1. Rabies Surveillance Dr Suresh Gupta Consultant
Pediatric Emergency Medicine
Sir Ganga Ram Hospital, New Delhi

2. Surveillance Standards
WHO Recommended
Surveillance Standards
for
Rabies

3. Rationale for Surveillance
WHO promotes
Human rabies prevention though PET
Disease Elimination through vaccination of dogs and other animal reservoirs
Surveillance is essential for
Detection of high risk areas
Detection of outbreaks quickly
Monitor use of vaccine

4. Recommended Case Definition
Case Classification:(Based on Clinical Description & Laboratory Criteria)
Human Rabies : -Suspected
-Probable
-Confirmed
Human Exposure to rabies:
-Possibly Exposed
-Exposed

5. Recommended types of surveillance
Surveillance in human population:
Human exposure to rabies
Human rabies case
Outbreak investigations
Surveillance in animal population
Wild and Domestic species reservoirs

6. 1. Presence/absence of rabies 2. Human rabies. a
1.Presence/absence of rabies 2. Human rabies a. Number of human deaths b. Human deaths according to animal species source of exposure c. People bitten by suspected dogs 3. Animal rabies a. Total number of dog cases b. Total number of other domestic animal cases c. Total number of wild animal cases d. Total number of bats cases 4. National rabies vaccine production and importation a. Veterinary vaccine according to vaccine types b. Human vaccine according to vaccine types c. Human rabies immunoglobulin 5. Rabies vaccine administration a. Dogs vaccination b. Human vaccine application - Post-exposure treatment c. Number of patients treated according to vaccination regimen d. Number of persons receiving treatment according to animal species source of exposure
Rabies Indicators

7. Recommended minimum data elements
Human Rabies Exposure
Case based data
Aggregated data
Surveillance of Deaths from Human rabies

8. Recommended data analysis, presentation and reports
No of human rabies death and rabies cases in animal(by species),by date of presentation
Human exposure by location, date of animal biting/scratch episode animal species, outcome in human and animal populations
Cases by geographical area and dates of biting, type of animal, occupation and outcome

9. Principal uses of data for decision making
Detect outbreaks in endemic areas and new cases in rabies free area
Determine high risk areas for intervention
Rationalize the use of vaccine and immunoglobulins
Evaluation of intervention for animal reservoirs and exposed human population

10. Special Aspects
Intersectoral cooperation of medical and veterinary services, community involvement and participation required for targeted response and control in animal reservoir.

12. Presence/Absence of rabies 2000
No information Absence Presence

13. Rabies trends in 2000
No information Rabies free Stable Decreasing Increasing

14. Geographical Distribution 2000
No information Rabies free Border area Limited area Most parts

15. Epidemiological pattern 2000
No information Rabies free Bat Dog Wild

16. Rabies situation and trend
Human Rabies 35-50,000/Year
Asia and Africa are the main
Animal Rabies
Africa 2344,USA 8509, Europe 5098, Asia ??
General Trends
Europe reporting decrease in rabies cases
Animal rabies Dog 57%, Wild life 33%, Bat 10%

17. Rabies and Prevention Human PET Vaccine Vaccine application in Dogs
Exposure to Dog- Africa 87%, Asia 97%, Europe 4%
Vaccine alone Africa 82%, Asia 88%, Europe 80%
Vaccine
Human Vaccine: 76% vaccine on cell culture
Animal Vaccine: 99% cell culture,
Vaccine application in Dogs
Compulsory in 13/25 African countries,3/10 American countries, 18/33 European countries, 3/10 Asian countries

18. Reported Human Rabies Cases in India

19. Reported Human Rabies Cases in India

20. Reported animal rabies cases in India

21. Reported animal rabies cases in India

22. Reported No of PET

23. Human and animal rabies vaccine produced or imported
Not available at Rabnet

24. Rabies Vaccination for dogs and other animal species
Not available at Rabnet

25. Current country information on rabies in India at Rabnet
Last update of this informations :
Region : Asia Country : India WHO Region : EURO
1) Presence of rabies and disease surveillance
Is rabies a notifiable disease?
Does a surveillance system exist?
Is it operational?
Does rabies occur in the country? yes
Does rabies exist in the entire country?
If No, please specify infected areas.
2) Reservoir species
First rabies reservoir Second rabies reservoir
not applicable not applicable
Third rabies reservoir Other reservoir
not applicable
3) Rabies vaccine used for human postexposure treatment
Primary cell line Diploid cell line Continuous cell line Nervous tissue
Treatment schedules not applicable not applicable not applicable
Other Schedules
Is vaccine also applied intra-dermaly ?

