We can146;t cull this problem

There are two recognised ways of preventing rabies: through animal birth control and anti-rabies programmes

The recent massacre of dogs in Bangalore has highlighted the issue of rabies in India. An acute central nervous system infection, rabies is characterised by central nervous irritation, aerophobia, hydrophobia, followed by paralysis and death. It is one of the most horrific deaths imaginable. The virus is found in the salivary glands and central nervous systems of infected, warm-blooded animals, including humans. The disease is caused by the bite of a rabies-infected animal or by exposure to the saliva of a rabid animal. It is one of the world8217;s oldest diseases.

For years, India has ranked highest in world rabies deaths. According to the 2004 8216;Final Report of the WHO-sponsored National Multi-centric Rabies Survey 20038217;, there are over 20,000 reported deaths in India annually. This study was conducted with the National Institute of Communicable Diseases NICD, Central Research Institute, and several other august institutions. Some 20,000 human rabies deaths per year translates roughly to one death every half an hour. It is widely believed, however, that the number of unreported deaths is much higher. This is nothing short of shameful, given that rabies deaths can be prevented.

There are two recognised ways of preventing rabies. One is by the implementation of animal birth control and the other is through anti-rabies programmes. The humane killing of an infected animal would certainly be part of an anti-rabies programme. But the indiscriminate killing of stray dogs would be the worst and cruellest way of addressing the issue. India has more that 25 million stray dogs. Are we to exterminate all of them to rid ourselves of rabies? Besides, apart from rodents, rabbits and hares, most animals, including bats, can be carriers. So where should one draw the line? Global experience shows that killing a dog population does not reduce rabies deaths, but animal sterilisation does. In India, of the 25 million stray dogs, only an estimated 70,000 are sterilised and vaccinated annually. The government must run a more comprehensive programme.

A sustained government community awareness campaign also needs to be mounted, which informs the public on what to do in case of an animal bite. Most are unaware of the immediate precautions which need to be taken. The 8216;WHO Guide for Rabies Pre- and Post-exposure Treatment in Humans8217; advocates that the general consideration in rabies post-exposure treatment requires administration of purified immunoglobulin and modern vaccine in what are defined as category III exposures. Dramatic decreases in rabies cases among humans have been achieved recently in China, Thailand, Sri Lanka and Latin America, following the implementation of programmes for post-exposure treatment. As per the WHO, category III exposure is defined as single or multiple transdermal bites, scratches of contamination of mucous membrane with saliva.

It is a well-established fact that vaccine administration alone cannot prevent rabies. The rabies immunoglobulin RIG also needs to be administered. This is because the vaccine only gives protection after 10-14 days. Thus, for a minimum period of 10-14 days that it takes the vaccine to seroconvert, the victim has no protection from rabies. It is thus essential that the rabies immunoglobulin be administered to any victims who have had category III exposure, as the rabies immunoglobulin, which contains ready antibodies to the deadly rabies virus, provides immediate protection against rabies in this window period.

The administration of RIG would give protection to the victim even if bitten by a rabid animal. When the rabies immunoglobulin is not given in such a case, it leads to a typical case of a 8216;vaccine failure8217; and death. To understand better how the vaccine and immunoglobulin work, it is useful to look at what is done in the case of a snake bite. In case one is bitten by a snake, the anti-snake venom serum is administered. This contains ready anti-bodies to the specific snake venom, and thus saves the life of the victim, even if the snake is poisonous. No vaccine is administered in the case of a snake bite. The rabies immunoglobulin works exactly as do these anti-venom serums.

According to the WHO and NICD study, the majority of human rabies deaths occurred in persons from low income groups. Abut 55 per cent of the 20,000 victims who died had sought hospital admission. However, the use of rabies immunoglobulin was low, with only two per cent of victims receiving treatment. While the government has done well in terms of rabies vaccine coverage, only two per cent of those who require the immunoglobulin are given it. The government needs to inform doctors, healthcare providers and the public about rabies immunoglobulin, and it needs to make the product, which is listed in some state tenders, readily available in government hospitals. As most of the victims are poor, the product requires to be made available free of cost.

Story continues below this ad

The government has done a sterling job of controlling polio. It needs to do the same for rabies. After all, polio leads to morbidity, whereas rabies is fatal if untreated. And, yes, when it comes to dealing with man8217;s best friend, let us not forget that we live in the land of Bapu, in the land of Ahimsa.

The writer is a lawyer and Mumbai-based management consultant