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Rabies: The National Shame

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By Dr Subhash Sundriyal
Rabies infection is fatal. While doing my medical internship, I got a chance to see a rabies patient in advanced stage and it left an indelible impression on me. Infected patients usually have a history of dog bite and the noticeable symptom manifests as hydrophobia (fear of water).

Even the sight of water or trying to offer drinking water is enough to trigger convulsions (‘fits’). These patients become aggressive or violent and may bite the attending paramedical staff/ doctors. So, they are quarantined in hospitals, allowing only supportive medical care till they die. Till date, only 5 cases have survived with good medical and nursing care.

In India, 36 million stray dogs wander near dwelling clusters in search of leftover food and develop a knack of surviving against all odds. If these dogs lick, scratch or bite human beings then chances of getting rabies increases. The speed of infection spread depends on severity of bite, and the body part where the bite has taken place. It is considered severe in the upper torso and risky in the lower torso. Annually, 20,000 deaths take place due to rabies in India and yet a national programme for prevention and control of Rabies is not in force.

The Rabies virus is bullet shaped, which attacks the nerves in the human body causing multiple symptoms from headache to fever and hydrophobia, ultimately. Rabies patients do not recover and treatment is purely palliative in making them comfortable till death.

Preventing Rabies infection poses a serious challenge in India especially since numbers of reported deaths are higher than anywhere else in the world. It is the moral responsibility of local municipal bodies to catch street dogs and get them inoculated and sterilised by local livestock officers. The health services in the area must do an intensive campaign on Rabies awareness and vaccination of pet dogs.

Stray dogs and pet dogs may acquire infection at any point of time, just as anybody else can get infection. These dogs bite humans and infect them with rabies virus. If street dogs are not sterilised and let loose in urban forests reserve, over a period of time they gradually turn into real feral canines. They may come to search for food in the peripheral area of the forest and bite the population residing in those areas. Last year, feral canines attacked the urban population in Khairabad block of District Sitapur in UP. This was the aftermath of carelessness on the part of local municipal bodies.

Anti Rabies Vaccination (ARV) is available in the pharmaceutical market. ARV, derived from Human Diploid Cell, is considered to be safer and superior. ARV is available in Government and Private Hospitals. The victim gets a card and a fixed schedule of days and doses which the doctors decide. The victim must get himself-herself vaccinated on the prescribed days. But it is advisable to get the first jab within 24 hours of the suspected lick or bite by a dog. It is very important to understand that ARV cannot cure rabies infection but gives a prophylactic cover to humans.

As an advisory – if a stray dog licks on a cut surface on the skin or bites, then try to keep an eye on the dog for a minimum of ten days. Observe the behaviour of the dog. If it turns aggressive (furious rabies) or becomes silent or listless (dumb rabies), it is time to get the complete schedule of ARV vaccination.

We are intensely debating on Covid recovery/deaths which by all efforts have a recovery rate of more than 90%, but ignoring the public health problem of 100% fatality in Rabies. This is a national blunder by the Health Sector in India.