ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Underestimating Rabies

Belated no doubt, but the government's move to prioritise rabies control is welcome.

Rabies kills 20,000 people in India every year giving it the unenviable distinction of leading the rest of Asia in rabies fatalities. The Association for Prevention and Control of Rabies in India (APCRI) estimates that this number also ranks India second as far as global deaths (55,000) due to rabies are concerned. The country’s cities including the four metropolitan ones account for 30% of these deaths and it does not take much imagination to realise that the slum colonies bear the brunt. However, the numbers do not adequately convey the horror of the suffering the disease unleashes on its victims. In a majority of the cases, these victims are from the poorest sections and also children. The Indian government has now proposed to categorise it as a priority disease for control under the Twelfth Five-Year Plan.

While rabies can be prevented through timely pre- and post-exposure vaccination, there is no treatment after it develops. Dogs are the source of nearly 99% of the human deaths but cats, mongooses and monkeys too can be hosts and transmitters. According to a study by the APCRI done in 2003, rural areas witnessed three times as many cases as the urban ones and a third of the deaths were in children below 14 years. Since majority of the bites affecting children go undetected and unreported, the crucial post-exposure treatment is missed, leading to the inevitable deaths, says the World Health Organisation (WHO). The WHO’s report on the disease in Asia makes for chilling reading. It points out that most rabies victims tend to die at home rather than being admitted to a hospital and this leads to “lack of surveillance data and underestimating of the health and economic implications of rabies among public health policymakers”. Worse, it does not receive the priority or attention it deserves and the usual lack of coordination between different official agencies in tackling it compounds the problem. States like Uttar Pradesh, Chhattisgarh, Orissa, Bihar, Assam, Madhya Pradesh and Andhra Pradesh account for a majority of these fatalities due to what is known as “furious rabies” and which is close to the popular perception of rabies. The other manifestation of the disease also characterised as the paralytic form (gradual paralysis of the muscles) shows less dramatic symptoms but is also fatal.

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