Announcement

Collapse
No announcement yet.

20,000 rabies deaths per annum in India - Maybe not

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • 20,000 rabies deaths per annum in India - Maybe not

    India has highest rabies death in Asia
    By PTI, Friday, 08 July 2011, 04:02 Hrs Bangalore: Almost 20,000 people die every year of rabies in India, making it the country with highest rabies fatalities in Asia and the second highest in the world, according to Association for Prevention and Control of Rabies in India.

    "Globally, about 65,000 people die due to rabies. In Asia, India tops the list as many neighbouring countries have been able to control the disease," Association for Prevention and Control of Rabies in India, Secretary General Thomas Mathew said here.

    "In Africa 45,000 people die every year while India ranks second with 20,000 death reported due to this disease," he added.

    Stating that many countries such as the US, the UK, Japan, Taiwan and Mexico have been able to control rabies, he said, lack of awareness and proper education about the disease has been the reason for the problem.

    A day ahead of the the two-day national conference on "Why Should Anyone die of Rabies in the 21st Century", he said the main cities along with four metros contributed to 30 per cent of the total deaths caused by rabies in India.

    About 17.4 million people were exposed to animal bites annually, he added.

    Pointing out reasons for the high fatality rate, UK-based Alliance of Rabies Control Executive Director Dr Deborah J Briggs said, "India has a large dog population, which is also one of the reasons for the current situation."

    Tamil Nadu Dr MGR Medical University Vice-Chancellor Mayil Vahanan Natarajan will inaugurate the two-day conference tomorrow.

    http://www.siliconindia.com/shownews...933-cid-1.html
    Twitter: @RonanKelly13
    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

  • #2
    Re: 20,000 rabies deaths per annum in India

    CMAJ. 2008 February 26; 178(5): 564?566.
    doi: 10.1503/cmaj.071488 PMCID: PMC2244675

    Copyright ? 2008 Canadian Medical Association
    Public health
    Rabies in India
    Rozario Menezes, MD
    Chief Medical Officer (retired), Mormugao Port Authority; Consultant, Pediatrics, Dr. M.M. Mesquita Hospital, Vasco-da-Gama, India




    ...
    In India, about 15 million people are bitten by animals, mostly dogs, every year and need postexposure prophylaxis. Since 1985, India has reported an estimated 25 000?30 000 human deaths from rabies annually (the lower estimate is based on projected statistics from isolation hospitals in 1985).2 The majority of people who die of rabies are people of poor or low-income socioeconomic status.3 The incidence of death from rabies in Asia is given in Figure 2.5 Because rabies is not a notifiable disease in India and there is no organized surveillance system of human or animal cases, the actual number of deaths may be much higher. The latest figure projected from the National Multicentric Rabies Survey, conducted in 2004 by the Association for Prevention and Control of Rabies in India in collaboration with the World Health Organization,1 is 20 565 deaths from rabies per year.

    ...
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2244675/
    Twitter: @RonanKelly13
    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

    Comment


    • #3
      Re: 20,000 rabies deaths per annum in India

      Published Date: 2012-06-10 15:22:39
      Subject: PRO/AH/EDR> Rabies - India: mortality estimates
      Archive Number: 20120610.1163188
      RABIES - INDIA: MORTALITY ESTIMATES
      ***********************************
      A ProMED-mail post
      http://www.promedmail.org
      ProMED-mail is a program of the
      International Society for Infectious Diseases
      http://www.isid.org

      Date: Sat 9 Jun 2012

      From: Merritt Clifton





      Comment on human rabies death toll in India


      -------------------------------------------


      [Merritt Clifton has forwarded the following commentary in response to ProMED-mail post Rabies - India: WHO travel alert 20120609.1162367, in which the moderator stated that: "The human death toll in India has been estimated as 35 000 per annum, but may now be declining".]



      Some history and discussion of the Indian estimates of human rabies deaths appears to be in order, not least because the figure of 35 000 per year has been used by Indian mass media since 1976, at least, and though it is often cited with various different attributions, I have yet to find anyone who really knows where it came from, or how it was calculated. The following is pared down from my cover article in the current edition of ANIMAL PEOPLE.



