In a deeply concerning revelation, Pakistan has emerged as a frontline battleground in the ongoing struggle against rabies, a deadly viral infection primarily spread through the bites of rabid animals. Disturbingly, dogs have emerged as the primary culprits, responsible for a staggering 99% of human rabies deaths in the country. (Source: https://www.emro.who.int/pak/programmes/rabies-control-program.html)
Historically, Asia bore the unfortunate distinction of being the epicenter of high number of rabies cases. Within South Asia alone, the annual death toll from rabies exceeds a grim 40,000 with the majority of these casualties attributed to dog bites. Pakistan standing as a significant contributor, accounts for 10% of the global tally of rabies – related fatalities annually. Nevertheless, recent surveys also unveiled a notable surge in Africa. (Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907975/#bb0030)
Rabies, though an endemic in Pakistan, remains a neglected disease despite the country grappling with a critically high incidence of dog bites. In a stark illustration of the severity of the issue, the National Health Management Information System (NHMIS) recorded an astounding 97,000 cases of dog bites in Pakistan in 2016, with three cities – Karachi, Peshawar and Hyderabad shouldering an overwhelming 84.2% of these reported cases. These recorded incidents caused major economic losses for the country. Adding to the challenge, is the absence of reliable data on human rabies deaths, leaving us with vague estimates of 2,000 to 5,000 deaths annually. A study conducted in Pakistan in 2019, shed light on a seasonal pattern with 60% of dog bite cases occurring during summer months (March to August) compared to 40% in winter season (September to February). Interestingly, research also exposed a dismaying reality: a significant portion of the population remains either unaware of the risks associated with rabid dog bites or fails to seek appropriate treatment for its prevention, exacerbating the public health threat posed by the deadly virus. This sobering fact highlights the urgency of addressing rabies as a critical public health concern that transcends regional boundaries.
ChildLife Foundation, a non-profit organization working in the health sector for improving pediatric emergency care across Pakistan with a presence in 200 hospitals underscores the principle that prevention is much more effective than cure. ChildLife provides full spectrum medical care, from emergency rooms to primary clinics, down to preventive practices. The emergency rooms are playing a crucial role in addressing the issue of dog bites, since 2022. With over 12,000 cases treated to date in children, the Foundation’s dedication to providing immediate medical attention is evident. This is an explicit reminder of the urgency surrounding the implementation of effective preventive measures.
Rabies can be prevented. By staying informed and taking the necessary precautions, we can protect ourselves and the vulnerable communities from this viral disease. Primary prevention is the linchpin to curbing this deadly menace. Central to this prevention strategy is the mission of educating individuals on how to handle themselves especially in vulnerable circumstances and to effectively respond in case of a dog bite. Immediate medical attention is paramount. Initial first aid involves thorough cleansing of the wound with clean water and soap or saline for deep wounds, as dog bites can often introduce contaminants. Post -exposure prophylaxis (PEP) including rabies vaccine and Rabies Immune Globulin (RIG) for severe wounds, stimulates the immune system to fight the virus. Tetanus prophylaxis may be administered simultaneously. Antibiotics are commonly recommended for dog bite injuries that have a potential risk of infection, which typically ranges between 15 to 20%.
Prevention is also contingent on responsible behavior, such as avoiding interactions with unfamiliar dogs, maintaining composure in their presence, and promptly reporting stray or aggressive dogs. High-risk groups such as veterinarians and travelers visiting endemic areas are advised to consider pre-exposure prophylaxis (PreP) for added protection. Additionally, preventive measures encompass ensuring that pets are regularly vaccinated, property controlled and not approached or disturbed by humans. A comprehensive strategy to combat rabies can further be complemented by public awareness campaigns, healthcare provider training and the establishment of a robust surveillance system.
The World Health Organization (WHO) is actively combating rabies in Pakistan by raising awareness, setting up specialized dog bite and rabies treatment centers, enforcing pet vaccination laws and employing modern approaches like bait vaccination, dog population control for reducing the number of stray dogs to curb rabies transmission and safeguard public health.
Embracing the 2023 theme of One Health, which recognizes the interconnectedness of human, animal and environmental health stands as a formidable strategy that underlines the fundamental concept, that the well -being of all living beings is intricately interlined and should be prioritized for the betterment of the society as a whole.
Dr. Aleya Ali – Program Lead Linkages, ChildLife Foundation