‘70 per cent vaccination can prevent transmission of rabies,’ says Dr PVM Lakshmi

Tuesday, 9 May 2017

There has been a rise in dog bite cases in Chandigarh in the past few weeks and some of the dogs were found to be rabid. Dr PVM Lakshmi, additional professor of the department of community medicine of PGIMER, tells Adil Akhzer about the steps that can be taken to handle the situation
There has been an increase in dog bite cases in the city. What do you think is the reason behind this?

There has been a rise in dog bite cases in Chandigarh in the past few weeks and some of the dogs were found to be rabid. Dr PVM Lakshmi, additional professor of the department of community medicine of PGIMER, tells Adil Akhzer about the steps that can be taken to handle the situation
There has been an increase in dog bite cases in the city. What do you think is the reason behind this?
The increase in the problem is because of the gaps in the pace of dog sterilisation and dog reproduction, low registration and vaccination of all dogs, including stray and pet. There are about 13,000 to 14,000 dogs in Chandigarh and their population is increasing. Everyday in the newspaper, there are reports of about 15-20 dog bite cases. This is only the tip of the iceberg, because there are more cases than those reported in newspapers where victims go for treatment to both private and government hospitals and clinic. The data from the rabies clinic in Chandigarh are also not correct as it won’t be reporting data from GMCH-32 and PGIMER and also people who were consulting private hospitals or physicians. This also does not include most of the scratches, licks and others that usually go unnoticed by the people mainly because of ignorance and still carry the potential of causing rabies.
What needs to be done to tackle the problem?
The main problem is of the potential of a dog bite to cause rabies, which is almost 100 per cent fatal. Disease control mostly lies in the control of dog population and vaccination. Because of multiple departments such as municipal corporation, animal husbandry and health departments are involved and all of them have varied priorities, this problem is mostly neglected or is not getting the required attention. Globally, this problem has caught attention in various countries, which has led to One Health initiatives.
One Health means if we have to address the health problems, especially where both humans and animals are involved, the health and animal husbandry departments should come together and share their resources for the control of the disease. In rabies though the control lies with the animal husbandry mainly, it has low budget allocation.
The health department can contribute their budget to the control of disease by constituting interdepartmental resource sharing MoUs. The crux of controlling the problem lies in a three-pronged strategy of control of rabies among dogs – registering all pet dogs, compulsory vaccination of all pet and stray dogs. Even if there is 70 per cent vaccination coverage, it can effectively prevent the transmission of rabies.
Among humans, several steps are required including IEC for increasing the awareness among community that they should seek treatment immediately after every dog bite or licks on mucous membranes or on open wounds irrespective of immunisation status of the animal.
Do you think the administration has done sufficient to tackle the problem?
The administration has woken up to the call of residents and has started implementing measures to control the menace. But the pace has to pick up. The administration has given more emphasis on dog sterilisation. Though this is important and a permanent solution, it requires a lot of resources and time. Hence to achieve the goal of rabies elimination faster, the vaccination of stray and pet dogs should be hastened and sterilisation can go hand in hand. Once we have achieved the target of more than 70 per cent immunisation coverage, more efforts can be shifted to sterilisation of dogs while maintaining 70 per cent coverage through vaccination. There is no system to identify how many dogs are vaccinated in a weekly drive by Chandigarh Administration.
As they are doing sterilisation and vaccination simultaneously, they have adopted the method of marking by making a cut on the ear. But currently they do not have a mechanism to identify the dogs that were only vaccinated. One point that needs to be remembered is the immunity of one time vaccination does not last  life long among dogs. They do require booster every six months. Hence, there is a need to catch all dogs repeatedly in a particular area every six months and give vaccination. Most of the dog owners are also not aware of the booster doses and hence think their dog is protected once they complete the primary schedule of vaccination. Even they need to be educated for the need for booster doses. In a week, specific day can be identified as dog immunisation day and needs to be widely publicised just like Village Health and Nutrition Days for immunisation among humans.
Sterilisation by the Chandigarh administration is already on. Do you think it needs to be strengthened further?
It is good that the Chandigarh administration has started the drive of dog sterilsation. However, hard they try it takes a longer time to sterilise all the stray dogs in the city. Hence, the current pace can be continued with further strengthening of vaccination coverage.
Do you think a survey is required to know the exact number of dogs in the city?
If a one-time survey was done to know the exact number of dogs, it was sufficient. It may not need to be repeated every year. A survey once in five years will be be sufficient. In the mean time, one can project the number of dogs if one knows how many dogs were sterilised and the reproduction parameters among dogs just light demographic projection of humans during the intercensal period.
Dog menace is not the problem of Chandigarh alone. Mohali and Panchkula too are facing it.
Dog are primarily territorial animals unlike mosquitoes, which do not have borders. Hence, the control of Chandigarh is not dependent on the control of Mohali or Panchkula dogs. Those administrations separately have to initiate measures for control of rabies if they want to have rabies-free cities. Now the Chandigarh administration is seeking help of Jaipur to tackle the problem.
What more options do Chandigarh administration have to bring down dog bite cases in the city?
Tamil Nadu has been successful so far in bringing down the dog bite and rabies cases. World wide and in Asia, few of the countries have achieved the rabies control. The lessons within India and from other countries in Asia who have successfully made their country rabies-free can be studied and adopted for Chandigarh. APCRI, a registered association with a group of experts working in the field of rabies control, has started its collaboration with Jamshedpur for control of rabies. Their technical expertise can be sought while planning for rabies control in Chandigarh apart from local expertise.
Doctors say there is a trend in rise in such cases from April to July. What is the reason behind it? What makes the dogs aggressive?
The dogs are usually aggressive during the late monsoon months when they are in oestrus and submissiveness peaks in winter when they are lactating. The male dogs are usually aggressive when it comes to their mating partner and their boundaries. The female dogs are more aggressive in the vicinity of their den and for feeding purposes.
The Chandigarh administration has made treatment for dog bite victims free. What more needs to be done to bring down the cost of dog bite serum?
The cost of dog bite serum, especially of human immunoglobulin, is costly as compared to equine immunoglobulin. The cost of the immunoglobulin will come down only if mass production is possible. Rather than spending money on immunoglobulins, it is important to control the dog population and give vaccination of dogs.

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