26. Contact address on rabies diagnosis, prevention and control in human and animal in India
For questions on rabies prophylaxis and treatment in human please contact or For questions on rabies diagnosis, surveillance and control in animals please contact
Last name
First name
Title
Position
Institution
Department
Street
Quarter
POBox
City
Postal code
State
Phone1
Phone2
Fax
Address

27. Epidemiology of Rabies#
30,000 Annual Deaths
10,00,000 PET annually
12 Govt.Institution (NTVs) for Human
9 Govt. Institution Veterinary NTVs,
1Pvt. Pharmas human TCV,
4 Pvt Pharmas veterinary TCVs.
15 Govt Inst. rabies diagnostic facilities in animals and 5 for testing post vaccination antibody titers in humans.
# Association for prevention and control of rabies in India (APCRI)

28. Annual Report at NICD 1997 Post-mortem diagnosis in animal 18/40
in samples by Negri body FAT & BT
Diagnosis in hydrophobia cases by
Corneal Smear 0/15
Serum Antibodies 2/15
Assessment of antibodies by modified CIEP test
Human /258
Animal l5/5

29. 6 month incidence of animal bite cases in 4 selected urban communities*
City Population Bites Incidence/1000
Banglore
Calicut
Coonoor
Rajamundry
Total
*Source: Based on reports of National Institute of Communicable Diseases

30. No of animal bite case reported by Municipal Medical Institutions in Delhi, 1995-1998*
Dog
Monkey
Cat
Horse
Buffalo
Unknown
Total
* Source: Municipal Health Officer, Delhi

31. No. bite cases with reference to animal involved 1998-2002*
Animal Total Case (Percentage)
Dog (83%)
Monkey (05%)
Buffalo (3.5%)
Cow-Ox (03%)
Cat (1.5%)
Rat (.75%)
Jackal (0.5%)
Leon/Leopard 11
Horse-Mule 30 (0.5%)
Mongoose 34 (0.5%)
Pig 6
Goat (0.5%)
Sheep 1
Others 4
Unknown 4
Contact Cases 131 (02%)
No. bite cases with reference to animal involved *
Total : 6190
* Source:CRI, Kasauli, APRICON 2003

32. Single animal biting many persons: Episodes reported from India*
Year Animal Bitten Died RIG
1992 Dog Yes
1995 Wolf No
1996 Dog No
* Source: Based on reports communicated to NICD

33. Classification of Animal bite cases reported (1998-2002)*
Year Class I Class II Class III Total
Total (1%) (15%) (84%)
* Source:CRI, Kasauli, APRICON 2003

34. No of Hydrophobia cases admitted to IDH, Delhi 1994-1999*
Year No of Hydrophobia cases
*Source: Infectious Diseases Hospital, New Delhi

35. Rabies Cases Admitted to IDH 1998
Age Number Percentage % % %
Sex
Male %
Female %
Total %
*Source: Jagvir Singh et al in Indian Pediatrics, Volume 38, 2001

36. Rabies Cases Admitted to IDH 1998 Antirabies Vaccination before hospitalization
Age Number No. Received ARV Percentage % % %
Sex
Male %
Female %
Total %
*Source: Jagvir Singh et al in Indian Pediatrics, Volume 38, 2001

37. Rabies Cases Admitted to IDH 1998 PET received by these cases*
Local wound care:
Only 2 cases
Vaccination:
Unvaccinated 67/215
Vaccinated 48/215
42 NTV( only 5 received>10doses)
6 TCV(all received < 3 doses)
Immunoglobulins:
Only 3 cases
1 case received (Wound care + NTV+ ERIG)
*Source: Jagvir Singh et al in Indian Pediatrics, Volume 38, 2001

38. Assessing Burden of Rabies in India*
1000+ million Population
24 million Dog Population
Dog:Man 1:12 to 1:40
Animal Bites: 2.1 million
90% due to dog ( 90% unvaccinated dog)
1.1 million PET (0.45 NTV and 0.65TCV)
No. of Rabies death 30,000/annually ????
* Source:APCRI, Newsletter Volume III, Issue 1 & 2, 2003

39. Assessing Burden of Rabies in India A WHO-APCRI National Multi Centric Survey Initiative 2003
This survey involves
20 Medical Colleges,
32 Veterinary College,
10 million Human Population
32 Veterinary Pathology Laboratories

40. What could be the answer for Rabies Surveillance in India ?
Integrated Disease Surveillance ??