Rabies as a Public Health Concern in India-A Historical Perspective

Evidence-based legislation, strong institutions and consensus needed to mitigate the negative impacts of free-ranging dogs

Dogs bring many benefits to our society but, if not properly managed, they can be detrimental for humans, livestock and wildlife. We highlight the increasing problems associated with free-ranging dogs using examples from two regions of the world where this issue is pervasive, India and South America. In these regions, free-ranging dogs spread diseases, injure people, harm biodiversity, and negatively impact human livelihoods. We discuss why mitigating these deleterious effects can be extremely complicated because there are diverse challenges such as: (a) a lack of or inappropriate legislations concerning free-ranging dog management and human-dog interactions, (b) unregulated intentional and unintentional feeding of free-ranging dogs, (c) limitations of animal shelters, (d) non-responsible ownership, and (e) uncontrolled dog populations. As the management of animal species is usually shaped by differing interests, existing policies and regulations, views and social influence of stakeholders, power asymmetries between interested parties is yet another challenge in this regard. We need evidence-based legislations and strong institutions (e.g., public health and conservation institutions) that are capable of implementing governance principles and managing the complexities of this socio-ecological system by taking science-based decisions, and balancing power asymmetries to promote consensus.

Tracking lethal threat: in-depth review of rabies

An infectious disease known as rabies (family Rhabdoviridae, genus Lyssavirus) causes severe damage to mammals' central nervous systems (CNS). This illness has been around for a very long time. The majority of human cases of rabies take place in underdeveloped regions of Africa and Asia. Following viral transmission, the Rhabdovirus enters the peripheral nervous system and proceeds to the CNS, where it targets the encephalon and produces encephalomyelitis. Postbite prophylaxis requires laboratory confirmation of rabies in both people and animals. All warm-blooded animals can transmit the Lyssavirus infection, while the virus can also develop in the cells of cold-blooded animals. In the 21st century, more than 3 billion people are in danger of contracting the rabies virus in more than 100 different nations, resulting in an annual death toll of 50,000-59,000. There are three important elements in handling rabies disease in post exposure prophylaxis (PEP), namely wound care, administration of anti-rabies serum, and anti-rabies vaccine. Social costs include death, lost productivity as a result of early death, illness as a result of vaccination side effects, and the psychological toll that exposure to these deadly diseases has on people. Humans are most frequently exposed to canine rabies, especially youngsters and the poor, and there are few resources available to treat or prevent exposure, making prevention of human rabies challenging.

South Asian Transplant Infectious Disease Guidelines for Solid Organ Transplant Candidates, Recipients, and Donors

These guidelines discuss the epidemiology, screening, diagnosis, posttransplant prophylaxis, monitoring, and management of endemic infections in solid organ transplant (SOT) candidates, recipients, and donors in South Asia. The guidelines also provide recommendations for SOT recipients traveling to this region. These guidelines are based on literature review and expert opinion by transplant physicians, surgeons, and infectious diseases specialists, mostly from South Asian countries (India, Pakistan, Bangladesh, Nepal, and Sri Lanka) as well as transplant experts from other countries. These guidelines cover relevant endemic bacterial infections (tuberculosis, leptospirosis, melioidosis, typhoid, scrub typhus), viral infections (hepatitis A, B, C, D, and E; rabies; and the arboviruses including dengue, chikungunya, Zika, Japanese encephalitis), endemic fungal infections (mucormycosis, histoplasmosis, talaromycosis, sporotrichosis), and endemic parasitic infections (malaria, leishmaniasis, toxoplasmosis, cryptosporidiosis, strongyloidiasis, and filariasis) as well as travelers' diarrhea and vaccination for SOT candidates and recipients including travelers visiting this region. These guidelines are intended to be an overview of each topic; more detailed reviews are being published as a special supplement in the Indian Journal of Transplantation .

Optimising rabies vaccination of dogs in India

Dog vaccination is the key to controlling rabies in human populations. However, in countries like India, with large free-roaming dog populations, vaccination strategies that rely only on parenteral vaccines are unlikely to be either feasible or successful. Oral rabies vaccines could be used to reach these dogs. We use cost estimates for an Indian city and linear optimisation to find the most cost-effective vaccination strategies. We show that an oral bait handout method for dogs that are never confined can reduce the per dog costs of vaccination and increase vaccine coverage. This finding holds even when baits cost up to 10x the price of parenteral vaccines, if there is a large dog population or proportion of dogs that are never confined. We suggest that oral rabies vaccine baits will be part of the most cost-effective strategies to eliminate human deaths from dog-mediated rabies by 2030.

Immune-adjuvant effect of vitamin A and probiotics supplementation on humoral response to cell culture rabies vaccine in rabbits

This study was carried out to evaluate the effects of vitamin A (Vit A) and probiotic co-supplementation with rabies vaccine on humoral immune response in New Zealand white (NZW) rabbits. For this experiment, 54 rabbits were randomized into six experimental and three control groups. Mixed cultures of commercial probiotics supplements and a dose of Vit A were administered to each animal. Results were compared with the control group fed with only basal diet. Animals in different treatment groups showed significantly higher sero-conversions against rabies vaccine. There was a significant increase (p < 0.001) in the titers of rabies antibodies in all treatment groups on 14th and 35th days than control C3 group. Both commercial probiotics irrespective of brand increase the humoral immune response of rabbits against rabies vaccine. The mean titer values of all groups G1-G6 and sub-controls (C1, C2) were generally above 3.6 EU/ml on day 14th and between 3.7 and 3.9 EU/ml, showing highest sero-conversion on 35th day than mean titer of C3 control = 3.091 and 3.505 EU/ml respectively on both days. The maximum titer values were obtained with the addition of organic carrots to the daily diet. These results suggest that simple dietary interventions using probiotics and Vit A in natural form may enhance the efficacy of rabies vaccine in the host. These cost-effective strategies can be applied for getting higher yields of polyclonal antibody production in animal models, thus providing promising means of improving the final product yield and can be adopted easily by the manufacturers.

