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Tips to Prevent Dog Bites

National Action Plan for Dog Mediated Rabies Elimination from India by 2030 (NAPRE)

Rabies is one of the most fatal zoonotic diseases which has tormented humans since antiquity. It is transmitted after the bite of a rabid animal and is 100 % fatal if the timely intervention in terms of appropriate management of wound and Rabies post exposure is not given to the animal bite victims. About 96% of the mortality due to Rabies is associated with dog bites. Effective prevention and control of Rabies could be achieved by concerted efforts by all stakeholders by adopting “One Health Approach”.

In 2015, the world called for action by setting a goal of “Zero human deaths due to dog-mediated rabies by 2030”, worldwide. Subsequently, four organizations – the World Health Organization (WHO), the World Organization for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO), and the Global Alliance for Rabies Control (GARC) – have joined forces, as the United Against Rabies collaboration, and determined to reach the global target of “Zero human deaths due to dog-mediated Rabies by 2030”. Countries like Western Europe, Canada, the US, Mexico, Japan & Latin America have already eliminated dog-mediated Rabies through successful canine rabies vaccination and One health approach.

NCDC in collaboration with the Ministry of Animal Husbandry organized a workshop on “Stepwise Approach for Rabies Elimination” with technical support from GARC (Global Alliance for Rabies Control). Gaps were identified in the ongoing National Rabies Control Program as well as activities undertaken by veterinary sectors and other stakeholders. Combined with the lessons edlearned from SARE workshop, international consultations on rabies, NRCP review meetings, discussions held during the National technical advisory group on Rabies, Standing Committee on Zoonoses, and external evaluation of the programme, it was felt, that to address the Rabies in the country, One Health Approach is required through concerted and coordinated efforts by all stakeholders. Accordingly, the “National Action Plan for dog mediated Rabies Elimination from India by 2030” (NAPRE) was conceptualized in the year 2018 by the Division of Zoonotic Disease Programme at NCDC and submitted to Ministry. Accordingly, a core committee was constituted under the chairmanship of DGHS and Commissioners animal husbandry. The core committee was having the representation of all key technical experts. Subsequently, the draft was circulated and comments were obtained from the stakeholders namely MoFAHD, MoEF&CC, MoAFW, MoPRI, and MoHUA, and other stakeholders such as NITI Aayog, MoST, NHRC, professional bodies, eminent veterinarian, medical and wildlife experts. A total of 30 key representative stakeholders provided their inputs including hon’ble members of parliament.

On the occasion of World Rabies Day i.e. 28th September 2023 , Union Minister for Health and Family Welfare Shri Mansukh Mandaviya and Union Minister of Fisheries, Animal Husbandry and DairyingShri Parshottam Rupala unveiled the National Action Plan for dog Mediated Rabies Elimination by 2030 (NAPRE) in the presence of Dr. Bharati Pravin Pawar, Minister of State for Health and Family Welfare and Shri Sanjeev Kumar Balyan, Minister of State of Fisheries, Animal Husbandry and Dairying.

This “National Action Plan” for Rabies Elimination in India has been developed with inputs by experts nominated by the different stakeholders. The National Action Plan for the Elimination of dog-mediated Rabies (NAPRE) in India provides a broad framework for combating Rabies. The NAPRE is a guidance document for the states / stakeholders to develop their own action plan, specific to their needs and aims at systematic reduction of Rabies risk through sustained mass dog vaccinations, pre and post exposure prophylaxis and public education until the country is completely free of dog-mediated Rabies. This document will help in the following: -

  • To prepare an action plan that canters on the elimination of human Rabies transmitted by dogs. 
  • To strengthen the States to the commitment on implementation of NAPRE. 
  • To ensure, for as long as possible, continuity of prevention of human Rabies with effective, quality assured and accessible vaccinations for all who need them. 
  • To strengthen capacities of the Public Health Services, Veterinary Services and the local governing bodies. 
  • To identify and support activities that when strategically used would eliminate dog mediated Rabies. 
  • To strengthen the coordination and support mechanisms among all stakeholders. 
  • To obtain and sustain high-level political commitment at the central and state level. 
  • To encourage community participation in urban and rural areas


