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LETTER TO THE EDITOR
Year : 2016  |  Volume : 2  |  Issue : 2  |  Page : 110-111

Envisaging the adoption of framework to globally eliminate rabies: World health organization


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India

Date of Web Publication19-May-2016

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, 3rd Floor, Ammapettai Village, Thiruporur - Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2394-7438.182727

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How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Envisaging the adoption of framework to globally eliminate rabies: World health organization. MAMC J Med Sci 2016;2:110-1

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Envisaging the adoption of framework to globally eliminate rabies: World health organization. MAMC J Med Sci [serial online] 2016 [cited 2019 Nov 12];2:110-1. Available from: http://www.mamcjms.in/text.asp?2016/2/2/110/182727

Sir,

Rabies is an infectious, vaccine-preventable disease of viral origin, which is primarily transmitted by the bites and scratches from infected animals, and is almost always fatal after the appearance of clinical signs.[1],[2] Apart from being reported in excess of 150 nations, the most significant public health concern is the high fatality associated with the disease, as every 10 min one person dies because of rabies, with maximum fatality in the Asian and African region.[1],[3] In fact, rabies infection results in close to 1000 deaths annually, with around 40% of bites by suspected rabid dogs in 0–15 years age-group.[1],[3]

For decades together, rabies has remained a neglected disease affecting the poor and vulnerable sections of the community, especially from the rural settings, who have no access to vaccines or immunoglobulin, and mortality among them, are never reported to the public health authorities.[2],[3] However, being a vaccine-preventable disease, the disease can be either prevented by vaccinating the dogs, or immunizing people before exposure, or administering postexposure prophylaxis (PEP) (comprises of immediate wound cleansing with soap and water, a course of rabies vaccine, and/or administration of rabies immunoglobulin).[3],[4]

Even though, the available estimates suggest that more than 15 million persons across the world are immunized with a vaccine as PEP measure on an annual basis, the cause of concern is its affordability.[3] In fact, the average cost of rabies PEP can result in catastrophic expenses for poor populations since a course of PEP can equate to wages of almost 40 days in most of the badly affected nation.[3]

Acknowledging the burden of the disease, high fatality rate, and the preventable nature of the disease, the World Health Organization (WHO) and its international partners have aimed for the global elimination of the disease.[2],[3] In fact, the disease has been eliminated from most of the Latin America and significant progress has been even achieved in some of the African Nations.[3] At the same time, the preventive package of services has to be expanded in the remote regions with the help of active community engagement to sustain the success.[2],[3],[4] Further, measures to improve the level of awareness among the general population, strengthening of the data collection (regarding bite incidence, fatality, etc.), increasing the demand for PEP, reducing the cost of human rabies vaccine through international collaboration, and educating children on how to avoid being bitten, can play a crucial role.[3],[5]

A specific framework has developed and advocated by the international agencies, which consists of ensuring affordability toward human vaccines/immunoglobulin, offering prompt treatment to people who get bitten, and conducting mass dog vaccinations as a primary prevention measure.[3] The stakeholders have aimed to bring down the cost of human rabies vaccines and supportive treatment through strong international collaboration (involving WHO, the World Organization for Animal Health, Global Alliance for the Control of Rabies, etc.,) so that quality-assured vaccines and rabies immunoglobulin can be made available in the peripheral health settings in endemic regions.[3] Vaccination of dogs has been envisaged not only due to its low cost (dog vaccines cost 40 times lesser than human vaccine), but also because by administering vaccines in 70% of dogs in a specific region, the number of human rabies cases can be brought down to zero.[1],[2],[5] Further, encouraging responsible pet ownership and proper population management of stray dogs can also reduce the incidence of cases for a sustained period.[6] To ensure the elimination of canine rabies, dog vaccination is the most cost-effective and only long-term solution as it will not only reduce the rabies specific death rate, but even significantly minimize the need of PEP as a part of dog bite patient care.[1],[3] However, to achieve this there is a great need to understand the population dynamics of free-roaming dog populations (viz., rates of birth, death and migration), to eventually assist the program managers in effective planning and implementation of mass dog vaccination campaigns.[6]

To conclude, the good thing in the battle against rabies is that it is totally preventable, and we have effective tools available in the form of human and dog vaccines, what remains is the challenge to ensure that the available tools are affordable and made accessible to all those who are at risk.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. Rabies – Fact Sheet No. 99; 2015. Available from: target="_blank" href="http://www.who.int/mediacentre/factsheets/fs099/en/". [Last accessed on 2015 Dec 08].  Back to cited text no. 1
    
2.
Abela-Ridder B. Rabies: 100 per cent fatal, 100 per cent preventable. Vet Rec 2015;177:148-9.  Back to cited text no. 2
    
3.
World Health Organization. New Global Framework to Eliminate Rabies; 2015. Available from: target="_blank" href="http://www.who.int/mediacentre/news/releases/2015/eliminate-rabies/en/". [Last accessed on 2015 Dec 11].  Back to cited text no. 3
    
4.
Burnett MW. Rabies: 2015 Update. J Spec Oper Med 2015;15:105-7.  Back to cited text no. 4
    
5.
Anderson M. Enhanced national rabies response preparedness. Aust Vet J 2015;93:N12.  Back to cited text no. 5
    
6.
Conan A, Akerele O, Simpson G, Reininghaus B, van Rooyen J, Knobel D. Population dynamics of owned, free-roaming dogs: Implications for rabies control. PLoS Negl Trop Dis 2015;9:e0004177.  Back to cited text no. 6
    




 

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