Interviews with Indian Animal Shelter Staff: Similarities and Differences in Challenges and Resiliency Factors Compared to Western Counterparts

Simple Summary

Previous knowledge about animal sheltering systems and perspectives of staff working in animal shelters has been centered around Western countries. However, staff in Indian shelters must tackle different kinds of problems, such as care of free-ranging dogs. We conducted interviews with ten participants working in animal shelters in India to begin to gain an understanding of their experiences. Participants reported that inadequate funding, community conflict, and too many animals in need created a challenge for animal shelter work. However, flexibility and positive relationships in their workplace, feelings of duty to animals, and understanding animal needs were identified as positive factors. The perspectives of Indian animal shelter staff showed that certain issues are similar to those encountered in Western shelters; however, other issues are specific to social, political, and cultural influences. Context specific research in animal sheltering is needed to gain a broader world understanding of human–animal relationships.

Abstract

Animal shelters in India are at the forefront of efforts to improve free-ranging dog welfare and tackle animal overpopulation. In terms of cultural and political context, access to resources, and public health challenges, they operate in a very different environment than Western counterparts. Despite these distinctions, current sheltering literature is largely centered around countries such as the United States. The goal of this exploratory study was to examine the experiences of Indian animal shelter staff. Researchers conducted ten semi-structured interviews, in a mix of Hindi and English, with managers, veterinary nurses, and animal caretakers from three shelters. Using thematic analysis, shelter challenges as well as resiliency factors that enable staff to cope with these challenges were identified. Key challenges were inadequate funding, community conflict, and high intake numbers. Resiliency factors included flexibility, duty of care, co-worker relationships, and understanding animal needs. The results of this qualitative study revealed that the experiences of shelter staff are shaped by social, political, and cultural factors and that there is a need for further, context specific research on Indian sheltering rather than only relying on Western perspectives.

Elimination of human rabies in Goa, India through an integrated One Health approach

Dog-mediated rabies kills tens of thousands of people each year in India, representing one third of the estimated global rabies burden. Whilst the World Health Organization (WHO), World Organization for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) have set a target for global dog-mediated human rabies elimination by 2030, examples of large-scale dog vaccination programs demonstrating elimination remain limited in Africa and Asia. We describe the development of a data-driven rabies elimination program from 2013 to 2019 in Goa State, India, culminating in human rabies elimination and a 92% reduction in monthly canine rabies cases. Smartphone technology enabled systematic spatial direction of remote teams to vaccinate over 95,000 dogs at 70% vaccination coverage, and rabies education teams to reach 150,000 children annually. An estimated 2249 disability-adjusted life years (DALYs) were averted over the program period at 526 USD per DALY, making the intervention 'very cost-effective' by WHO definitions. This One Health program demonstrates that human rabies elimination is achievable at the state level in India.

Rabies: Repetition of an Old Tragic Story in Southeastern Iran

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Eliminating dog-mediated rabies: challenges and strategies

Rabies is an acute encephalitis caused by a lyssavirus. It is primarily transmitted through bites of infected dogs which results in the worldwide death of an estimated 59000 humans every year. The disease is preventable through the application of post-exposure prophylaxis (PEP) and its elimination has been demonstrated in many countries by applying multiple interventions simultaneously. Nonetheless, rabies is still widespread in many developing countries, primarily due to the poor implementation of intervention strategies that include inadequate dog-bite wound management practices, unavailability/unaffordability of PEP by the communities, failure to control the disease in free-roaming dogs and wildlife, improper dog population management, weak surveillance and diagnostic facilities and a lack of a One Health approach to the disease. In this review, strategies to control dog-mediated rabies through a One Health approach were discussed. We recommend applying multiple interventions against the disease by involving all the concerned stakeholders in selected urban and rural areas of the countries where rabies is endemic. An empirical demonstration of disease freedom in the selected areas through a One Health approach is needed to convince policymakers to invest in rabies prevention and control on the national level. This multifaceted One Health control model will enhance the likelihood of achieving the goal of global rabies eradication by 2030.

Rabies control in South Asia requires a One Health approach

Rabies is a vaccine-preventable viral disease present in more than 150 countries around the world. Globally, almost 60,000 people die each year from rabies, of which more than 58% are in Asia and around 45% in South Asia with especially high incidence in India, Pakistan and Bangladesh. Vaccination coverage of both people and stray dogs is low in the region and in general people are not given enough protection and information about pre- and post-exposure prophylaxis. Engagement of multiple sectors and One Health collaboration including community education, awareness programmes and vaccination campaigns are critical to control and elimination of rabies.

One Health and Neglected Tropical Diseases-Multisectoral Solutions to Endemic Challenges

One Health is defined as an approach to achieve better health outcomes for humans, animals, and the environment through collaborative and interdisciplinary efforts [...].