Historically, efforts to control rabies in Kerala have largely centered on two main strategies: Animal Birth Control (ABC) programs aimed at reducing the stray dog population, and Post-Exposure Prophylaxis (PEP) to treat individuals after a potential rabies exposure.
However, a significant shift in global rabies prevention strategies, driven by the ‘One Health’ principle, points towards a more cost-effective path. Instead of heavily relying on expensive ABC programs or solely expanding PEP, the new consensus emphasizes directly tackling canine rabies, as dogs are the primary transmitters of the virus.
This modern approach is called Integrated Bite Case Management (IBCM). It’s a comprehensive strategy rooted in the ‘One Health’ concept, uniting community participation with enhanced animal surveillance, widespread dog vaccination, and efficient post-bite care (including wound management and PEP). The goal is a sustainable reduction in both canine and human rabies cases.
A Unified Effort
Currently, IBCM is being rolled out as a joint venture across six key areas in the Thiruvananthapuram district, including the Corporation area and the Pothencode, Chirayinkil, Parassala, and Nedumangad blocks. This collaborative project involves the Health Department, Animal Husbandry, Local Self-Governments (LSG), and various non-governmental organizations.
Organizations like Mission Rabies, known for successfully eradicating rabies in Goa, along with the Compassion for Animals Welfare Association (CAWA) and People for Animals, are actively assisting the Health Department with critical tasks such as animal surveillance and dog vaccination efforts on the ground.
IBCM implements a unified surveillance system for both humans and animals. This ensures that every animal bite incident in the community is identified and thoroughly investigated, covering both the affected person and the animal involved.
When an animal bite occurs, health workers diligently investigate the incident, providing immediate wound care and ensuring timely Post-Exposure Prophylaxis (PEP) if necessary. Simultaneously, veterinary staff safely capture the biting animal and place it under observation in a specialized facility to monitor for rabies symptoms. Should the animal succumb within ten days, laboratory tests are conducted to confirm rabies.
The Benefits of This Approach
Dr. Zinia T. Nujum, the lead researcher for the IBCM project and an Additional Professor of Community Medicine at Kollam Medical College, highlights the significant benefits of this systematic strategy. ‘It ensures that any rabid animal is promptly isolated from the community, preventing further danger,’ she explains. ‘This also allows for the smart allocation of PEP resources, as bites from healthy animals don’t necessitate PEP treatment. Accurate rabies reporting and thorough data collection are crucial. They help us understand the true extent of the disease and pinpoint specific areas with higher transmission rates, enabling targeted interventions like ‘ring vaccination’ for all domestic and stray dogs within a two-kilometer radius to safeguard the community.’
Dr. Nujum further elaborates, ‘Kerala records between 1.2 to 3.8 lakh animal bites each year. While only a tiny fraction (0.9% to 1.5%) of these exposures are truly rabid, every reported case currently requires PEP. Moreover, about 30% of these bites need immunoglobulin (IG) serum, resulting in a staggering annual state expenditure of ₹24-26 crore on PEP. IBCM is designed to optimize PEP usage, enhance animal surveillance, and re-emphasize widespread dog vaccination. Sustained implementation of these efforts will undeniably lead to a significant decrease in canine rabies.’
Over the last year, the project areas have seen considerable improvements in both domestic dog vaccination rates and overall animal surveillance effectiveness.
Initial analysis from the project’s intervention phase revealed that more than 740 reported animal bite cases were investigated on-site. This meticulous work identified 39 probable canine rabies cases, with 16 ultimately confirmed. This clearly demonstrates how a systematic surveillance approach can effectively isolate true rabies cases within a community, allowing for swift and appropriate protective actions.
The success of the IBCM strategy hinges on fostering strong collaborations across various sectors, ensuring seamless teamwork among all involved parties, and providing effective community counseling.
However, several challenges remain for the state to truly excel in rabies elimination. These include establishing robust connections between local health centers and veterinary hospitals, bolstering staffing levels in veterinary facilities, actively engaging registered animal welfare NGOs for vaccination and surveillance, and addressing public apprehension to ensure full community cooperation.