Health Department –
  Health Ministry officials-
 State level officials-

Animal Husbandry Department-
       

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The key strategic actions to achieve the objective of the human health component are as under:-

  1. To Ensure availability of Anti Rabies Vaccine (ARV) and Anti Rabies Serum (ARS) to all Animal Bite Victims at all levels of health facilities
    • To advocate the states for utilization of cost-effective Intra-dermal Rabies vaccines for Rabies Post Exposure Prophylaxis by organizing Sensitization workshops for stakeholders at national/ regional level for shifting IM to ID route – sensitization of health professional both in government and private sectors to routinely practice ID route instead of IM route for Rabies prophylaxis.
    • Financial assistance to states from Centre through earmarking funds for ARV/ARS procurement in National Free Drugs Initiative scheme and inclusion of ARV/ARS in Essential drug list at all levels.
    • Strengthening infrastructures for treating the victims of animal bites- by establishing Model Anti Rabies Clinics.
    • Ensuring availability of trained manpower concerning appropriate animal bite management/ID inoculation/ ARS infiltration.
    • Ensure uninterrupted supply of ARV/ARS and close monitoring ARV/ARS demand and supply positions to avoid stock out positions.
    • Establishing monitoring mechanism for recording and reporting of Adverse Event Following Immunization (AEFI) for Rabies.
  2. Capacity building of professionals in appropriate animal bite management
    • Training of State, district and below District level health care professionals on program management aspects.
    • Joint training of Health and Veterinary professionals on the operational aspect of the Rabies Elimination plan.
    • Training on Surveillance of Animal Bites and Rabies Case investigations and Notification.
  3. Strengthening Surveillance of animal bites and Rabies cases in human.
    • Ensuring implementation of Rabies notification in Human health sectors through the web portal for notification of animal bite victims/Rabies cases.
    • Strengthening reporting system about animal bites and Rabies incidence through IDSP and IHIP.
    • Resource mapping – mapping the facilities (State/ District wise) for management of Animal bite victims, Treatment facilities for suspected Rabies cases or Infectious Diseases hospitals and mapping of laboratories for Rabies diagnostic.
    • Establishing Model Anti Rabies Clinics.
  4. To strengthen diagnostics capacity on Rabies:
    • To identify and establish Rabies referral laboratories at the National, regional, and State level in the State government medical colleges, Infectious disease hospitals or tertiary care hospitals as per the need of the program. These labs will provide the recommended ante mortem and post mortem diagnostic facilities such as Directs Fluorescent Antibody test/ Sellers Stain/ Molecular Diagnosis by PCR and ELISA
    • Training and capacity building of lab professionals (National / State level Training workshop) by periodic and hands-on training on Rabies diagnostics.
  5. Information Education and communication (IEC) for increasing awareness about the diseases and the importance of seeking timely and appropriate treatment for animal bites
    • Development of IEC material for undertaking IEC activities (Print/ Electronic material- audio visual spots for a mass media campaign).
    • Framing of definitive IEC Strategy/ guidelines for the identified target audience (Health professional/ Veterinary professionals/ Children-school health education / Community or field workers (ASHA/ ANMs and Paravets/ General Community/ Media.
    • Including IEC especially in school

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National Rabies Control Programme (NRCP)

Rabies is responsible for extensive morbidity and mortality in India. The disease is endemic throughout the country. Except for Andaman & Nicobar and Lakshadweep Islands, human cases of rabies are reported from all over the country. The cases occur throughout the year. About 96% of the mortality and morbidity is associated with dog bites. Cats, wolf, jackal, mongoose and monkeys are other important reservoirs of rabies in India. Bat rabies has not been conclusively reported from the country.

