Our Anti-Rabies Clinic is one of the centers in Jammu & Kashmir where animal bite cases are managed as per the WHO and National Rabies Control Program (NRCP) guidelines.
Various activities carried out at our center are:
Post Exposure Prophylaxis to animal bites: All the animals’ bites are assessed and categorized into one of the three categories (as per WHO classification). Anti-Rabies vaccine (ARV) using the current recommended intradermal route is given to category-2 and category-3 patients. Rabies immunoglobulin (Anti-Rabies Serum) is administered to category-3 patients. Both vaccines and immunoglobulins are provided free of cost to every patient. There is also a separate area for local washing of the wound as local washing with running water for 10 to 15 minutes decreases the viral load at the site of the bite. The staff also provides counselling to the patients about wound care and follow-up for the next due doses. Antibiotics, analgesics, and tetanus prophylaxis are also provided depending upon the vaccination status.
Training: The clinic is a teaching center for medical and para-medical students of Government Medical College Srinagar, hands-on training is provided to medical interns regarding the administration of the vaccine.
Research activities: As research is one of the pillars of every medical college, various research activities are being carried out regarding various aspects of rabies throughout the year. Currently, our center is one of the fifteen sites for the Multicentric study conducted by the Serum Institute of India through IQVIA. The study is a randomized controlled study of the safety and immunogenicity of Rabishield and Rabivax-S post-exposure prophylaxis regimens in Patients with Potential Rabies exposure.
The clinic is equipped with the facility to manage any Adverse Events following Immunization (AEFI), with a well-developed AEFI management section.
Various scientific sessions regarding the recent updates about the management of animal bites are carried out from time to time. On the eve of ‘World Rabies Day’ which is observed on the 28th of September every year all over the world, the department of Community Medicine also organizes the continued Medical Education Programs in which stakeholders from various departments like Srinagar Municipality Corporation (SMS), Sher-e-Kashmir University of Agricultural Science and Technology-Kashmir (SKUAST-K), etc. are participating.
The Awareness generation in the general public regarding the prevention of Rabies is carried out by our field staff in the community through various IEC activities.
What to do after an animal bites?
Wash the wound immediately (as early as possible) under running tap water for at least 10 minutes. Use soap or detergent to wash the wound (if soap is not available then use water only to wash the wound).
After thorough washing and drying the wound apply disinfectant – e.g. povidone iodine, spirit, etc.
Don’t apply irritants viz. chili, soil, oils, turmeric, lime, salt, plant juice, etc.
Don’t touch the wound with bare hands.
Report immediately to the nearest Health facility.
Don’t bandage the wounds unless done by the expert after RIG injection
Don’t suture the wound after animal bite.
(The author is incharge medical officer at Anti-Rabies Clinic, Department of Community Medicine, SMHS Hospital, Srinagar and can be mailed at drhamidarsam@gmail.com )
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.