      On 29 Apr 2012, as ProMed noted on 1 May 2012 [Rabies - India: (WB) 20120501.1119730], Indian national health minister Gulam Nabi Azad presented the most recent Indian government statistics on mortality from all causes to the Lok Sabha, the Indian parliament. After discussing heart disease, diabetes, and cancer, Gulam Nabi Azad mentioned that only 223 human rabies deaths were recorded in India in 2011. This was barely 1% of the 2002 government estimate (20 000), which was a projection meant to be an average over 10 years, 1992-2002.



      As rabies is not a notifiable disease in India, reports of human rabies deaths are not routinely forwarded to the federal health ministry. Therefore, the figure that Gulam Nabi Azad used on 29 Apr 2012 may have been low -- but how low? The Animal Welfare Board of India, Federation of Indian Animal Protection Organizations, and Animal Birth Control India all track canine rabies outbreaks, albeit relatively informally, and do collect and share human mortality information as part of their work. Longtime Blue Cross of India chief executive and Animal Welfare Board of India member Chinny Krishna e-mailed to me shortly after Gulam Nabi Azad spoke that 'the figure given by Gulam Nabi Azad is in the opinion of many of us working on the ground much closer to reality" than the previous figures of 20 000.



      Introducing the use of street dog vaccination and sterilization to combat canine rabies in 1966, Krishna was already skeptical of the WHO and Indian government estimates of human rabies fatalities by 1976, when he first criticized the figure of 35 000. "For at least 25 years, I fought the claim of 35 000 rabies deaths in India yearly," Krishna posted recently to FIAPO. "I spoke at the Association for Prevention and Control of Rabies in India conference at Bhubaneshwar when the decennial figures for 1992-2002 were released," lowering the estimated toll to 17 000 diagnosed human deaths and 3000 deaths that went undiagnosed. Krishna suspected that the high figures were produced by the combination of inadequate case tracking, faulty diagnostic work, and official projections based on obsolescent and inaccurate presumptions about how rabies spreads.



      Eventually Krishna persuaded People for Animals founder Maneka Gandhi, who for more than five years was the Indian federal minister for animal welfare, and was also for a time minister for statistics, but Mrs Gandhi lost her cabinet position before she could organise an official reappraisal of the rabies numbers. Likewise convinced was Animal Welfare Board of India chair Rammehar Kharb, a retired military veterinarian who on appointment in May 2006 pledged to "eradicate rabies from India by mass vaccination of stray dogs." WHO-South East Asia Regional Organization technical officer for veterinary public health Gyanendra Gongal also came to question the official numbers. Journalist Hiranmay Karlekar in a 2008 book entitled 'Savage Humans & Stray Dogs' attributed the inflated human rabies death estimates to the desire of makers of post-exposure vaccines to sell more of their product to dog bite victims and to their biggest customers, the government clinics that are mandated to treat dog bite victims free of charge.



      ANIMAL PEOPLE pointed out repeatedly, beginning in 1997, that several mosquito-borne and tick-borne diseases, common to India but not widely recognized until relatively recently, also produce high fever and other rabies symptoms, and are likewise frequently fatal if left untreated. Undetected insect-carried febrile illnesses could easily have accounted for most of the unconfirmed "rabies" death toll. Chinny Krishna sought unsuccessfully on several occasions to enlist FIAPO members to participate in an unfunded national rabies data collection effort. At the June 2011 Asia for Animals conference in Chengdu, China, Krishna assembled representatives of the AWBI, ABC India, ANIMAL PEOPLE (including myself), and Humane Society International for an informal brainstorming session which concluded that available information on clinically confirmed rabies cases suggested that the annual human rabies death toll in India could not be more than 2000 to 3000. Data from Andhra Pradesh and Goa states, released after rabies outbreaks in 2011, later projected a range of 2000 to 3150 human rabies deaths per year, if all states were afflicted to the same extent."I would not necessarily go so far as to say that the number of human rabies cases a year in India is around 2000," Humane Society International president Andrew Rowan said at the time, "but I certainly suspect it is well below 20 000."