Evolution of National Rabies Control Program

In the 11th five-year plan (2007–2012) Rabies control efforts in India gained momentum and the Ministry of Health and Family Welfare, Govt of India approved a “Pilot Project for the Control of Human Rabies”, for which ` 8.65 crores were allocated. For the first time, Rabies control in animals, animal birth control and vaccination of stray dogs were mentioned in this plan, as components of animal welfare to be handled by the Animal Welfare Board of India. The project was implemented by NCDC in 5 cities Delhi, Ahmedabad, Pune, Bangalore and Madurai and the project began in January 2008 and continued till 2012. The objectives of the project were prevention of human deaths due to Rabies, enhancing awareness in the general community, developing trained health manpower, strengthening diagnostic facilities, strengthening surveillance and maintenance of continuous surveillance and sensitization of other sectors. Experience gained in the pilot project indicated that strategy is feasible, reproducible, and implementable.

With the lessons learned in the pilot project, the Ministry of Health and Family Welfare approved National Rabies Control Programme (NRCP) in the 12th Five Year Plan for rollout in the entire country. During the 12th Five years plan, from 2014 to 2017, a small pilot was also taken to test the strategy of Animal Health Components in Haryana and Chennai through the Animal Welfare Board of India (AWBI) under the aegis of the Ministry of Environment, Forest and Climate Change, Govt of India. From 2017 onwards NCDC is coordinating to implement Human Health Component of National Rabies Control Program. From the financial year 2019-20 onwards, human health component activities at the State and District level are being funded by the National Health Mission’s program implementation and planning mechanism


Aim of NRCP-

To reduce mortality due to Rabies among human beings and progressively achieve the Global Target of reducing deaths due to Rabies to “Zero by the year 2030”.

Objectives:

·  To facilitate prompt management of animal bite cases in humans by appropriate post exposure prophylaxis (PEP). 

· Advocacy for states to adopt and implement Intradermal route of Post exposure prophylaxis for Animal bite Victims and Pre-exposure prophylaxis for high risk categories.

· Training of Health Care professionals on appropriate Animal bite management and Rabies Post Exposure Prophylaxis.

·  Strengthening Surveillance of animal bites and Human Rabies cases  

·  Strengthening of Network of Laboratories under NRCP for Human Rabies Diagnosis.

·  Creating awareness in the community through Advocacy & Communication and Social Mobilization.

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Informative Jingle: Hindi, English, Assamese, Bengali, Gujrati, Punjabi , Kannad, Kashmiri, Malyalam, Marathi, Orriya , Tamil , Telgu.

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Dr. Simmi Tiwari
MBBS, DNB(SPM), PGDHHM
Joint Director & HoD
Centre for One Health
National Centre for Disease Control, MoHFW
Email ID- drsimmi@ncdc.gov.in

Address: 
Center for One Health
National Centre for Disease Control,
Directorate General of Health Services,
Ministry of Health and Family Welfare,
Government of India,
22 – Sham Nath Marg, Delhi - 110054

Contact Number:
011-23930178

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Rabies Free City

A "Rabies Free City" is a city that has been officially declared free of rabies, meaning that there are no reported cases of rabies in the city or its surrounding areas. Achieving this status requires a concerted effort by local authorities, animal health professionals, and the community to prevent and control the spread of the disease.

Tips to Prevent Poster

Rabies Helpline Poster

Subhas Chandra Bose was an Indian nationalist whose defiance of British authority in India made him a hero among many Indians, but his wartime alliances with Nazi Germany and Imperial Japan left a legacy vexed by authoritarianism, anti semitism and military failure.

Vitae at voluptatem .
World Zoonoses Day observed by NCDC, NOHPPCZ, Guwahati, Assam on 6th July 2024


World Zoonoses Day observed by Telangana on 6th July 2024
World Zoonoses Day observed by Gujarat on 6th July 2024
National Consultation on Legal Environment Assessment for One Health Activities in India on 27 & 28 June 2024
Intersectoral coordination and SAPRE activities review under NRCP by state level zoonotic committee of Rajasthan on 12th August 2024.

