(IN) Stray dogs are a growing threat to public health

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BMJ 2002;325:66 ( 13 July )

http://bmj.com/cgi/content/full/325/7355/66/l

 

Sanjay Kumar New Delhi

 

Almost all cases of rabies in India are due to stray dogs, which act as a

reservoir for the disease, according to the National Institute of

Communicable Diseases, based in Delhi. The number of bites remain high, yet

legal pressure from animal rights groups is thwarting attempts to tackle the

problem.

 

Delhi alone is believed to have some 250 000 stray dogs, which are

multiplying, intimidating, creating a nuisance, and biting people—infecting

some with rabies. The number nationwide is estimated at around 25-8 million,

according to the institute, although there has not been a count. Almost all

the dogs are unvaccinated against rabies.

 

When a night guard was bitten by a suspected rabid dog some months back in

west Delhi, he had to pay 1300 rupees (£17; $27; €27)—equivalent to a

month’

s wages—for anti-rabies shots. He killed the dog the next morning, pelting

it with stones and bricks.

 

Legal action by animal rights activists to thwart attempts to control the

stray dog population has been led by the recently ousted minister Maneka

Gandhi, who also instigated a ban on animal experimentation in scientific

institutions, alleging ill treatment.

 

The WHO estimates that worldwide 40 000 to 70 000 people die from rabies

every year. " Nearly 30 000 of these deaths occur in India, " said Derek Lobo

of the WHO’s communicable diseases department in New Delhi. The National

Institute of Communicable Diseases says that almost 96% of rabies cases in

India are caused by stray dogs, the remainder being caused by pet dogs,

cats, monkeys, mongooses, and jackals. Nearly 2.2 million people a year in

India are bitten by animals, only 1.4 million of whom seek treatment.

 

Dr Keshwa Nand Tewari, Delhi’s municipal health officer, told the BMJ that

animal bites remain high in Delhi: 31 414 in 1999, 32 556 in 2000, and 31

816 in 2001. Rabies continues to take a toll, with 241 deaths in 1999, 219

in 2000, and 172 in 2001.

 

Under the Animal Birth Control Rules 2001, which were introduced after

pressure from animal rights groups, municipal authorities cannot kill

healthy stray dogs. Meanwhile the Delhi municipal corporation’s dog trapping

programme remains ineffective. In 2000-1 the corporation trapped only 983

stray dogs, handing them over to non-governmental organisations for

sterilisation. Municipalities do not have sterilisation facilities, and

non-governmental organisations have very little capacity to deal with the

problem.

 

" The situation will hardly change till the animal birth control rules are

struck off, " said Ajay Bahl, a lawyer who has studied the problem in detail.

 

Another problem has been the continued use of antiquated anti-rabies nerve

tissue vaccine in India. The vaccine is cheap but neurotoxic and painful for

patients, who have to take 10 shots. The incidence of neuroparalytic

complications in India has been between 1 in 5500 and 1 in 11 000 cases,

says the National Institute of Communicable Diseases.

 

" As far back as 1992, the WHO expert committee recommended phasing out of

nerve tissue vaccine and replacing it with safer tissue culture vaccine, "

said Derek Lobo.

 

" Costs have come down now, with proven efficacy of intradermal

administration of tissue culture vaccine where one fifth of the

intramuscular dose is used, " he said. " Cost is no more a consideration, " he

added. But the drugs controller of India has yet to give permission for

intradermal administration.

 

" There is no comprehensive rabies control programme in India, but there is a

serious need for it, " said Dr Tewari.