Dr. Naresh Rakha, Professor & Head Dept. of Epidemiology & Preventive Medicine CCS HAU Hisar.

1. Epidemiology of Rabies and its strategic control Dr. Naresh Rakha, Professor & Head Dept. of Epidemiology & Preventive Medicine CCS HAU Hisar.

2. Rabies is a global problem Don't fear, But prevent Rabies

3. What is Rabies? Rabies is an acute, dreadful and Deadly viral infection of the central nervous system affecting all warm blooded animals

4. Rabid dog will bite anything

6. EPIDEMIOLOGY • India has 27 million dogs • Dog : Human ratio 1 : 40 ) • Stray dog population – 80% • Animal bite incidence – 17.5 million/ year - 66% children • Every 2 seconds a man is bitten by dog • Every ½ Hour a man dies of rabies • More than 20,000 human death every year 40% of people bitten by dogs don’t go for treatment

7. EPIDEMIOLOGY CONT. • India has highest incidence of rabies in the world (80%) • 96% human rabies due to dog bite, out of which 11% due to pet dog bite • Rest 4% due to contact with jackals, cats, monkeys, mongoose etc. • For the last 10 years human death figure is constant. • In army – 1 death per 6 lakh soldiers • Death of one cattle per 1 lakh cattle ( 2830 )

8. Rabies in India: human • Each year about 7 million people undergo post exposure rabies treatment after a dog bite. • Association for Prevention and Control of Rabies in India (APCRI) reported in 2004 that there were 20,565 reported human deaths over the period of one year. Due to mis-diagnosis and under-reporting, the actual number of rabies deaths is believed to be higher. • About 70% of the victims are children younger than 15 years.

9. Global Epidemiology Scenario • Estimates suggest that 1 person dies of rabies every 10-15 minutes and about 1000 persons undergo post bite prophylactic vaccination every hour in the world.

10. Rabies incidence in animals • Incidence more in summer months and particularly during the draught season • Incidence of rabies is uniform in all age groups of livestock. • More in cattle, buffaloes, sheep and goats compared to horse and swine,

11. Rabies in Haryana / India • Common in most parts of India and widely prevalent in animal population of Haryana. • Of about 25 to 30 million dogs in India (2003), Haryana, estimated to have 1.5-1.9 million dogs • The situation of rabies in Haryana is no better, if not worse than national figures • Most of dogs in villages are ownerless, stray or at best termed as ‘common dogs’ • These dogs play a major role in the spread of rabies.

12. Risk from common dogs • Common dogs are fed by local residents but their movements, although limited, are unregulated & daily activities are unmonitored. • Thus their contact with rabid animals and subsequent transmission to livestock gets ignored sometimes. • The dogs reared by farmers in rural and sub urban Haryana, while visiting fields, frequently come in contact with wild animals/ rabies reservoirs and thus bring the infection into the domestic animal population.

13. Increasing dog population • Medical practitioners are recently advising ‘Pet therapy’ to the over stressed executives. • Because of nuclear structure of the families and mounting emotional stress, pets are being increasingly used as companions for children and old people. • This has made dog keeping more popular and thus has doubled the challenge of rabies control.

14. Treatment and control • No treatment is effective in humans or animals once the symptoms of rabies are evident. • Control is possible through wound care & prophylactic vaccination only.

15. RABIES CONTROL PROGRAMME IN INDIA No systematic programme Animal Birth Control ( ABC ) Catch, neuter, vaccinate and release – 1.4 lakh (0.52 %) Neutering policies not well defined Vaccination of reservoir population – Best choice India spends Rs 1500 crores ( US$ 375m) for rabies vaccine in humans

16. Rabies control in animals in Haryana • Animal welfare Board of India has envisaged a multi-target rabies control program wherein stray dogs are sterlized, rehabilitated and orally immunized. • Haryana Urban Development Authority at Gurgaon is arranging finances and an NGO volunteers will help catch the stray dogs, get them sterilized from qualified vets and rehabilitate them from wherever they were caught, along with feeding anti rabies baits • The model rabies program to be implemented in Gurgaon needs to be extended to cover the whole state of Haryana. • Stray monkeys and cats also need to be included in the program since even these can act as reservoir of rabies.

17. Vaccine for animals in Haryana • Haryana Veterinary Vaccine Institute at Hisar has been producing and supplying the pre and post bite vaccine. • WHO recommends that cell culture vaccines should replace brain tissue derived vaccines as soon as possible. • Tissue culture vaccine, available in the market, is economical and hence is being used for prophylaxis primarily.