The State-level Zoonotic Committee convened on 12th August 2024 to review and discuss the progress of activities under the National Rabies Control Program (NRCP) in alignment with the State Action Plan for Rabies Elimination (SAPRE) in Rajasthan. The meeting brought together representatives from key departments, including the Veterinary Department, Urban Local Bodies (ULB), PSM & Microbiology Department of SMS Medical College, Sheep & goat department, Veterinery college, wildlife and the Animal Welfare Bureau of India.

World Zoonoses Day observed by GMC DODA, Jammu and Kashmir on 6th July 2024
On World Rabies Day, the Centre for One Health, NCDC (MoHFW) in collaboration with WHO organized a two-day Regional Workshop at Hotel Imperial, New Delhi on 27-28 September.

On World Rabies Day, the Centre for One Health, NCDC (MoHFW) in collaboration with WHO organized a two-day Regional Workshop at Hotel Imperial, New Delhi on 27-28 September. The primary objective of the workshop was to develop the State Action Plan for Dog-Mediated Rabies Elimination (SAPRE) for the Northern Region states.

On World Rabies Day, the Centre for One Health, NCDC (MoHFW) in collaboration with WHO organized a two-day Regional Workshop at Hotel Imperial, New Delhi on 27-28 September. The primary objective of the workshop was to develop the State Action Plan for Dog-Mediated Rabies Elimination (SAPRE) for the Northern Region states.

On second day of workshop, on the occasion of World Rabies Day, 28th September 2024, Ms. Punya Salila Srivastava, OSD (Health), Ministry of Health & Family Welfare, GoI) launched the State Action Plan for Dog-Mediated Rabies Elimination (SAPRE) for State of Tamil Nadu, Mizoram, and Meghalaya, along with guidelines for the Rabies-Free City Initiative. The launch event was graced by esteemed dignitaries including the Ms. Punya Salila Srivastava, (OSD (Health), Ministry of Health & Family Welfare, GoI), Ms. L. S Changsan (Additional Secretary, Ministry of Health & Family Welfare, GoI), Ms. Latha Ganapathy (Joint Secretary, Ministry of Health & Family Welfare, GOI), Sh. Rahul Bhandari (Secretary, State Animal Husbandry, Fisheries & Dairy Development Department, Punjab), Dr. Sarita Chauhan (Joint Secretary, DAHD, MoFAHD, GoI), Dr. L.Swasticharan (Addl. Deputy Director General, Ministry of Health & Family Welfare, GoI), Ms. Payden, Deputy WHO Representative of India, WHO.

The workshop concluded with state presentations outlining their action plans and commitments towards rabies elimination. The participants expressed their gratitude to the Centre for One Health for organizing the workshop and providing invaluable insights and resources to combat rabies effectively.

Overall, the Regional Workshop was a significant step towards achieving the goal of rabies elimination in the Northern Region states and fostering collaboration between various stakeholders involved in the fight against rabies.

NTAC Sub Committee Meeting on Rabies Monoclonal Antibodies mABS 1 Aug 2023
Rabies General Aspects and Laboratory Diagnostic Techniques Launch On Annual Day Division of Zoonotic Disease and Centre for Arboviral and Zoonotic Disease 29 July 2022
State Review Meeting Under National Rabies Control Programme at NCDC 01 November 2021
Remove -Joint Launch by Honrable Union Minister HFM and Honrable Union Ministry FADH of National Action Plan for Dog Mediated Rabies Elimination from India by 2030 on World Rabies Day on 28 September 2021
National Joint Streering Committee Rabies Elimination on 28 July 2023
Division of Zoonotic Disease Programs and Centre for Arboviral and Zoonotic Disease organized National Hands on Training for Laboratory diagnosis of Rabies under aegis of WHO Collaborating Centre for Rabies Epidemiology NCDC 15 March 2022
Tamilnadu State level workshop was held on 10th and 11th August 2023 at Mahaballipuram
Regional Workshop on State Action Plan for Rabies elimination in Guwahati by 18-19 May 2023
Nationl Consultation on Issues Pertaining to rabies Elimation by 2030 and Human Dog Conflicts 30 Nov 2022
Meeting of core committee for National Action Plan For Dog Mediated Rabies Elimination From India on 7th January 2020
A Canine Anti-Rabies Vaccination and Sterilization drive was organized especially for NCDC Delhi campus in association with NDMC for World Rabies Day 2019
State Level ToT for NRCP Punjab on 23rd Feb 2021
SDMC Pratibha Co-Ed School Najafgarh World Rabies Day 2019
SDMC Primary School Lajpat Nagar- IV New Delhi and MCD School at Raja Garden Delhi World Rabies Day 2019
Delhi Action Plan for Dog Mediated rabies Elimibation 14-15 Sep 2022
What is Rabies PEP Post Exposure Prophylaxis

