India sees more deaths from rabies than any other country and nearly three-quarters of them occur in just seven central and south-eastern States, according to a research that will be published shortly in the journal PLOS Neglected Tropical Diseases.
The research is part of the ongoing ‘Million Death Study’ that uses ‘verbal autopsies’ to identify causes of death that take place in a nationally representative sample of over two million Indian households.
Using this methodology, researchers estimated that there were 12,700 deaths in the country in 2005 from ‘furious rabies,’ whose victims display the classic symptoms associated with the disease, such as fear of water (hydrophobia). Almost three-quarters of those deaths were in Chhattisgarh, Uttar Pradesh, Odisha, Andhra Pradesh, Bihar, Assam and Madhya Pradesh.
Uttar Pradesh alone accounted for about one-third of the deaths, observed Wilson Suraweera and other researchers in their paper, a condensed version of which was provided to TheHindu. With such geographic concentration, targeted rabies prevention campaigns aimed at both humans and animals “might achieve a significant reduction in the number of deaths or potentially even elimination of deaths from this disease.” The research team noted that its figure underestimated the actual number of rabies deaths in India since paralytic or atypical forms of the disease could not be identified.
A 2003 assessment carried out by the Association for Prevention and Control of Rabies in India, with the support of the World Health Organisation, had estimated the number of ‘furious rabies’ deaths at about 17,000. A factor of 20 per cent was added to take into account paralytic or atypical rabies, taking the total number of deaths to around 20,000.
The absolute number of deaths estimated by the two studies is not “hugely different, given India’s large population, different methods used in the studies and different definitions,” said Prabhat Jha, director of the Centre for Global Health Research and senior author of the paper that is to appear in PLOS Neglected Tropical Diseases, in an email.
The methodology of the ‘Million Death Study’ could be underestimating the extent of rabies in the country, according to Manish Kakkar, a public health specialist in infectious diseases at the Public Health Foundation of India. It could miss the clustering of cases created by a rabid dog biting more than one person. The 2003 study, on the other hand, used a community-based approach that was specifically designed to pick up such clusters.
Local factors heavily influenced how such clusters of cases formed in different parts of the country. Those factors needed to be understood and taken into account when identifying high-prevalence areas, he pointed out.