Rabies in India: Current Scenario and Prospects of Elimination

IN A NUTSHELL
Author's Note
India has the highest burden of human rabies, as annually an estimated 20,000 deaths are known to occur and this accounts for nearly one-third of the annual global burden of about 55,000 to 60,000 deaths. This article turns the spotlight on what this scourge means for India whereby prospects of (and difficulties in) eliminating dog mediated human rabies from India by 2030 are taken into consideration

By Professor (Dr) Tanushree Mondal

Editor – APCRI  Journal

Professor of Community Medicine, RG Kar Medical College, Kolkata, India

profcmrgkmc24@gmail.com

Dr. M.K. Sudarshan*

Founder President and Mentor

APCRI, Bangalore, India

Email: mksudarshan@gmail.com

Rabies in India

Current Scenario and Prospects of Elimination

 

Rabies is a practically 100% fatal disease and the very few who have survived are with residual neurological disabilities for the rest of their lives.  Rabies is caused by a virus known as rhabdovirus that is present in the saliva of rabid animals.  Following bites, scratches and even licks on wounds by rabid animals, the virus is deposited in the wound/s.  If timely and proper lifesaving post –bite/ exposure prophylaxis (PEP) is not received by the rabies exposed person, then the virus travels via the nerves and reaches the brain. This usually takes about 3 weeks to 3 months, known as incubation period. Subsequently the person manifests with symptoms of the disease like fever, headache, body ache, fear of water (hydrophobia), fear of breeze (aerophobia), fear of light (photophobia), spasm or paralysis, etc and ordinarily survives for 2 to 5 days. In the majority, the death is very painful and agonizing.

The Current Scenario

The burden of human rabies

India has the highest burden of human rabies, as annually an estimated 20,000 deaths (1) are known to occur and this accounts for nearly one-third of the annual global burden of about 55,000 to 60,000 deaths (2). The principal vector of the disease is dogs accounting for 99% human rabies globally and 97% in India. The other animals involved in rabies transmission in India are cats (2%) and wild animals (1%) like mongoose, jackals, wild dogs and others. But this figure is now two decades old and not tenable. Interestingly, another national multicentric rabies survey done recently in 2022-23 by Indian Council of Medical Research has shown that 5726 human rabies are estimated to occur annually in the country (3), which appears realistic but needs its acceptance by Government of India. The sooner it happens it is good for India.  This is because in the last two decades much progress has been made like the sheep brain/Semple vaccine was discontinued and replaced by modern rabies vaccines in 2005, cost–effective intra-dermal rabies vaccination (IDRV) was introduced in 2006, vast improvents in the logistics of rabies biologics following better transportation and communications and lastly, there is an overall upliftment in the socio-economic status of the people.  All these have contributed to the reduced number of human rabies deaths in the country. 

The dogs and their role in disease transmission

As per Indian ethos and constitution, all living beings have a right to live and co-exist in the society. The dogs are popular pets in 11.3 % households in India (4). Also, there are a large proportion of dogs in the neighbourhood known as community dogs, also referred to as stray/street dogs. It is estimated that there are about 90 million dogs in the country of which 30 million are pets and 60 million community dogs/strays. In 2001, for the safety and welfare of these stray dogs under the prevention of cruelty to animals act (PCA 1960), animal birth control (ABC) rules were passed in the parliament that ensure no harm is done to stray dogs and the civic municipal bodies take care of them.

The World Health Organization – Association for Prevention and Control of rabies in India (WHO –APCRI) national multicentric rabies surveys done in 2003 and 2017 showed that 96.2% and 83% of human rabies deaths respectively in the country were following dog bites.

Figure 1: A dog chasing a motorcyclist, a common sight in the cities of India

The WHO – APCRI national multicentric survey of 2003 showed an estimated 17.4 million animal bites occurred annually in India. However, two decades later in 2022-23, the national multicentric survey of Indian Council of Medical Research (ICMR), showed it to be around 9.1 million, but this survey had some limitation like the effect of the ongoing Covid pandemic in the country, etc.

Unfortunately, rarely there are instances of unsupervised infants and toddlers and the very old being mauled to death by pack of dogs in the communities.  Also, the sudden and unexpected aggression by street dogs have led to injuries, maiming and even human deaths due to accidents.  As a result, often there are conflicts in the populations about having strays on the streets. The animal welfare organizations (AWOs) are very protective and vocal about welfare of stray dogs in the country. Recently, as per the guidelines of animal welfare board of India (AWBI), there are attempts by civic bodies in the country to feed these stray dogs timely in the day at designated places by identified and trained community volunteers and that is expected to reduce aggression of the street dogs.