Rabies PEP (Post Exposure Prophylaxis) is the emergency treatment given to a person who may have been exposed to rabies virus through a bite or scratch from an infected animal. Rabies PEP consists of the following steps: 

Wound treatment: The wound should be washed and flushed with soap and water for at least 15 minutes and disinfected with an antiseptic as soon as possible after the exposure.

Rabies immunoglobulin: This is a human or animal-derived product that contains antibodies against rabies virus. It is given by injection around the wound site to prevent the virus from spreading to the nervous system. It should be given as soon as possible, preferably within 24 hours of exposure, and no later than 7 days after the first dose of vaccine.

Rabies vaccine: This is a safe and effective vaccine that stimulates the body’s immune system to produce its own antibodies against rabies virus. It is given by injection in the arm or leg, usually in a series of four/ five doses on days 0, 3, 7, 14 and 28 after exposure depending on route of administration. 

Rabies PEP is very effective in preventing rabies if given correctly and promptly. All three steps of equally importasant.

Which Animal Transmits Rabies

Rabies is transmitted by bite or scratch of mammals/ warm blooded animals. Dogs are responsible for up to 99% of human rabies cases, however the virus can be transmitted from the bite of any rabid animal. Human rabies cases have occurred because of bites from cats, Monkeys, mongooses, jackals, foxes, wolves and other carnivorous animals. Many animals will become aggressive and bite when they have rabies, including horses and donkeys. In animals where biting is not common, such as cattle and buffalo, transmission can still occur through exposure to saliva. Care should be taken while examining sick animals that are salivating.

There is no evidence suggesting that Rabies is being transmitted by bat exposure in India. 

Can Rabies Be Transmitted Through Organ Transplantation

Yes. Organs transplanted from rabid organ donors can transmit rabies to the organ recipient. Individuals with symptoms of encephalitis (inflammation of the brain) before death should therefore be excluded as organ donors. Human-to-human transmission has never been confirmed outside the organ transplantation situation

Can person infected with Rabies transmit it to other humans

The risk of Human to human Rabies transfer is minimal and there are no well documented cases, other than very rare cases resulting from infected organ transplant. However, caregivers should be vigilant when looking after patients with rabies and avoid contact with their saliva and other excretions. Hand washing and good personal hygiene are of upmost importance when caring for patients with rabies. As per National Guideline people who have been exposed closely to the secretions of a patient with rabies may be offered PEP as a precautionary measure. 

Q4

Subhas Chandra Bose was an Indian nationalist whose defiance of British authority in India made him a hero among many Indians, but his wartime alliances with Nazi Germany and Imperial Japan left a legacy vexed by authoritarianism, anti-semitism, and military failure.

How Does Rabies Develop In Humans

After entering the human body e.g. through an animal bite, the rabies virus enters the peripheral nervous system and migrates to the central nervous system (spinal cord and brain). The infected person exhibits behavioral changes and clinical signs when the virus reaches the brain. Clinical signs typically appear 2-3 months after a person has been infected. In exceptional cases, clinical signs can develop after a few days, or after more than six months, following an exposure.

