Challenges to human rabies elimination highlighted following a rabies outbreak in bovines and a human in Punjab, India

Abstract

In August 2015, a rabies outbreak occurred in bovines in a Punjab village, India; subsequently, a farmer in the same village died of rabies in October 2015. We surveyed farmers to describe the outbreak, the demographics and rabies prophylaxis administered to householders on case farms, and farmers’ knowledge of rabies prevention and treatment. We used multiple correspondence analysis to guide investigation of associations between demographics, farm status and rabies knowledge, attitudes and practices. The number of affected bovines was unusually high; 15 cattle and buffalo died on 13 smallholder farms (attack rate 4%). Post‐exposure vaccinations were administered to 24 people (median 2 doses). Affected farms had significantly larger households and were more likely to keep their livestock outside (therefore, accessible by stray dogs), suggesting that the impact of the outbreak was disproportionally borne by households of lower socio‐economic status. Primary sources of rabies information were friends and neighbours, not health authorities or media. Women who had not received formal education were less likely to have heard of rabies. Although case farm participants were more likely to have heard about rabies from a veterinarian, their knowledge and practices to prevent rabies did not reflect the level expected considering their contact with a health professional; they were more likely to believe that traditional remedies prevent rabies and less likely to tell their children to avoid playing with stray dogs than participants from other farms. This study highlights knowledge dissemination disparities that, if typical of rural locations, could obstruct attempts to eliminate canine‐mediated human rabies in India. Therefore, understanding the pervasiveness and influence of traditional medical beliefs on treatment‐seeking behaviour, communication structures within villages and the impact of local practices such as carcass disposal on dog populations will be essential to ensure that rabies control strategies are effective in rural India.

Drivers of zoonotic disease risk in the Indian subcontinent: A scoping review

“…Studies in India found some participants had heard about rabies, but knowledge of first-aid following a bite was poor, with application of chillies, turmeric or kerosene and visiting traditional healers recommended [ 33 , 35 , 37 ]. In two Pakistan studies, most participants stated there had been no rabies awareness campaign in their community [ 28 , 38 ], with similar findings in India [ 32 , 35 ]. People reported getting their information from friends, family and neighbours, with women who had received no formal education likely to be less aware of the disease [ 32 ].…”

“…In two Pakistan studies, most participants stated there had been no rabies awareness campaign in their community [ 28 , 38 ], with similar findings in India [ 32 , 35 ]. People reported getting their information from friends, family and neighbours, with women who had received no formal education likely to be less aware of the disease [ 32 ]. Other common sources of information included media and television [ 30 , 37 ].…”

“…Fourteen sources described drivers of rabies related to lack of awareness and understanding of the disease, its causes and prevention. Communities often reported low awareness of rabies, in terms of preventing bites and behaviour following a bite or other contact with potentially infected animals [ 28 , 29 , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] ]. Some sources discussed community beliefs and the use of traditional medicines as prevention or post-exposure prophylaxis [ 29 ].…”

Estimation of the incidence of animal rabies in Punjab, India

“…Both stray cattle and stray dogs are mostly dependent on food sources associated with the human population and therefore, are likely to have an overlapping home range. Cattle or buffaloes have previously been reported to be more likely to be bitten when kept in streets and open ground areas in Punjab [26]. However, we are not aware of any scientific investigation conducted to investigate stray cattle and dog home ranges and further investigations are required to fully elucidate this association.…”

Recent Research on Occupational Animal Exposures and Health Risks: A Narrative Review

“…Other authors highlighted additional emerging zoonotic viral pathogens in the food animal workforce, including a report of brucellosis among sheep farmers in Egypt and knowledge and biosecurity practices among Indian animal farmers about rabies [46,47]. Msimang and colleagues reported on Rift Valley fever seroprevalence among animal farmers and veterinarians in South Africa, concluding that infection with this re-emerging pathogen is likely notably higher than previously recognized and under-diagnosed in the region [50].…”