The child was agitated and restless. He had been bitten by a dog a month before while playing with his friends on the ground. However, instead of receiving the preventive rabies shot, the illiterate parents relied on home remedies.
Last year, when a teenage boy was rushed to Raigad rural hospital with hydrophobia and seizures, Dr Sudhir Prasad diagnosed the symptoms at a single glance—it was rabies.
The child was agitated and restless. He had been bitten by a dog a month before while playing with his friends on the ground. However, instead of receiving the preventive rabies shot, the illiterate parents relied on home remedies.
“If only he got rabies shot on time, his life could have been saved. Once rabies symptoms appear, the chances of survival are extremely low,” said Dr Prasad. “Moreover, distinguishing rabies from other severe illnesses like cerebral malaria or meningitis can pose additional challenges.”
The teenager was one of the nine under the age of 14 years who lost their lives due to rabies in Maharashtra in 2022, as indicated by state data. Overall, between 2017 and 2022, a total of 361 people fell victim to the zoonotic disease, of which 10 percent were children up to the age of 18 years.
“Almost 70 per cent of the deceased were male, attributed to their higher outdoor activity compared to women. Additionally, psychologically, men tend to neglect treating their wounds, exacerbating the condition. By the time there due to its aggressive effects on the central nervous system (CNS), it’s often too late for effective intervention,” said a senior officer from Directorate of Health Services (DHS).
In 2017, a total of 75 people died due to rabies, decreasing to 66 in 2018. The numbers surged to 78 in 2019. During the Covid-19 pandemic, with limited outside movement, fatalities dropped to 35. In 2021, following the relaxation of Covid-19 restrictions, the numbers rose to 56. In 2022, fatalities stood at 51.
Insufficient resources for stray dog sterilization and vaccination, coupled with citizens’ limited first-aid training and delayed care after dog bites, contribute to the increasing rabies cases, experts say. Rabies is a viral disease that impacts the central nervous system, causing severe neurological symptoms and, ultimately, death. It spreads through the saliva of infected mammals, with transmission commonly occurring through bites. Among these, dog bites are the most common mode of transmission. It has no cure.
Dr Pradeep Awate, former state surveillance officer, explained that the rabies virus travels along peripheral nerves to the brain, causing inflammation.
As the infection progresses, neurological symptoms intensify, leading to agitation, confusion, and paralysis. “The characteristic hydrophobia (fear of water) emerges, making swallowing difficult. Respiratory failure ensues, resulting in death,” he said.
Survival is rare once clinical symptoms of rabies appear, despite the availability of post-exposure prophylaxis (PEP). Emphasizing the critical need for prompt vaccination after potential exposure, rabies is nearly universally fatal. However, in rural areas, obtaining post-exposure vaccine after a bite can be challenging, leaving many without this crucial treatment.
“Following grade III bites, when the skin is breached, many doctors, especially in rural Maharashtra, lack awareness that they should administer both the anti-rabies vaccine and the fast-acting rabies antibodies (immunoglobulins),” said Dr Muralidhar Tambe of the Association for Prevention and Control of Rabies. According to the World Health Organization , India contributes to 36 per cent of global deaths caused by rabies. Additionally, India accounts for 65% of rabies-related deaths in the South-East Asia region.
Dr JC Khanna, former medical superintendent of Mumbai’s largest veterinary hospital, Bai Sakerbai Dinshaw Petit Hospital in Parel, said that the street dog population is rapidly increasing, but authorities lack adequate data.
He emphasized, “Along with training to the doctors and sensitisation among the public, there is a need for a comprehensive health program, similar to those for polio, and a dog census. Municipal authorities, grappling with pollution and waste, often prioritize dog vaccination less due to competing priorities.”
Last year, the state health department declared rabies as a notifiable disease which means private doctors would also have to report the case.
Source : The Indian Express