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Picture Courtesy: The Hindu

Context:

According to recent research published in One Health (December 2024), rabies is widespread in the country, thrives largely among dogs, and overwhelmingly affects the poor and socially marginalised.

Current Status of rabies in India:

• India accounts for about one-third of global rabies deaths, with nearly 20,000 deaths annually, making it the worst-affected country in the world.
• Rabies remains endemic in India and is primarily transmitted through dog bites.
• The disease disproportionately affects the poor, including daily wage workers, rural communities, waste pickers, brick-kiln workers, and socially marginalised groups.
• Lack of awareness, poor access to healthcare, and unaffordability of treatment greatly increase the risk of death from rabies.
• India has an estimated 80 million free-roaming dogs and around 20 million dog bites every year.
• Post-exposure treatment is inadequate, as about 5% receive no vaccine and nearly half do not complete the vaccination schedule.
• Rabies Immunoglobulin (RIG) is scarce, expensive, and often unavailable in public hospitals.
• Health-system failures such as delayed or refused treatment and poor wound management lead to preventable deaths.
• Vaccine supply is insufficient, as India needs 60 million doses but produces only about 50 million and exports part of it.
• Children under 15 years make up nearly 40% of rabies cases, making them the most vulnerable group.
• The Catch–Neuter–Vaccinate–Release programme alone is inadequate due to high yearly dog population turnover of about 40%.
• India has developed monoclonal antibody alternatives to RIG, but they are still under pharmacovigilance and not yet part of national guidelines.

Source: WHO

What is Rabies?

• Rabies is a vaccine-preventable viral disease that affects the central nervous system, leading to progressive inflammation of the brain and spinal cord.
• It occurs in over 150 countries and territories across the world.
• The virus is transmitted to humans and other animals primarily through the bite or scratch of infected animals, most often dogs.
• If timely medical care is not provided after exposure, the infection almost always leads to death.
• Rabies is recognised as a Neglected Tropical Disease (NTD), disproportionately affecting poor and remote communities.
• Although effective vaccines and immunoglobulins exist, access and availability remain inadequate in many regions.
• Children aged 5–14 years are among the most frequent victims due to higher exposure and lower awareness.

Types of Rabies in Humans

Furious Rabies

This is the more common form and is characterised by:

• agitation and hyperactivity
• fear of water (hydrophobia)
• fear of air or breezes (aerophobia)
• episodes of confusion and aggression

Death typically occurs within a few days due to cardiorespiratory failure.

Paralytic Rabies

This form progresses more slowly and is often missed or misdiagnosed.
Paralysis begins near the bite site, gradually spreads, and leads to coma and death.
Because of its subtle presentation, paralytic rabies contributes significantly to under-reporting of cases. 

Transmission:

Rabies is caused by the rabies virus, which targets the brain and nervous system.
Transmission occurs mainly through:

• bites or scratches from infected animals
• saliva entering open wounds or mucous membranes

Dogs account for up to 99% of human cases, making dog-mediated rabies the primary public health concern in many countries.

Symptoms of Rabies:

Early symptoms are usually non-specific and may include:

• fever and body pain
• tingling, burning, or unusual sensations around the bite site

As the infection spreads to the nervous system, severe inflammation of the brain and spinal cord develops, which is almost always fatal without prior vaccination.
The incubation period can range from one week to one year, depending on the site of the bite and the amount of virus introduced.

Prevention of Rabies:

Rabies is entirely preventable with proper public-health measures.
Key strategies include:

• vaccinating dogs, which remains the most cost-effective way to prevent human rabies
• reducing dog bites through community awareness and responsible ownership
• pre-exposure or post-exposure vaccination in humans where required

Dog vaccination not only prevents infection in animals but also decreases human exposure and reduces the need for post-exposure treatment. 

Government initiatives for prevention and control of rabies in India:

National Rabies Control Programme (NRCP): The Central Government supports States to ensure availability of vaccines and immunoglobulins, improve surveillance, train health workers, and raise public awareness about wound washing and timely PEP.

National Action Plan for Rabies Elimination 2030: India aims for zero human deaths from dog-mediated rabies by 2030 under a One Health approach, focusing on mass dog vaccination, dog population control, and universal access to post-exposure prophylaxis.

Animal Birth Control and Anti-Rabies Vaccination: Urban local bodies run programmes to sterilise and vaccinate free-roaming dogs, helping reduce dog bites and rabies transmission in a humane way.

Free or Subsidised PEP in Public Hospitals: Many government facilities provide free anti-rabies vaccines and immunoglobulins, reducing financial burden on bite victims.

Integrated Disease Surveillance Programme (IDSP): Rabies and dog-bite cases are tracked and reported to enable early public-health response.

Conclusion:

Rabies in India remains a completely preventable yet persistently fatal disease, mainly affecting the poor and children. Strengthening dog vaccination, humane population control, timely post-exposure treatment, and public awareness under the One Health approach is essential. With sustained implementation of national programmes and reliable access to vaccines and immunoglobulins, India can realistically achieve zero dog-mediated human rabies deaths by 2030. 

Source: The Hindu