      --

      communicated by:

      Merritt Clifton

      Editor, ANIMAL PEOPLE

      PO Box 960

      Clinton, WA 98236

      USA

      [It is apparent from the above that the figure for the extent of human rabies mortality in India is in urgent need of revision. It would help if human rabies was ranked as a notifiable disease in India.



      The HealthMap interactive map of India can be accessed at: http://healthmap.org/r/1pSH. - Mod.CP]

      See Also

      Rabies - India: WHO travel alert 20120609.1162367
      Rabies - UK (03): (London) ex India, fatal outcome 20120529.1148757
      Rabies - UK (02): (London, England) ex India, human, canine 20120524.1143694
      Rabies - UK: (London, England) ex India, human, canine 20120523.1142429]
      .................................................c p/sh
      http://www.promedmail.org/direct.php...120610.1163188
      Twitter: @RonanKelly13
      The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

      Comment


      • #4
        Re: 20,000 rabies deaths per annum in India - Maybe not

        Published Date: 2012-06-11 16:47:57
        Subject: PRO/AH/EDR> Rabies - India (05): mortality estimates
        Archive Number: 20120611.1164493
        RABIES - INDIA (05): MORTALITY ESTIMATES
        ****************************************
        A ProMED-mail post
        http://www.promedmail.org
        ProMED-mail is a program of the
        International Society for Infectious Diseases
        http://www.isid.org

        Date: Sun 10 Jun 2012

        From: Merritt Clifton [edited]





        Further to my ProMED-mail posting: "Rabies - India (04): mortality estimates 20120610.1163188", I have today [10 Jun 2012] reviewed 535 reports of "dog menace" published by Indian news and medical media since 2005 to see what more might be abstracted or deduced.



        Firstly, in historical order, according to The Statesman of 11 Jul 2011, a Major Harvey, who was the director of the Pasteur Institute at Kasauli in July 1911, reported that through "personal inquiries" he had learned "that out of 3289 Indians bitten by rabid dogs or dogs suspected of being rabid, only 1636 came for treatment." Divorced from context over time, Major Harvey's finding may have had legs.



        The human population of India as of 1907, the most recent census year preceding 1911, was approximately 219 million. The human population of India as of 2003 was 1.1 billion, just about 5 times larger.



        A 2003 report by the Bangalore-based Association for Prevention and Control of Rabies in India (APCRI), sponsored by the World Health Organisation (WHO), found 20 565 deaths from rabies in 2003, with over 96 per cent transmitted by dogs, mostly strays.



        Multiplying Major Harvey's 3289 Indians bitten by rabid dogs by 5 to account for population growth produces a total of 16 445. Add the 3000 that the APCRI added to account for unreported cases, over the vehement opposition of Blue Cross of India chief executive Chinny Krishna (as recounted in my previous posting), and the total comes to 19 445, which is close enough to 20 565 for dancing and horseshoes, and too close to get to a rabid dog. Split the difference and one gets exactly 20 000. This might be just coincidence and circumstantial evidence at best, but as Henry David Thoreau remarked, "Some circumstantial evidence is very strong, as when you find a trout in the milk."



        In 2009, Tamil Nadu recorded 3 deaths against 263 across the country, and in 2010, they recorded 2 deaths against 162 nationally (source: National Health Profile 2010).



        The figure of 223 human rabies deaths in India in 2011, cited in the Lok Sabha by Indian health minister Gulam Nabi Azad on 29 Apr 2012, would appear to come from National Health Profile 2011.



        How complete might these numbers be? My search through the 535 articles produced the following annual tallies of death accounts:



        2004: 66

        2005: 123

        2006: 73

        2007: 195

        2008: 29

        2009: 23

        2010: 103

        2011: 69



        Obviously, not every human rabies death is reported by English-language news media. But equally obviously, the totals that have been reported are markedly lower than the National Health Profile numbers: cumulatively, 70 per cent lower. Thus, if the National Health Profile numbers are low at all, the undercounting cannot be demonstrated from other reportage.