18. Vaccine failure in animals • Despite reported use of post bite vaccine, several cases of rabies are reporting to Veterinary Institutions in Haryana & Veterinary Clinics HAU, Hisar. This might be due to failure of cold chain required for maintenance of adequate efficacy of the product. • Site of dog bite in ruminants is very close to brain. So, the incubation period in such bitten animals is quite short & thus proper vaccination is needed immediately.

19. Diagnosis of rabies in animals Department of Veterinary Epidemiology and Preventive Medicine has been getting requests from field vets as well as farmers to diagnose the suspected cases of rabies. The experts have visited and confirmed the cases through laboratory examination. It is important to note that sometimes it becomes difficult for farmers to identify the symptoms of rabies in ruminants as these are different than those exhibited by rabid dogs.

20. Rabies in ruminants of Haryana transmitted though bite of rabid dog

21. Rabies control through vaccination Availability of vaccines Nervous tissue vaccine – Discontinued in Nov. 2004 in most places including Haryana, on the recommendation of WHO, but used in some places Tissue culture vaccine - Limited supply Oral rabies vaccine – Not available

22. Vaccines • Introduction of oral vaccine ( SAG –2 ) • Testing under Indian conditions - is essential • Annual requirement – 30 million doses • Available – 18 million doses • Net deficit – 12 million doses

23. SAFETY AND EFFICACY STUDIES ON ORAL VACCINE (SAG-2) PREPARATIONS • All the dogs were dewormed and vaccinated against canine distemper, Rubarth hepatitis, parvo virus and leptospirosis. • Pre-vaccinated animals tested for antibody and virus. • Immunosupression with Vetalog-4 Inj. of 1.2 mg.

24. SAFETY AND EFFICACY STUDIES ON ORAL VACCINE (SAG-2) • Clinical observation Safety trial – 219 days Efficacy trial – 199 days • Saliva collection- For excretion of vaccine virus (D0 to D5) • Neutralizing antibody detection after vaccination : D0, D14, D28, D56

25. BAITING OF STRAY DOGS

26. PILOT PROJECT ON ORAL RABIES VACCINATION OF STRAY DOGS Indian Govt. approved the project for 5 years No. of doses to be used – 0.8 million 1st year - 0.1 million doses 2nd year - 0.1 million doses 3rd year - 0.2 million doses 4th year - 0.2 million doses 5th year - 0.2 million doses

27. Issues at a glance • In India with 27 million dogs, animal birth control looks difficult. • Vaccination is the practical choice parenteral for accessible dogs and oral vaccination for non-accessible dogs • Birth control coupled with parentral and oral immunization may be holding the answer to this mega problem. • Shortage of conventional vaccines • ORV (SAG-2) is convenient in immunization of stray dogs • Bait acceptance is 92 % • ORV is safe for dogs as no adverse clinical signs and no replication of virus

28. Suggestions to be considered to implement rabies control program in Haryana • All the dogs kept by owners should be licensed by competent authorities. In villages, dogs be registered with Panchayats like Municipal Committees in cities are authorized to register and issue licenses. • All licensed dogs should be vaccinated against rabies as per recommended schedule from a qualified Vet. A certificate of Vaccination of the pet should be maintained by owner along with documentary proof of purchase of anti rabies vaccine dose.

29. Two more suggestion 3. Village Panchyats through the Block Development Officer and Municipal Committees through District administration should be provided with adequate funds to ensure free vaccination for common dogs. 4. Pet practitioners whether in Govt. jobs or in the private sectors should be instructed to treat the dogs which is licensed and has been properly vaccinated against rabies as evident from the certificate. This will encourage people to get their pets vaccinated regularly.

30. Last three suggestions • Vaccination should preferably be done in the winter season. • Thermo sensitive additives should be attached with the vaccine to reduce the problem of failure of cold chain. • 6. Damage caused by the rabid dog to the third party (victim of bite) should be duly compensated by its negligent owners and a suitable legislation in this respect be brought in, on the pattern of negligence under Motor Vehicles Act.

31. Appeal • Public awareness and education through extension activities & popular media will help in combating the disease. • Animals Welfare Board of India has already undertaken programs to curb the rabies menace. Govt. and Non Govt. Institutions along with some dedicated volunteers need to come at a common platform to take initiative to shoulder the responsibility since rabies eradication is a Herculean task.

32. Tell the Children • Donot try to pat wild, captive or stray animal even if they are dead, Pat only the Pet. • Regular vaccination of Pets. • In case the behavior of animal is changed, stay away. • Upon bite of dog, monkey, mongoose or any other warm blooded animal with aberrant behaviour, wash the wound with soap and lot of water then consult the doctor immediately. • Donot tie or cover the wound. • Donot apply irritants like Lal Mirch at the wound • Post exposure vaccine can save life

33. Thank You