Tens of thousands killed by rabies in India

New strategies against rabies propagation in India

09/22/2014

Rabies is a 100 percent preventable disease that still causes around 60,000 deaths per year, according to the World Health Organization (WHO). India is the country with the most infections and deaths. Vaccination could significantly reduce the incidence of the infectious disease, but the vaccine is too expensive for nationwide care of the population. Therefore, the street dogs, which are considered the main vectors of rabies, are at least to be captured, vaccinated and sterilized in the urban centers of India, reports the news agency „dpa“.

With the immunization and sterilization of dogs in the fight against rabies, the WHO has already gained experience in Southeast Africa. The chief physician of the project, Dr. med. François Xavier Meslin, said last year in a WHO press release, that the method of canine immunization is the most cost-effective way to avoid most human rabies deaths. But doubts remain about the efficiency of the method. An immunization of all stray dogs in India is considered by many experts to be almost hopeless. Dog immunization will be one of the topics at the World Rabies Day (September 28).

Children most at risk from rabies
Nationwide exists in India „a high risk of biting injuries by stray dogs and transmission of rabies, even in the cities“, reports the Foreign Office and adds: „Monkeys can also transmit rabies.“ Before a trip to India, it is therefore urgent to review the rabies vaccine and, if necessary, refresh it. But the local population is inadequately protected here. The vaccine is simply too expensive and can not be maintained in all regions of the country. The news agency „dpa“ reports in its latest release from the only state clinic in the Indian capital, New Delhi, which has adequate vaccine supplies. Nurse Sunil Yadav, who works there, has already seen many desperate relatives who came to the clinic with their sick children. „Children are most at risk from the disease“, reports WHO and adds: „Four in ten rabies deaths affect a child under the age of 15.“

Prevent spread of the pathogens into the brain
„Wound cleansing and immunization within hours of biting a rabid animal can prevent the onset of rabies and death“, explains the WHO. But here the time factor plays an essential role. Treatment should begin as soon as possible after the bite. In the Indian capital, however, many infected people reach the state-owned Maharishi-Valmiki-Hospital with considerable delay, so that the triggering viruses have already reached the brain and the disease is fatal. In principle, every rabies patient who has been brought in is first taken to the washroom, where the wound is cleaned for several minutes with soap, thoroughly rinsed and treated with iodine, she reports „dpa“ citing the nurse Sunil Yadav. In this way, the viral load can be reduced by up to 80 percent. Subsequently, the patient is injected with the rabies immunoglobulin - directly around the wound and in the arm, so Yadav on. This should prevent the virus from spreading from the wound into the central nervous system and causing a fatal inflammation in the brain.

Antibody only in a state hospital of the capital in stock
Actual should „anyone who is bitten will receive a serum“, quotes the „dpa“ the physician Mukesh Naran, who runs the rabies project in the Maharishi-Valmiki-Hospital Hospital. However, the clinic is the only state hospital in the 25-million-inhabitant city, in which the antibodies are kept permanently. This is due to the price, because „a bottle of serum costs 5,000 rupees (64 euros)“, explained the doctor to the „dpa“. Patients who have been bitten by an infected animal often have to go through some hardships to get to the clinic at all, according to the medical professional, because the hospital is around 35 kilometers from the city center. „People come with buses, car rickshaws, cars, bicycles or run to us“, the news agency quotes the statement of the doctor. Ambulances for the transfer of patients from other clinics are not available. In the various privately managed clinics New Delhi, however, the patients would have to pay for the treatment themselves, which is not possible for most of those affected.

Dog immunization to curb rabies?
A preventive rabies vaccine is too expensive and costly, according to the medical profession for a nationwide supply of the population in India. Because the vaccine is relatively expensive and the immunization must be done over several injections on different days. In addition, every two to five years it would need a refresher of the vaccine. „So it tries to contain the danger by the animals“, quotes the „dpa“ the Managing Director of the Rabies Foundation in Asia, Ashwath Narayana. Since the killing of stray dogs since 2001 was prohibited by law „the dogs are captured, vaccinated, sterilized and released, especially in the urban centers“, Narayana continues. This type of canine immunization has already been practiced in South East Africa with WHO support. However, given the extreme size of the dog population, India still has doubts about the chances of success. Gadey Sampath, a doctor at the Hyderabad Institute for Preventive Medicine, explains to the rabies that 80 percent of stray dogs have to be immunized against rabies in order to fight rabies in one of the megacities „dpa“. Also, it would require an annual renewal of vaccination, which would be implemented only in the context of a nationwide, coordinated action, said Sampath. But rabies is not considered an epidemic in India. Thus, the country is likely to continue in the medium term with up to 20,000 rabies deaths per year remain the main area of ​​rabies. (Fp)