The State government on December 5, Monday, declared human rabies — a fatal viral disease that spreads through the bite of rabid animals (mainly dogs) — as a notifiable disease under the Karnataka Epidemic Diseases Act, 2020.
Following this, it is now mandatory for all government and private health facilities (including medical colleges) to report all suspected, probable, and confirmed human rabies cases to the State Health Department.
“Prevention, control, and elimination of rabies from a geographical area can only be achieved through strong surveillance and disease-reporting systems. Notification will facilitate contact-tracing and prompt prophylactic measures to prevent infection in other people exposed to the same source. Hence, human rabies is declared as a notifiable disease,” stated the notification issued on December 5.
Rabies kills about 20,000 persons in India every year, with up to 60% of cases occurring in children under 15 years of age. To address the issue of rabies in the country, a National Rabies Control Program (NRCP) has been implemented in the country since the 12th Five Year Plan. Rabies is the oldest recognized zoonotic disease (transmitted from animals to humans) with an extremely high fatality rate.
Deaths
According to NRCP, 6,644 clinically suspected human rabies cases and deaths have been reported from 2012 to 2020. This is based on regular and routine reports received from the States and UTs. Karnataka reported 22 human rabies deaths in 2020, 28 in 2021 and 32 in 2022 so far.
M.K. Sudarshan, founder president and mentor of Association for Prevention and Control of Rabies in India (APCRI), said the number of human rabies cases and deaths are grossly under-reported.
“Rabies is being reported under the programme by Infectious diseases (ID) hospitals through monthly reports. There are three ID hospitals in Karnataka — one each in Bengaluru, Mysuru and Kolar — all in the southern part of the State. The rest of the State remains largely uncovered. These ID hospitals get cases referred from neighbouring States too and these get added to the State’s figures. Thus, the true incidence of human rabies in the State remains largely incomplete,” he said.
Deaths due to rabies
Different studies quote different figures of animal bites incidence and deaths due to rabies in humans. As per WHO estimates, India accounts for 36% of the global and 65% of the human rabies deaths in the South East Asia region.
“According to WHO – APCRI national multicentric survey done in 2003-04 in India, an estimated 20,000 human rabies deaths and 17.4 million animal bites occur. As per the Million Deaths Study (MDS) 2012, India has an estimated 12,700 human deaths due to rabies per year. As per the Central Bureau of Health Intelligence, the number of human rabies cases reported a declining trend in deaths due to rabies through the last decade,” explained Dr. Sudarshan, who is also the Chairman of Karnataka’s COVID-19 Technical Advisory Committee (TAC).
“As per these two national survey estimates about 600 to 1,200 human rabies deaths are expected to occur in Karnataka. In the absence of a reliable disease reporting system now human rabies has been recommended to be made notifiable by all the States,” he pointed out.
“The government of India has now initiated a nationwide survey through National Institute of Epidemiology (NIE) and Indian Council of Medical Research (ICMR) to obtain new estimate of human rabies deaths in the country and the results are expected in the early 2023.,” he said.
In fact, human rabies was declared a notifiable disease by the Centre in September 2021. Subsequently, the Union Health Ministry wrote to Principal Secretaries of all States and UTs to make human rabies a notifiable disease. Currently, apart from Karnataka, human rabies is a notifiable disease in Andhra Pradesh, Kerala, Tamil Nadu, Madhya Pradesh, Punjab, Tripura, Goa, Gujarat and Maharashtra.
