WRD at NCDC, Delhi

Rabies is a disease where a person sees his own death. The certainty of death and the uncertainty of the hour of death is a most dreadful experience. Ironically, the person is tormented with thirst and fear of water at the same time. Studies in India have shown that people who die due to rabies have either not taken any treatment or have received partial or inappropriate treatment.

The National Centre for Disease Control (NCDC), Directorate General of Health Services under Ministry of Health & Family Welfare (MoH & FW) has observed WRD since its inception. This is in accordance with the global objective of preventing human rabies deaths by increasing awareness amongst the general community regarding rabies and its prevention which includes timely and appropriate treatment and responsible ownership of animals and working toward the coordination of veterinary community and medical resources on a "One Health" approach. Various activities have been carried out since 2007 (see picture)

In 2010, NCDC, adopted a novel approach to observe WRD. It was organized in collaboration with the Delhi School of Social Work, University of Delhi and over one hundred social work post graduate students were sensitized on rabies and its prevention. These students interact with low socio economic groups and create awareness on day to day issues including animal bites and rabies. This year the focus is on school teachers and students. It is proposed that teachers will be educated on rabies and its prevention and will in turn impart knowledge to students. As well as a public lecture, a poster competition with prizes will be held in the schools.

Observing WRD has also helped in sensitizing policy makers and in launching a pilot project to prevent human rabies deaths in 2008 which is being carried out as a 'New Initiative' in 5 cities: Ahemdabad, Bangalore, Pune, Madurai and Delhi. The objectives of the project are prevention of human deaths due to rabies, enhanced awareness in the general community, inceased trained health manpower, strengthened diagnostic facilities, strengthened surveillance and maintenance of continuous surveillance and sensitization of other sectors.

To date, 43 core trainers trained at NCDC, Delhi have in-turn trained approximately 2065 doctors and paramedical staff in appropriate animal bite management in the pilot project. Improvements are:

• Uniform and appropriate animal bite management as per the guidelines
• Wound washing facilities in all the centres.
• 54 centres in the pilot project cities have implemented the more econimical Intra-dermal route of inoculation of cell culture vaccines
• Increased and appropriate use (local Infiltration in the wound) of immunoglobulins
• Establishment of new Anti-Rabies Clinics (ARCs) in Ahemdabad, Bangalore, Pune.

Prior to initiation of the project available data was analyzed which indicated that many people did not seek post exposure treatment after animal bites leading to high mortality. The general community related rabies to "Dog-bites" only. None of the pilot project cities was carrying out awareness campaigns to create awareness in general community. Prototype educational material was developed at NCDC, the pilot project cities translated and disseminated it adopting innovative methods to create awareness in general community. For example, in Pune radio jingles are played in between the popular programmes, messages are displayed on the rear of the public buses. In Ahemdabad, scroller machines, with important messages scrolling on them, are placed in strategic locations. Similarly, in Bangalore pamphlets are distributed frequently with the daily newspapers with the addresses of anti-rabies centres. Stickers with simple pictorial messages have been pasted in public transport buses and in public places in Madurai. Hoardings have been put in all the pilot project cities. Posters have been displayed in schools and antirabies treatment centres. After the initiation of the project there is enhanced awareness regarding animals transmitting rabies and timely and appropriate animal bite management in general community as indicated by increase in attendance at ARCs and reporting of animal bites other than from dogs.

In addition, one laboratory in each pilot project city has been strengthened and surveillance has been strengthened. An Interface is being developed with veterinary sector so that a comprehensive strategy for control of rabies can be rolled out through out the country.

Contributed by Veena Mittal, Mala Chhabra, R L Ichhpujani, and L S Chauhan of the WHO Collaborating Centre for Rabies Epidemiology, Delhi..