A STRAY BITE CAN BE FATAL

Anti-rabies vaccination, controlling the stray dog population with ABC surgeries and other rabies-prevention programmes in the city need to be intensified, officials and experts tell Shweta Tripathi

The city’s stray dog population is growing every day, and fatalities and accidents are becoming a common occurrence. Fear among the denizens is palpable, especially after a rabies-infected stray dog mauled 29 people in north Chennai in November 2023.

This incident created an uproar on social media platforms where the Greater Chennai Corporation (GCC) and the State Health Department were both hammered with allegations of being lackadaisical in vaccinating the strays and preventing such mishaps.

Thus began a stray dog census that was organised by the GCC, which revealed that the population of stray dogs had increased by 1,200 in 2018, and as many as 3,900 stray dogs were sighted in the Royapuram zone alone.

DPH study

A study conducted by the Directorate of Public Health and Preventive Medicine (DPH) showed that in 2023, there were 20 fatalities due to rabies in TN. A decline from 28 in 2022. However, over 50% of the deaths was because people did not get vaccinated, as per the study.

Vaccinating dogs and performing ABC surgeries are becoming difficult for the State Health Department and the GCC due to factors such as large population of dogs, short reproductive cycle of the canines, and animal lovers preventing the staff from catching the stray canines to perform the surgeries among others.

In 2022, there were around 8.83 lakh animal bites reported in TN, and 121 rabies-related deaths from 2018-2022. It shows a declining fatality rate but we’re nowhere closer to the goal of zero rabies-related deaths.

Under-reporting of cases

While there is an Integrated Health Information portal to notify all rabies cases, many private hospitals do not update it, though the notification has increased in the last 10-15 years.

As per the data from DPH, in Tamil Nadu, there were 300 dog bites per 10 lakh population in 2008, which increased to 1,055 in 2022. This shows that a large number of cases remain under-reported.

Mis-categorisation is another concern. With control programmes scaling up towards elimination of dog-mediated rabies, surveillance is expected to increase and lead to subsequent improved data quality.

“Pre-exposure prophylaxis regimen – a series of rabies vaccine doses given before coming into contact with the rabies virus – should be administered for professionals who are exposed to an environment conducive for the virus transmission. However, there’s no data on who gets the medication, and no mandate for providing proof of vaccination in any occupation,” states Dr TS Selvavinayagam, director, DPH.

An important strategy in preventing rabies among humans involves post-exposure prophylaxis, utilising cost-effective intra-dermal anti-rabies vaccines (ARV) and immunoglobulin. While both are available for free with funding from the State and the Union governments, the lack of compliance to the vaccination schedule is a huge concern among doctors.

In fact, the State Health Department issued guidelines to ensure prompt administration of treatment in government hospitals for patients regardless of arrival time, and streamlining the provision of the medicines sans delay for early management of bites.

The TN Medical Service Corporation also keeps an inventory through a Drug Distribution Management System to enable remote monitoring of stock availability of ARV in all GHs.

DPH officials pointed out that the State had also issued orders to ensure availability of minimum 20-30 doses of ARV and immunoglobulin in all primary health care centres.

Mis-categorisation

In a Coimbatore-based study, only half of the victims had received their 1st dose of ARV on the same day of the bite. The most common reason quoted was the low-risk perception and the unavailability of vaccines in hospitals.

The study also reported that there were mis-categorisations of animal bites, with many category 3 bites being categorised as 1 or 2.

Only 54.5% had received their 1st dose of ARV on the same day of the bite, and 60% had completed all 4 doses of vaccination irrespective of date appropriateness. The most common reason cited for the delay in getting the 1st dose among 25% of participants was low-risk perception, while 19.4% said that ARVs were not available. Around 14.2% of the participants considered it as low risk and stated it as a reason for not completing the treatment plan.

“We must train more professionals on the anti-rabies guidelines, strengthen the implementation of the animal bite management protocol and build mechanisms to monitor them. We need awareness programmes about it and the importance of seeking timely treatment for animal bites,” said Dr Selvavinayagam and Sudharshini Subramaniam in an article on medical analysis titled, ‘Rabies Elimination in Tamil Nadu: Where we stand’

Many patients do not disclose a previous rabies vaccination. So when they visit a hospital, doctors usually vaccinate them. “If there was a dog bite in 6 months after the previous vaccination, a booster is required based on evaluation of the bite. Therefore, it’s necessary to consult the doctor even if they had been vaccinated a few months ago,” averred a senior doctor in a city-based GH.

People usually ignore the first aid to be given in case of a dog bite, which delays the care, while in some cases people miss on the immunoglobulin due to mis-categorisation.

“Many do not get vaccinated or take immunoglobulin because it’s a small bite or that they were bitten by a puppy. This can escalate to rabies because we do not know if the dog was infected or not,” said public health expert and former director of DPH, Dr K Kolandaisamy. “For first-aid, the wound has to be washed thoroughly and then the vaccine and/or immunoglobulin must be given. Often, people take only a single dose and do not complete the vaccination course.”

A data analysis of rabies-related deaths in Tamil Nadu for the last 5 years (2018-2022) revealed that less than 1% of the victims were completely vaccinated. Pet dogs were the major source of infection and the incubation period varied from less than a month to one year. The study also emphasised that lack of awareness among the victims about rabies treatment as a major factor for fatalities.

ABC surgeries

GHs across the city have been receiving accident cases – victims who were injured due to stray dogs chasing them. Fund allocation to manage the stray dogs is falling short.

“Funding allotted is Rs 20 crore. Only 1.21 lakh dogs can be neutered at the rate of Rs 1,650/dog. According to WHO, at least 70% of stray dogs should be neutered within a short period to have any impact on population reduction. The ABC should be done continuously for at least 10-13 years if we want to stabilise the population at present level,” said a senior official at the DPH.

The number of stray dogs increases by 10% every year. In the last 3 years, it has surged by 30% in the city.

A senior official with the GCC stated that there has been resistance from animal lovers in the city while the Corporation staff try to catch the canines for ABC surgery. “However, we’ve managed to carry out the surgery, and ensured that all 3,900 dogs in the zone were vaccinated against rabies.” The GCC carries out census and mass immunisation in other zones too.

There are 5 animal birth control centres — Pullianthope, Lloyds Colony, Kannamapettai, Meenambakkam and Shollinganallur, and two more will be functional soon. In 2023, the civic body caught 19,640 stray dogs, and 14,855 were sterilised.

Earlier, the Corporation had tied up with the Blue Cross of India for conducting ABC surgeries. However, due to manpower shortage, the agreement has been withdrawn temporarily.

As per the census in 2018, there were 53,366 stray dogs in the city. At least 68,577 dogs were vaccinated against rabies in 2019. Stating that the ABC surgeries had been scaled up, J Kamal Hussain, veterinary officer, GCC, added: “Residents can adopt the strays and ensure they have been vaccinated. Such steps will reduce the population and prevent mishaps. We’ve also been conducting regular meetings with many residents’ welfare associations, NGOs, animal-lovers, and volunteers to create awareness.”

A data analysis of rabies-related deaths in TN from 2018 to 2022 revealed that less than 1% of the victims were completely vaccinated. Pet dogs were the major source of infection

Pre-exposure prophylaxis regimen – a series of rabies vaccine doses given before coming into contact with the rabies virus – should be administered for professionals who are exposed to an environment conducive for the virus transmission. However, there’s no data on who gets the medication

— Dr TS Selvavinayagam, director, DPH