Estimates of the burden of human rabies deaths and animal bites in India, 2022-23: a community-based cross-sectional survey and probability decision-tree modelling study.
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Thangaraj Jeromie Wesley Vivian, Krishna Navaneeth S, Devika Shanmugasundaram, Egambaram Suganya, Dhanapal Sudha Rani, Khan Siraj Ahmed, Srivastava Ashok Kumar, Mishra Ayush, Shrinivasa Basavaraj, Gour Devendra, Madhukar Major, Verma Nirmal, Sharma Parul, Soni Ravinder Kumar, Ramasamy Sabarinathan, Mohandas Sreelakshmi, Baidya Subrata, Rehman Tanveer, Yeldandi Vijay V, Singh Akashdeep, Sreedevi Aswathy, Tandale Babasaheb V, Purakayastha Debjani Ram, Reddy Mahendra M, Toppo Manju, Solanki Nitinkumar Valjibhai, Ghosh Pramit, Jaiswal Prashant, Vyas Shaili, Das Shampa, Palo Subrata Kumar, Prasanth Venela, Rozario Amanda G A, Durairajan Chokkalingam, Delli Anitha, Sasi Aruna, Pandiyan Chandhini, Ashwathnarayana Doddabale Hanumanthaiah, Joy Sam, Isloor Srikrishna, Sudarshan Mysore Kalappa, Rahi Manju, Murhekar Manoj V, Human Rabies Study Collaborators
Аннотация
METHODS: We conducted a community-based nationwide cross-sectional survey with a multistage cluster-sampling design from March 2, 2022 to Aug 26, 2023, covering 60 districts in 15 Indian states. The head of the household or an adult family member was interviewed to collect information about animal-bite history in family members, receipt of anti-rabies vaccination (ARV), and death following animal bite in the family. Annual animal-bite incidence along with 95% CIs were estimated after applying the sampling weights and adjusting for clustering. We estimated annual human rabies deaths using a decision-tree probability model with parameters from the community survey and laboratory data on rabies positivity among suspected rabid dogs.
FINDINGS: Of the 337 808 individuals residing in the 78 807 households surveyed, 2052 gave a history of animal bite, mostly (1576 [76·8%]) due to dogs in the past 1 year. The weighted and adjusted annual incidence of animal bite was 6·6 (95% CI 5·7-7·6) per 1000 population, translating into 9·1 million bites nationally. Annual dog-bite incidence was 5·6 (4·8-6·6) per 1000. Among people who had been bitten by a dog, 323 (20·5%) did not receive ARV, and 1043 (66·2%) received at least three doses. Nearly half (615 [49·1%]) of the 1253 individuals who received one dose did not complete their full course of vaccination. We estimated 5726 (95% uncertainty interval 3967-7350) human rabies deaths occurring annually in India.
INTERPRETATION: Although there was a substantial decline in human rabies deaths over the past two decades, to eliminate dog-mediated human rabies by 2030, India needs to fast-track its actions by adopting a focused one-health approach. Integrating human and animal surveillance, ensuring timely administration of full course of post-exposure prophylaxis, and accelerating dog vaccination across the country are crucial steps towards this goal.
FUNDING: Indian Council of Medical Research.