Rabies

12.08.2025

Rabies

Context

Rabies, a fatal yet preventable zoonotic disease, causes thousands of deaths annually, with developing nations most affected; WHO classifies it as a Neglected Tropical Disease.

Nature and Cause

• Type of Disease: Acute and almost always fatal viral infection affecting mammals, including humans.
• Causative Agent: Rabies virus, an RNA virus classified under the Rhabdoviridae family.
• Mode of Transmission: Primarily spread through saliva from the bite or scratch of an infected animal, most often dogs.

Disease Progression

1. Entry Point: Virus enters via broken skin or mucous membranes.
    
2. Local Multiplication: Initial replication occurs in muscle cells near the bite site.
    
3. Neural Spread: Virus travels along peripheral nerves toward the brain.
    
4. CNS (Central Nervous System) Impact: Causes inflammation of the brain (encephalitis) and disrupts nervous system functions.
    

Epidemiological Highlights

• Mortality: 100% fatal after symptom onset.
   
• Animal Reservoirs:
   
  • Dogs account for ~99% of human rabies cases.
     
  • Also found in cats, monkeys, and certain wild species.
     
• Geographic Spread: Present globally except Antarctica.
   
• Incubation Period: Typically 1–3 months; can vary from a week to over a year.
   

Clinical Symptoms

Early Signs: Fever, discomfort, tingling, or burning at the bite site.
 Advanced Stages:

• Furious Rabies: Hyperactivity, aggression, hydrophobia (fear of water).
   
• Paralytic Rabies: Progressive muscle weakness, paralysis, coma, and death.
   

Rabies Situation in India

• Rabies continues to be a major public health concern in India, which accounts for around 36% of global rabies deaths.
   
• The disease causes an estimated 18,000–20,000 deaths annually in the country.
   
• Children under 15 years contribute to about 30–60% of reported rabies cases and fatalities, largely because bites in this age group are often unnoticed or unreported.
   
• Dogs are the primary source of transmission, responsible for approximately 97% of human rabies cases.
   
• Other sources include cats (around 2%) and wild animals such as jackals and mongooses (about 1%).
   
• Rabies is endemic across all regions of India.

Prevention and Control Measures

1. Animal Vaccination

• Regular canine vaccination programs to block transmission at the source.
   

2. Human Vaccination

• Pre-exposure Prophylaxis: For high-risk groups (e.g., veterinarians, lab staff).
   
• Post-exposure Prophylaxis (PEP): Immediate wound cleaning with soap and water followed by a full vaccine course (4–5 doses).
   

3. Awareness Campaigns

• Education on bite prevention and the urgency of prompt medical care.
   

Challenges

• Low Awareness: Many rural communities lack knowledge about PEP.
   
• Vaccine Accessibility: Limited availability in remote areas delays treatment.
   
• Animal Control Gaps: Stray dog population management remains insufficient.
   
• Cultural Barriers: Reliance on traditional healing methods instead of medical care.
   

Way Forward

1. Mass Dog Vaccination Drives: Prioritise high-incidence zones to break the transmission cycle.
    
2. Universal PEP Access: Ensure vaccine stock in all primary health centres.
    
3. Community Education: Engage schools, local leaders, and NGOs in awareness outreach.
    
4. Integrated One Health Approach: Coordinate veterinary, medical, and public health sectors for joint action.
    
5. Global Collaboration: Support WHO’s goal of zero human rabies deaths by 2030 through joint funding and data-sharing.
    

Conclusion

Rabies is an entirely preventable yet universally fatal disease once symptoms begin. Eliminating human rabies deaths hinges on proactive dog vaccination, timely human prophylaxis, widespread awareness, and a coordinated One Health strategy. With sustained policy action and community participation, rabies can be relegated to history.