Prospects of elimination of dog mediated human rabies from India by 2030

The World Health Organization and other UN agencies in 2015 together pledged to eliminate dog mediated human rabies from the world by 2030, and the slogan is zero by thirty.  That is to eliminate 99% of the global burden of human rabies by 2030. Consequently, in sync with the global plan, in 2021 Government of India, despite the ongoing Covid-19 pandemic, launched the national action plan for rabies elimination (NAPRE) (5). As India has a federal structure, based on the NAPRE, the states have commenced state action plans for rabies elimination (SAPRE) by 2030.  To prioritize and accelerate the progress, from 2024, rabies free cities action plans are being implemented (6). The key components of all of these are – providing free rabies post – exposure prophylaxis (PEP) to all rabies exposed individuals timely, correctly and completely; mass dog vaccination (MDV) covering 70% of the dogs in the community, dog population management (DPM), promoting responsible pet ownership and advocacy, awareness, education, and operational research. The key elements for achieving these are – 3Ps i.e. prevention, promotion and partnership.

In view of large reservoir of rabies in the dog population in the country, federal structure and varying degrees of progress and performances by the states, inadequate resources and weak intersectoral coordination and cooperation, the elimination of dog mediated human rabies by 2030 appears difficult. Hence, it is recommended that the zero by thirty action plan be implemented as a 100% centrally sponsored programme with the same vigour and force of polio eradication. Only then tangible benefits will be seen soon on the ground.

 

References

  1. Assessing burden of rabies in India: WHO sponsored national multi-centric rabies survey 2003. Association for Prevention and Control of Rabies in India https://www.researchgate.net/publication/45261915_Assessing_Burden_of_Rabies_in_India_WHO_Sponsored_National_Multicentric_Rabies_Survey_2003
  2. WHO Expert Consultation on Rabies: WHO TRS N°1012 Third report, 14 April 2018 https://www.who.int/publications/i/item/WHO-TRS-1012
  3. Estimates of the burden of human rabies deaths and animal bites in India, 2022–23: A community-based cross-sectional survey and probability decision-tree modelling study. Jeromie Wesley VivianThangarajet al The Lancet Infectious Diseases Volume 25, Issue 1, January 2025, Pages 126-134 https://www.sciencedirect.com/science/article/abs/pii/S1473309924004900
  4. APCRI –WHO Indian Multicentric Rabies Survey , 2017 http://apcri.in/pdf/WHO-APCRI%20Rabies%20Survey,%202017%20-%20Final%20Report.pdf
  5. National Action Plan for Dog Mediated Rabies Elimination from India by 2030 https://rr-asia.woah.org/app/uploads/2022/12/india-napre-rabies.pdf
  6. Ministry of Health and Family Welfare. Government of India. Operational Guidelines. Rabies Free City Initiative. A Step Towards Rabies Free India by 2030.https://ncdc.mohfw.gov.in/wp-content/uploads/2024/11/Rabies-Operational-Guidelines_25th-Sept_24.pdf

 

* Dr M. K. Sudarshan profile: 

Founder, President and Mentor, Association for Prevention and Control of Rabies in India,
Former Professor, Principal and Director, Kempegowda Institute of Medical Sciences (KIMS), Bangalore, 
Chief Editor, Indian Journal of Public Health 
Member, WHO Expert Advisory panel on Rabies & Expert Consultations on Rabies, Member of National Technical Advisory Committee (NTAC) on Rabies
Leader in Health Research in India
Chairman, National Expert Consultation on Rabies and Chairman, Karnataka State Covid-19 Technical Advisory Committee (TAC) and Chair, South East Asia Region(SEAR)- Rabies Technical Advisory Group.
Recipient of Dr. B C Roy Doctor's Day for Excellence in Medical Education (2010), Lifetime Achievement Award (2013), Best Community Health Professional Award (2014), Rajyotasava Award (2021), Eminent Teacher Award from Rajiv Gandhi University of Health Sciences, Karnataka(2022), National Medical Recognition Award (2022) and Honorary Doctorate (D.Sc. Honoris Causa) in Science from Rajiv Gandhi University of Health Sciences (2023) and Dr I.C. Tiwari Memorial Lifetime Achievement Award (2025).