The growing threat of 'Rabies in Rajbari'

As a physician witnessing the escalating crisis of dog bites in our community, I feel compelled to address the mounting public health emergency that has gripped the Rajbari district over the past four months. The statistics are not merely numbers on a page—they represent a genuine threat to our community's well-being.

In my capacity as an emergency management expert, I've observed an unprecedented surge in dog bite cases. Last Sunday alone, our hospital administered anti-rabies vaccinations to 157 individuals, which should give us all pause. The daily average of 50-80 new cases presented to our emergency department represents a significant burden on our healthcare infrastructure and, more importantly, a serious risk to public health. Though these vaccines are also given to cat-bite/scratch patients, there is no doubt that an alarming rise of incidents has been officially reported. 

The vaccine service is available in Room 203 of Rajbari District Sadar Hospital and in-charge of the vaccination team is also puzzled by the high rise of dog bite incidents for the last couple of months.  

What particularly disturbs me as a medical professional is the reported aberrant behaviour of these canines. Patients consistently describe unprovoked attacks, a characteristic often associated with rabid animals. The presence of suspicious neck ulcerations observed in several of the aggressive dogs adds another layer of concern to this already complex situation.

For last 2 months, almost every day in first half of the day, we have received so many patients who complain about the same dog biting several passers-by. 

From a clinical perspective, our community must understand the gravity of dog bites and their potential consequences. The World Health Organization, in collaboration with Bangladesh's health authorities, has established a clear classification system for dog bite exposures, which I will elucidate for public awareness.

The World Health Organization (WHO) categorizes rabies exposure into three categories, each requiring specific treatment protocols. These guidelines, customized for Bangladesh, are as follows:

Category 1: Touching or feeding animals or licks on intact skin.

Treatment: Wash the site thoroughly with soap and water only. No vaccination is required in this category.

Category 2: Minor scratches or abrasions without bleeding.

Treatment: Proper wound management and administration of the anti-rabies vaccine (ARV) as soon as possible, ideally on the first visit.

Category 3: Single or multiple transdermal bites or scratches with active bleeding, licks on broken skin, contamination of mucous membranes with saliva, or exposure to bats.

Treatment: Immediate wound management, administration of anti-rabies vaccine, rabies immunoglobulin (RIG), and prophylactic antibiotics if necessary. Anti-tetanus vaccination may also be required in some cases.

Failure to adhere to these guidelines can lead to catastrophic outcomes, including viral encephalitis and death, as rabies remains untreatable once symptoms manifest.

The availability of government-supplied anti-rabies vaccine (ARV) at our facility provides some reassurance, but vaccination alone cannot stem this tide. As a medical professional, I strongly advocate for a multi-faceted approach encompassing several critical components.

Why are these incidents rising?

Several factors may be contributing to the increase in dog bites in Rajbari:

Unvaccinated stray dog population: Stray dogs serve as reservoirs for the rabies virus. Limited vaccination coverage among these animals likely exacerbates the risk.

Possible zoonotic illness in dogs: Observations of ulcers on some dogs' necks necessitate veterinary and pathological investigations. These symptoms may point to zoonotic diseases affecting canine behavior and increasing aggression.

Inadequate surveillance and reporting: The absence of robust epidemiological data on rabies cases and dog bites hampers effective response measures.

Lack of awareness and delayed treatment: Community-level ignorance about rabies' severity leads to delayed medical interventions, significantly increasing mortality risk.

Changes in dog behaviour: The aggressive, unprovoked attacks reported suggest possible rabid or stressed behavior among the dog population, a sign of environmental or health stressors.

Public health and medical interventions

To combat this alarming rise in dog bites, a multi-pronged, scientifically guided approach is essential:

Mass dog vaccination sampaigns: Immediate vaccination of stray and domestic dogs is crucial to breaking the transmission cycle. Vaccinating at least 70% of the canine population can significantly reduce rabies transmission.

Enhanced surveillance systems: Implementing a real-time surveillance mechanism to monitor dog bite incidents, rabies cases, and treatment compliance can aid in early outbreak detection and intervention.

Rapid post-exposure prophylaxis (PEP): Ensuring an uninterrupted supply of ARV and RIG at all healthcare facilities, particularly in high-risk zones like Rajbari, is non-negotiable. Establishing rapid-response PEP clinics would reduce delays in treatment.

Community health education: Targeted educational campaigns highlighting the importance of immediate wound washing, prompt medical consultation, and adherence to PEP schedules are vital. School-based programs can focus on children, who are among the most vulnerable.

Veterinary collaboration: Investigation of abnormal canine behavior and health conditions, such as observed neck ulcers, should involve veterinary pathologists to determine potential zoonotic links and guide further control measures.

Stray dog population management: Humane sterilization programs and ethical relocation strategies should be employed to manage the stray dog population effectively.

Strengthening laboratory facilities: Regional laboratories should be equipped to perform molecular diagnostics for rabies and other zoonotic diseases, ensuring accurate and timely disease identification.

Rabies and its broader implications

Rabies control is not merely a local issue but a global health priority under the One Health framework, emphasizing the interconnectedness of human, animal, and environmental health. Bangladesh has committed to the global goal of achieving zero human rabies deaths by 2030, and addressing this outbreak aligns with that mission. The current situation in Rajbari serves as a microcosm of larger challenges faced nationwide.

A call for collective action

The rise in dog bite incidents is a stark reminder of the need for an integrated response that includes public health authorities, animal health experts, local governance, and community participation. As a medical professional, I emphasize the need for immediate and evidence-based interventions to mitigate this crisis. Rabies is preventable, and with sustained efforts, we can save lives and create a safer environment for all. Let us act decisively and collaboratively to confront this pressing public health threat.