New Delhi: Around 91 lakh animal bites occur in India every year, the majority by dogs, and although 80 percent of the dog-bite victims receive one dose of anti-rabies vaccine, just about 40 percent complete the prescribed vaccination schedule.
These findings have emerged from a nationwide survey on the animal bite burden and human rabies in India, held for the first time in the last two decades and led by the Indian Council of Medical Research-National Institute of Epidemiology (ICMR-NIE). It was published in The Lancet last month.
The survey also found that only a tenth of the eligible dog bite victims received passive immunisation and around half of pet dogs in households were not vaccinated against rabies, a fatal disease that is preventable by up to 99 percent through immunisation.
The researchers associated with the analysis used information from the survey and animal laboratories and estimated that 5,726 human rabies deaths took place per year in India—showing a nearly 75 percent decrease in deaths in the past 20 years, even though India continues to contribute around 35 percent of the global human rabies death burden.
The previous estimate on rabies deaths in India, carried out by the apex health research agency in 2003, had suggested that nearly 20,000 people succumbed to the viral disease annually.
“Although there was a substantial decline in human rabies deaths over the past two decades, to eliminate dog-mediated human rabies by 2030, India needs to fast-track its actions by adopting a focused one-health approach,” the researchers have said in their survey analysis.
Integrating human and animal surveillance, ensuring timely administration of the full course of post-exposure prophylaxis, and accelerating dog vaccination across the country are crucial steps towards this goal, they have added.
ICMR-NIE scientist Dr Jeromie Wesley Vivian Thangaraj, the lead surveyor associated with the project, told ThePrint that the results from the survey were important indicators in assessing the country’s status in its National Rabies Control Programme.
“While the decreasing number of rabies deaths, and post exposure prophylaxis rising considerably over the last 20 years, are good signs, it’s alarming that only about 50 percent of dog owners get their pets vaccinated against the disease—which is crucial for curbing the transmission of rabies,” he said.
“Additionally, we do not even know what percentage of stray dogs are vaccinated in India as this is not documented and was also outside the purview of our survey,” he added.
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What survey found
The researchers carried out a community-based nationwide cross-sectional survey in 60 districts across 15 states between March 2022 and August 2023, involving 78,807 households.
The history of dog bites was collected for 3,37,808 individuals from these households. The annual animal-bite incidence was 6.6 per 1,000 population and the annual incidence of dog bites was 5.6 per 1,000 population.
Annual dog-bite incidence was 7.5 per 1,000 among children aged 0-14 years, 7.8 per 1,000 among people older than 60 years, 7.6 per 1,000 among male individuals and 3.5 per 1,000 among females.
The dog-bite incidence was more in rural areas—5.8 per 1,000—as compared to urban areas where it was 5.0 per 1,000. The annual dog-bite incidence ranged between 3.8 to 7.6 per 1,000 in different regions.
Of the 1,576 dog bites reported, 614 or 39 percent were by pet dogs and 1,281—over 81 percent—were unprovoked attacks.
A total of 1,144 or 72·6 percent of dogs were available for monitoring of their health status for 10 days, of which 1,066 or 93.6 percent were alive after 10 days. Most bites resulted in a single wound, predominantly on the lower limbs, upper limbs, torso, and the head or face.
The most common type of wound was abrasion, followed by laceration, puncture wounds, and avulsion, and of the 1,576 bite victims, 849 or 53.9 percent reported washing their wounds with soap and water, and 276 reported applying some locally available remedies, such as chilli and turmeric powder.
Nearly 83.6 percent of the victims, on the other hand, sought medical care at health facilities, with most seeking care within 24 hours.
Among people who had been bitten by dogs, 1,253 or 79.5 percent received at least one dose of anti-rabies vaccine (ARV), 1,043 or 66.2 percent received three doses, while 638 or about 40 percent received all the prescribed doses.
Of the 1,253 individuals who received at least one dose of ARV, 615 or 49.1 percent did not complete the full course. Also, only 81 or nearly 5 percent bite victims reported taking rabies immunoglobulin.
Another crucial finding was that while nearly a fourth of households interviewed reported having a pet or domestic animal, 18.6 percent of households reported that they had a pet dog and only around half of the pet dogs were vaccinated.
The implications
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 nearly 100 percent fatal.
India follows a vaccination policy for rabies as suggested by the World Health Organization.
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 provides passive immunity in the form of ready-made anti-rabies antibodies to tide over the initial phase of infection.
The current guidelines also advise that a certain group of people—categorised as high-risk individuals—should receive pre-exposure prophylaxis too.
Such high-risk individuals include laboratory staff handling the virus and infected material, clinicians and paramedics attending to hydrophobia cases, veterinarians, animal handlers and catchers, wildlife wardens, quarantine officers and travellers from rabies-free areas to rabies-endemic areas.
Newer estimates will have substantial implications on the global burden of rabies, given that India contributes around 35 percent of the global human rabies death burden, the scientists have noted.
Findings from this study will provide clarity on the current status of this burden and enable the programme managers to prioritise strategies and tailor efforts to eliminate dog-mediated rabies by 2030, they say.
Specifically, India needs to adopt a one-health approach by integrating human and animal surveillance, ensuring timely administration of a full course of post-exposure prophylaxis for all bite victims, and prioritising the scaling up of mass dog vaccination across the country, the survey researchers have said.
(Edited by Nida Fatima Siddiqui)
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