        I concluded my previous posting by mentioning that data from Andhra Pradesh and Goa states, released after rabies outbreaks in 2011, later projected a range of 2000 to 3150 human rabies deaths per year for the whole of India, if all states were afflicted to the same extent. My search of the 535 articles produced recent human rabies death totals from several other states, including Uttar Pradesh, Tamil Nadu, and Manipur. These respectively project 365, 72, and 900 human rabies deaths per year for the whole of India. Putting all of the state totals together projects about 415 human rabies deaths per year for the whole of India.



        --

        Merritt Clifton

        Editor, Animal People

        PO Box 960

        Clinton, WA 98236

        USA



        [ProMED-mail thanks Merritt Clifton for this further analysis of estimates of human rabies mortality in India. The need for rabies virus infection of humans to become a notifible disease in India becomes ever more apparent.



        A map of the states of India can be accessed at: http://www.mapsofindia.com/maps/indi...itical-map.htm. - Mod.CP]

        See Also

        Rabies - India (04): mortality estimates 20120610.1163188
        Rabies - India (03): WHO travel alert 20120609.1162367
        Rabies - UK (03): (London) ex India, fatal outcome 20120529.1148757
        Rabies - UK (02): (London, England) ex India, human, canine 20120524.1143694
        Rabies - UK: (London, England) ex India, human, canine 20120523.1142429
        Rabies - India (02): (TN) canine, human 20120509.1127919
        Rabies - India: (WB) 20120501.1119730]
        .................................................c p/msp/sh
        http://www.promedmail.org/direct.php...120611.1164493
        Twitter: @RonanKelly13
        The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

        Comment


        • #5
          Re: 20,000 rabies deaths per annum in India - Maybe not

          Published Date: 2012-06-14 10:25:04
          Subject: PRO/AH/EDR> Rabies - India (06): mortality estimates
          Archive Number: 20120614.1168031
          RABIES - INDIA (06): MORTALITY ESTIMATES
          *****************************************
          A ProMED-mail post
          http://www.promedmail.org
          ProMED-mail is a program of the
          International Society for Infectious Diseases
          http://www.isid.org

          Date: Thu 14 Jun 2012

          From: Merritt Clifton [edited]





          Rabies mortality estimates - the last word


          ------------------------------------------


          The National Health Profile of India, published by the Central Bureau of Health Intelligence within the Directorate General of Health Services, under the Ministry of Health and Family Welfare, actually began reporting markedly lower rabies death numbers in 2005 -- but apparently nobody noticed until Indian health minister Gulam Nabi Azad on 29 Apr 2012 brought the latest data to the Lok Sabha [House of the People, the lower house of the Parliament of India].



          The National Health Profile of India human rabies death numbers:

          2005: 274

          2006: 361

          2007: 221

          2008: 244

          2009: 260

          2010: 162

          2011: 223



          The National Health Profile is a source of data about many other diseases commonly discussed by ProMED-mail (see http://cbhidghs.nic.in/index2.asp?sl...&sublinkid=706). Why has no one brought this resource to our attention before?



          --

          Merritt Clifton

          Editor, Animal People

          PO Box 960

          Clinton, WA 98236

          USA



          http://www.animalpeoplenews.org

          [ProMED-mail thanks Merritt Clifton for his continuing analysis of estimates of human rabies mortality in India. With these data from the Indian Central Bureau of Health Intelligence, this thread is now cut.



          Hopefully the relevant international agencies and travel advice organisations will take note and revise their statements downward accordingly.



          A map of the states of India can be accessed at http://www.mapsofindia.com/maps/indi...itical-map.htm and the HealthMap/ProMED-mail interactive map at http://healthmap.org/r/1pSH. - Mod.CP]

          See Also

          Rabies - India (05): mortality estimates 20120611.1164493
          Rabies - India (04): mortality estimates 20120610.1163188
          Rabies - India (03): WHO travel alert 20120609.1162367
          Rabies - UK (03): (London) ex India, fatal outcome 20120529.1148757
          Rabies - UK (02): (London, England) ex India, human, canine 20120524.1143694
          Rabies - UK: (London, England) ex India, human, canine 20120523.1142429
          Rabies - India (02): (TN) canine, human 20120509.1127919
          Rabies - India: (WB) 20120501.1119730]
          .................................................c p/mj/dk
          http://www.promedmail.org/direct.php...120614.1168031
          Twitter: @RonanKelly13
          The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