What are the body fluids that can carry and spread the rabies virus

The most common route of transmission is through the saliva of a rabid animal. However, the rabies virus has also been found, and could possibly be transmitted, through other bodily fluids such as tears, and nervous tissue. Rabies virus is not found in blood or faeces. There are no evidence-based reports of human rabies arising from consumption of milk, including breastmilk, or cooked meat. However, consuming the meat or milk of a rabid animal is strongly discouraged. Individuals or professionals who slaughter rabies-infected mammals and handle tissues of rabid animals may be at risk of contracting the virus through breaks in their skin. These individuals should use specialized personal protective equipment and consult infectious disease specialists if they suspect they have been exposed to rabies infected carcasses.

How is rabies transmitted

When a person is bitten or scratched by an animal that has rabies, the virus can enter their body through the saliva of the infected animal. The virus can also infect a person if the animal licks an open wound, a cut, or the mucous membranes of the mouth and nose.

Is PEP necessary if milk or milk products from a rabies-infected animal are consumed

There is no laboratory or epidemiological evidence to show that rabies is transmitted via the consumption of milk or milk products. Therefore, PEP is not required for consuming any milk or milk products from rabies infected animals.

Is it safe to give Rabies Vaccine to pregnant woman

Rabies is a potentially fatal disease and PEP is life-saving. Hence pregnancy is not considered a contraindication to post exposure prophylaxis. Studies have indicated no increased incidence of abortion, premature births, or foetal abnormalities associated with rabies vaccination.

WHAT IS RABIES

Rabies is a viral disease transmitted from mammals to humans. There are two clinical manifestations of rabies: furious and paralytic. Furious rabies is the most common form of human rabies. Once symptoms of the disease develop, either form is almost always fatal.

Can the consumption of raw meat from a rabies-infected animal transmit rabies

Consuming the meat from a rabid animal is strongly discouraged. Although no human cases have been documented following the consumption of uncooked meat from a rabid animal, butchering or eating a rabid animal may potentially transmit rabies. If an exposure occurs, PEP should be initiated. Cooked meat does not transmit rabies; however, it is not advisable to butcher or consume meat of any kind from an infected animal. The carcass should be buried or burned if possible, with advice from a veterinary professional.

What should be the first aid in case of Animal Bite

If a person is bitten by an animal, the following measures should be taken

  • Wash wounds and scratches immediately with soap or detergent and flush them thoroughly up to  15 minutes with copious amounts of running  water. If soap is not available, flush with water alone. Wound washing is the most effective first-aid treatment against rabies. 
  • Apply an iodine-containing or anti-viral medication preparation on top of the wound 15 minutes after it has been washed and flushed. 
  •  Take the person to a health care facility for further assessment and treatment by a healthcare professional as soon as possible.


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Record dog bites caused by stray, pet dogs separately: Govt to states

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Subhas Chandra Bose was an Indian nationalist whose defiance of British authority in India made him a hero among many Indians, but his wartime alliances with Nazi Germany and Imperial Japan left a legacy vexed by authoritarianism, anti-semitism, and military failure.Subhas Chandra Bose was an Indian nationalist whose defiance of British authority in India made him a hero among many Indians, but his wartime alliances with Nazi Germany and Imperial Japan left a legacy vexed by authoritarianism, anti-semitism, and military failure.Subhas Chandra Bose was an Indian nationalist whose defiance of British authority in India made him a hero among many Indians, but his wartime alliances with Nazi Germany and Imperial Japan left a legacy vexed by authoritarianism, anti-semitism, and military failure.

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Subhas Chandra Bose was an Indian nationalist whose defiance of British authority in India made him a hero among many Indians, but his wartime alliances with Nazi Germany and Imperial Japan left a legacy vexed by authoritarianism, anti-semitism, and military failure.Subhas Chandra Bose was an Indian nationalist whose defiance of British authority in India made him a hero among many Indians, but his wartime alliances with Nazi Germany and Imperial Japan left a legacy vexed by authoritarianism, anti-semitism, and military failure.