New Delhi: The National Centre for Disease Control (NCDC) under the Union health ministry has formed a panel to consider introducing a pre-exposure prophylaxis or vaccination against rabies for all children aged around one, amid “rising instances of dog bites in most states”, ThePrint has learnt.
This is the first time, according to top government sources, that the Centre has initiated steps for introducing pre-exposure rabies vaccination through its nationwide Universal Immunization Programme (UIP).
“A 10-member committee under NCDC was constituted for this purpose three months back and has held two-three meetings so far,” a senior NCDC official told ThePrint.
A second NCDC told ThePrint that “the committee has suggested that introducing pre-exposure vaccination to infants around the age of 1 year as part of the UIP may be a good idea and evidence in this regard is being gathered before it can be taken to the National Technical Advisory Group on Immunization (NTAGI) for final approval.”
The NTAGI is the top advisory body in the government that helps it formulate immunisation-related policies.
Dr Simmi Tiwari, who heads the NCDC’s Centre for One Health and is in charge of the National Rabies Control Programme said the agency was currently looking at the feasibility aspect of introducing pre-exposure rabies vaccination for children.
“It may involve getting feasibility studies done in two-three states, analysing whether [anti] rabies vaccine can be offered in sync with other vaccines offered under the UIP, cost-related aspects and issues related to market landscape in terms of availability of huge amounts of vaccines needed for the initiative,” she said.
Tiwari also insisted that when it came to controlling dog bites and rabies in the country, the larger issue of dog-human conflict, exacerbated by uncontrolled animal birth and community feeding of stray dogs, should also be urgently addressed.
Pre-exposure rabies vaccination for children is already advised by paediatricians in the county, and experts working in the field have welcomed the NCDC’s proposed initiative, given the “rising menace” of dog bites in the country.
The National Action Plan for Dog Mediated Rabies Elimination from India by 2030, launched by the Centre this year says that rabies, a highly fatal zoonotic disease, is responsible for significant morbidity and mortality in India — nearly 20,000 every year — the highest in the world. The disease is endemic in the country.
The document also says that human and animal cases of rabies, a disease that is incurable but can be prevented with vaccination, are reported from all over the country throughout the year.
According to government estimates, about 96 per cent of the morbidity and mortality due to rabies is associated with dog bites, even though cats, rodents and monkeys apart from some other animals can also transfer the rabies virus to humans.
Although rabies affects people of all age groups, children are the most vulnerable and constitute 40 per cent of the people exposed to dog bites in Rabies-endemic areas.
In response to a question in the Rajya Sabha on 12 December, the health ministry had informed the Parliament that over 27.5 lakh cases of dog bites had been reported from across the country in 2023, much higher than the nearly 21.8 lakh cases reported in 2022.
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Gathering evidence for proposed initiative
Rabies is a vaccine-preventable, zoonotic, viral disease affecting the central nervous system and once clinical symptoms such as hydrophobia and paralysis appear, rabies is virtually 100 per cent fatal.
India follows a vaccination policy for rabies as suggested by the World Health Organisation.
The national guidelines on rabies prevention suggest that in case of minor scratches without bleeding due to a dog bite in previously unvaccinated individuals, four doses of rabies vaccine (on days 0,3, 7 and 28 from being bitten) should be administered when it is given intradermally.
But if the vaccine is given through the intramuscular route, five doses of vaccine should be administered on days 0, 3, 7, 14 and 28.
Also, in case of multiple wounds or deeper bites, an additional layer of protection — rabies immunoglobulin, also called anti-rabies serum — is also advised to be applied to the wound. This immunoglobulin provides passive immunity in the form of ready-made anti-rabies antibodies to tide over the initial phase of the infection.
The current guidelines also advise that a certain group of people — categorised as high-risk individuals — should receive pre-exposure prophylaxis too. These include laboratory staff handling the virus and infected material, clinicians and para-medicals attending to hydrophobia cases, veterinarians, animal handlers and catchers, wildlife wardens, quarantine officers and travellers from rabies-free areas to rabies-endemic areas.
While many physicians and veterinary doctors suggest that those who regularly engage with stray dogs should receive pre-exposure vaccination against rabies, it is not part of the existing guidelines.
The Indian Academy of Paediatrics, the professional network of child specialists in India, however, advises this vaccination for children in their infancy.
The government too, has started seeing the benefit in this advice, said the first NCDC official cited above.
“Pre-exposure vaccination against rabies can remarkably bring down rabies-related deaths in India because in many cases children do not report such cases before it is too late,” he said.
The official added that once incorporated as part of the UIP, the vaccine against rabies can be clubbed with other vaccines that are offered to infants. This will save them an extra visit to vaccination centres, he said.
Experts working on rabies prevention welcomed the initiative.
“Now, it may be a good idea to introduce this vaccination for kids through the UIP given that dog bites are a rising menace throughout the country,” Dr Amir Maroof, a professor of community medicine with the University College of Medical Sciences in Delhi told ThePrint.
While it may be a better idea to introduce a two-dose pre-exposure vaccination for children in areas with the highest prevalence of dog bites, Maroof said, given the impracticality of the exercise, it may be a good starting point to start offering a one-dose anti-rabies vaccine to infants all across the country.
“There is evidence that even one-dose vaccine against rabies results in neutralising antibodies that provide long-term immunity against rabies even though the number of antibodies may be lesser than two doses pre-exposure prophylaxis,” said Maroof, who is also the honorary secretary of a national not-for-profit organisation, Consortium Against Rabies.
Maroof also insisted that while a nationwide pre-exposure vaccination for kids may be an important tool for controlling rabies-related deaths in India, more significance should be given to ensuring vaccination against rabies for all dogs and controlling the population of stray dogs in the country, in order to eliminate rabies-related deaths.
“One health approach — which is an integrated method to balance and optimise the health of people, animals and the environment — is the best way to control and curb a zoonotic disease like rabies,” he said.
(Edited by Poulomi Banerjee)
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