Epidemiology, Impact and Control of Rabies in Nepal: A Systematic Review

Abstract

BackgroundRabies is a vaccine-preventable viral zoonosis belonging to the group of neglected tropical diseases. Exposure to a rabid animal may result in a fatal acute encephalitis if effective post-exposure prophylaxis is not provided. Rabies occurs worldwide, but its burden is disproportionately high in developing countries, including Nepal. We aimed to summarize current knowledge on the epidemiology, impact and control of rabies in Nepal.MethodsWe performed a systematic review of international and national scientific literature and searched grey literature through the World Health Organization Digital Library and the library of the National Zoonoses and Food Hygiene Research Centre, Nepal, and through searching Google and Google Scholar. Further data on animal and human rabies were obtained from the relevant Nepalese government agencies. Finally, we surveyed the archives of a Nepalese daily to obtain qualitative information on rabies in Nepal.FindingsSo far, only little original research has been conducted on the epidemiology and impact of rabies in Nepal. Per year, rabies is reported to kill about 100 livestock and 10–100 humans, while about 1,000 livestock and 35,000 humans are reported to receive rabies post-exposure prophylaxis. However, these estimates are very likely to be serious underestimations of the true rabies burden. Significant progress has been made in the production of cell culture-based anti-rabies vaccine and rabies immunoglobulin, but availability and supply remain a matter of concern, especially in remote areas. Different state and non-state actors have initiated rabies control activities over the years, but efforts typically remained focalized, of short duration and not harmonized. Communication and coordination between veterinary and human health authorities is limited at present, further complicating rabies control in Nepal. Important research gaps include the reporting biases for both human and animal rabies, the ecology of stray dog populations and the true contribution of the sylvatic cycle.InterpretationBetter data are needed to unravel the true burden of animal and human rabies. More collaboration, both within the country and within the region, is needed to control rabies. To achieve these goals, high level political commitment is essential. We therefore propose to make rabies the model zoonosis for successful control in Nepal.

When Micro Drives the Macro: A Fresh Look at Disease and its Massive Contributions in the Hindu Kush-Himalaya

“…Several outbreaks of rabies have been reported in the canines and bovines in Nepal with its high morbidity and 100% mortality of the livestock (DoAH 2016a, b). Data show that rabies kills about 100 livestock and 10-100 men per annum being the highest risk in the southern terai plain particularly due to agricultural lands, wildlife areas, and the open border with India (Devleesschauwer et al 2016). Rabies is gaining significance in travel medicine particularly because there are many reports of bites and scratches into both tourists and foreign residents by rhesus monkeys (Macaca mulatta) that live anthropogenically near temples in many parts including the Kathmandu Valley, one of the oldest cities of the Himalayan countries (Devleesschauwer et al 2016;Pandey et al 2002).…”

Changing Trend of Infectious Diseases in Nepal

“…During the period of 1992-1996, a total of 181 human rabid cases were reported (diagnosed clinically; among them one which was diagnosed by mouse inoculation) and were from 37 different Districts with the history of dog bite [44]. Per year, rabies is reported to kill about 100 livestock and 10-100 humans, while about 1,000 livestock and 35,000 humans are reported to receive rabies postexposure prophylaxis, however, these estimates are very likely to be serious underestimations of the true rabies burden [45] (Fig. 3).…”

“…Recently, Herpes virus associated eye disease is reported to be 10.3% [46]. Epidemic of acute hemorrhagic conjunctivitis occurs on every 2 to 3 years and is found [45] to be associated with viruses such as Adenovirus and Coxsackie virus [47]. Interestingly, a mysterious ocular manifestation known as SHAPU (seasonal hyperacute panuveitis) predominantly affecting the children is reported only from Nepal [48].…”

Detection of virus-neutralising antibodies and associated factors against rabies in the vaccinated household dogs of Kathmandu Valley, Nepal

“…China has the second highest incidence of rabies [8] with an annual 2,000 to 3,000 human deaths, of which more than 95% are due to the bite of a rabid dog [5]. With the two neighboring countries having a high rabies burden, the disease has become endemic and a priority zoonotic disease in Nepal as well [9]. There, the disease has been confirmed in cattle, buffaloes, goats, alpacas, dogs, and mongooses.…”

“…One is the urban cycle which involves domesticated dogs, and the other is the sylvatic cycle which involves wildlife [10]. A study conducted between 1991 and 2000 showed that more than 96% of rabies patients shared a history of rabid dog exposure, indicating that the urban cycle is the main source of human rabies [9]. Large numbers of human rabies cases in Nepal are due to stray and community dogs.…”