          Comment


          • #6
            Re: 20,000 rabies deaths per annum in India - Maybe not

            Deaths from Symptomatically Identifiable Furious Rabies in India: A Nationally Representative Mortality Survey

            Wilson Suraweera1, Shaun K. Morris1,2, Rajesh Kumar3, David A. Warrell4, Mary J. Warrell5, Prabhat Jha1*, for the Million Death Study Collaborators?

            Abstract
            Background
            It is estimated that India has more deaths from rabies than any other country. However, existing estimates are indirect and rely on non-representative studies.

            Methods and Principal Findings
            We examined rabies deaths in the ongoing Million Death Study (MDS), a representative survey of over 122,000 deaths in India that uses enhanced types of verbal autopsy. We estimated the age-specific mortality rates of symptomatically identifiable furious rabies and its geographic and demographic distributions. A total of 140 deaths in our sample were caused by rabies, suggesting that in 2005 there were 12,700 (99% CI 10,000 to 15,500) symptomatically identifiable furious rabies deaths in India. Most rabies deaths were in males (62%), in rural areas (91%), and in children below the age of 15 years (50%). The overall rabies mortality rate was 1.1 deaths per 100,000 population (99%CI 0.9 to 1.4). One third of the national rabies deaths were found in Uttar Pradesh (4,300) and nearly three quarters (8,900) were in 7 central and south-eastern states: Chhattisgarh, Uttar Pradesh, Odisha, Andhra Pradesh, Bihar, Assam, and Madhya Pradesh.

            Conclusions and Significance
            Rabies remains an avoidable cause of death in India. As verbal autopsy is not likely to identify atypical or paralytic forms of rabies, our figure of 12,700 deaths due to classic and clinically identifiable furious rabies underestimates the total number of deaths due to this virus. The concentrated geographic distribution of rabies in India suggests that a significant reduction in the number of deaths or potentially even elimination of rabies deaths is possible.

            ... full paper at;

            http://www.plosntds.org/article/info...l.pntd.0001847
            Twitter: @RonanKelly13
            The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

            Comment


            • #7
              Re: 20,000 rabies deaths per annum in India - Maybe not

              As per reports from the States, deaths due to rabies, during the last three years (CBHI data) in the country are as under:-


              Year // Cases/ Deaths
              2011 // 253
              2012 // 212
              2013 // 138
              2014 // 70 (up to Sept, 2014)

              State wise details are given below:-

              India.png

              Notes: Number of deaths is equal to number of cases.
              Source: Monthly Health Condition Reports from Directorate General of Health Services/UTs



              Health is a State subject. It is primarily the responsibility of the State Government to ensure the availability of anti- rabies vaccine. However, under the National Health Mission (NHM), funds are provided to States/UTs to strengthen their health care system including support for anti-rabies vaccines based on the requirement posed by the States in their Programme Implementation Plans.

              For prevention of deaths due to rabies, Government of India is implementing National Rabies Control Programme under XII Five Year Plan, which has both human and animal health components. NCDC is a nodal agency to implement human health component. The strategy includes:

              ? Training of health professionals in appropriate animal bit management.
              ? Implementation of intra dermal route of inoculation of cell culture anti-rabies vaccines
              ? IEC in general community.
              ? Strengthening laboratories for diagnosis of rabies.
              ? Strengthening surveillance.

              Animal health component is being implemented by Animal Welfare Board of India (AWBI) initially in Haryana and Chennai to pilot test the strategy which includes.

              ? Mass vaccination of dogs.
              ? Dog population management,
              ? Strengthening surveillance & response.

              The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.

              *****


              MV/BK


              (Release ID :112063)
              http://pib.nic.in/newsite/erelease.aspx?relid=112063
              Twitter: @RonanKelly13
              The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

              Comment

              Working...
              X