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Table of Contents   
EDITORIAL COMMENTARY  
Year : 2017  |  Volume : 10  |  Issue : 4  |  Page : 779-780
Targeting global elimination of rabies by 2030: Stakeholders' consensus


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, India

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Date of Web Publication5-Oct-2017
 

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Targeting global elimination of rabies by 2030: Stakeholders' consensus. Ann Trop Med Public Health 2017;10:779-80

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Targeting global elimination of rabies by 2030: Stakeholders' consensus. Ann Trop Med Public Health [serial online] 2017 [cited 2017 Oct 23];10:779-80. Available from: http://www.atmph.org/text.asp?2017/10/4/779/196496
Rabies is an infectious and zoonotic viral disease which is certainly fatal after the onset of clinical signs, and has been reported across more than 150 nations.[1] However, the tens of thousands of deaths attributed to the disease are predominant in the Asian and African regions.[1],[2]

It is really an alarming concern that though the disease is 100% preventable through timely vaccination, yet it continues to result in deaths, all of which can be prevented.[1],[2] Moreover, four out of every 10 cases have been reported among the children less than 15 years old.[1]

It has been observed that almost 99% of all the humans acquire the infection through the bites or scratches of domestic dogs via their saliva, while the remaining cases result due to bats and have been reported in America, Australia, and Western Europe.[1],[2] Thus, despite being present in almost all regions of the world, the infection is a neglected disease, as it generally affects rural people with poor socioeconomic status and other vulnerable group of people, whose deaths are often not notified and have no or limited access to vaccines and immunoglobulin.[1],[3] In addition, owing to the poor awareness among people about the disease and the availability of resources, eventually most of the victims lose their battle to the infection.[1]

The disease has quite a variable incubation period varying from less than 1 week to more than a year, based on the viral load and place of virus entry.[2] The patients usually present as either furious (70% of the total cases) with signs of hyperactivity or as paralytic with a prolonged course, coma, and eventual death.[1] It is quite frequent to misdiagnose the paralytic type and hence many such cases go unreported.[3] From the clinician's perspective, the disease cannot be diagnosed by means of any test before the development of the clinical disease, nevertheless subsequently or even after death, the infection can be confirmed by the isolation of the virus or antigen or nucleic acids in appropriate body samples.[1],[2],[3]

Acknowledging the public health importance of the disease, the global stakeholders, including human and animal health sector have reached a consensus, to eliminate the disease globally by 2030.[1]

This rests on the strategies of vaccinating dogs (the most cost-effective approach), and conducting preventive immunization among people, and based on the implementation of these measures, significant strides have been achieved in various nations through the support of international welfare agencies.[1],[2],[3],[4] However, the approach of dog vaccination will not only minimize the disease-attributable deaths, but also the necessity to administer post-exposure prophylaxis (PEP) after dog-bite.[4]

Preventive immunization can be administered either as pre-exposure (especially among travelers, laboratory personnel working with the disease, or other related viruses, individuals playing with dogs, etc.) or as post-exposure prophylaxis (comprising of prompt local treatment of the wound, complete course of approved vaccines, and rabies immunoglobulin, if indicated).[1],[4]

The available estimate suggests that every year in excess of 15 million people receive PEP around the globe.[1] Nevertheless, the major challenge for the policy makers has been the cost and easy accessibility of the vaccines and the immunoglobulin, as it amounts to catastrophic expenses for poor populations.[2],[4] Although, disease-related stockpiles of dog and human vaccines have been gradually developed, but the need of the hour is to ensure that these vaccines reaches to the vulnerable population groups at an affordable cost.[1] In addition, there is a great need to improve the awareness of people about the disease, and ways to prevent dog bites, and to adopt innovative measures like mobile-based applications for the strengthening of the surveillance.[1],[2],[5]

To conclude, rabies has been rated as an important priority due to its distribution, high case fatality ratio, and the preventable nature of the disease. However, the need of the hour is to expand the reach of preventive measures and ensure it is beneficial to all.

Acknowledgements

SRS contributed in the conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work.

PSS contributed in the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work.

JR contributed in revising the draft, approval of the final version of the manuscript, and agreed for all aspects of the work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. Rabies - Fact Sheet; 2016. Available from: http://who.int/mediacentre/factsheets/fs099/en/. [Last accessed on 2016 Jun 19].  Back to cited text no. 1
    
2.
Bagcchi S. Rabies: the most common cause of fatal encephalitis in India. Lancet Neurol 2016;15:793-4.  Back to cited text no. 2
    
3.
Pieracci EG, Schroeder B, Mengistu A, Melaku A, Shiferaw M. Blanton JD, et al. Notes from the field: Assessment of health facilities for control of canine Rabies – Gondar city, Amhara region, Ethiopia, 2015. MMWR Morb Mortal Wkly Rep 2016; 65:456-7.  Back to cited text no. 3
    
4.
Bertozzi M, Rinaldi VE, Cara GD, Appignani A. A glance at rabies pre-exposure and post-exposure prophylaxis for dog bites. Afr J Paediatr Surg 2016;13:107-8.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Mtema Z, Changalucha J, Cleaveland S, Elias M, Ferguson HM, Halliday JE, et al. Mobile phones as surveillance tools: Implementing and evaluating a large-scale intersectoral surveillance system for rabies in Tanzania. PLoS Med 2016;13:e1002002.  Back to cited text no. 5
    

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Correspondence Address:
Saurabh RamBihariLal Shrivastava
3rd Floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur, Guduvancherry Main Road, Sembakkam Post, Kancheepuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.196496

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