This article is related to Rabies and One health co concept related to it as per the 2023 World Rabies day theme All for 1 One health for All.

1. All for 1, One health for all
Dharya Yadav
THIRD YEAR VCRI Namakkal , 637002 TANUVAS
Email-dharyay12199@gmail.com
Mobile no. - 9997489467
One Health is a multi-sectoral, interdisciplinary, and collaborative
approach to attain optimal health for animals, the environment, and
humans (CDCP, 2020). One Health can provide a framework for
national authorities to understand and implement it for improved
connectivity and collaboration among various stakeholders (Jarhult and
El Zowalaty, 2020).
One Health offers an approach to yield added value from the collective
strengthening of human, animal, and environmental health systems to
enable their coordination and collaboration to address threats at the
human-animal-environment interface for effective prevention,
detection, response, and recovery.
One health includes -
 Human health
 Animal health
 Agricultural and plant health
 Environment health
Implementation of One Health does not require merger of various
sectors. Basic tenet of One Health is to strengthen core capacity in
every sector that has a bearing upon prevention, detection, response and
recovery to zoonotic infections and AMR, and assure a sustainable,
strong, beneficial and productive mechanism of coordination and
collaboration that results in synergistic action for public good.
One Health is an approach. On recognition of its importance, a process
to initiate its implementation has to begin. Instead of commencing in a
big way and across all diseases, it may be better to identify most
practical few entry points, which can be considered in context with a
rapid assessment for feasibility.

2. A few examples are:
 AMR
 pandemic or any other critical event
 endemic and epidemic zoonoses, and
 initiatives by professional bodies/associations
ONE HEALTH AND RABIES
Rabies is a highly fatal panzootic disease caused by Lyssavirus
(Rhabdoviridae) which is a single stranded, negative sense, non-
segmented RNA that infects the nervous system and salivary glands .
All species of domestic animals are susceptible to rabies. Rabies virus
is highly neurotropic in the infected host causing acute fatal and
progressive fatal encephalomyelitis. Virus transmission occurs mainly
via animal bite and once the virus is deposited in the peripheral wounds,
centripetal passage occurs towards the central nervous system. Rabies
should be suspected in patients with concomitant history of animal bite
and traditional clinical presentation, but lack of such clues makes ante-
mortem diagnosis a major challenge (Rupprecht et al.,2002). Two
clinical forms of Rabies are recognized the dumb or paralytic type -
primarily due to damage to the spinal cord and the furious form mainly
due to damage to the brain. Rabies is a major public health threat
causing an estimated 59,000 human deaths every year across the globe
(Hampson et al., 2015), while approximately 20,000 people die
annually in India. It is endemic throughout the country with the
exception of Andaman, Nicobar and Lakshadweep Islands (Aneesh,
2017). A novel strategy for combating Rabies is the interdisciplinary
“One Health approach”. The American Veterinary Association defines
One Health as “the collaborative effort of multiple disciplines -
working locally, nationally, and globally - to attain optimal health .
IN CONTEXT TO INDIA
Rabies is responsible for extensive morbidity and mortality in India.
The disease is endemic throughout the country. With the exception of
Andaman & Nicobar and Lakshadweep Islands, human cases of rabies
are reported from all over the country. The cases occur throughout the
year. About 96% of the mortality and morbidity is associated with dog
bites. Cats, wolf, jackal, mongoose and monkeys are other important

3. reservoirs of rabies in India. Bat rabies has not been conclusively
reported from the country.
To address the issue of rabies in the country, National Rabies Control
Programme was approved during 12th FYP by Standing Finance
Committee meeting held on 03.10.2013 as Central Sector Scheme to be
implemented under the Umbrella of National Health Mission.
Objectives
 Training of Health Care professionals on appropriate Animal bite
management and Rabies Post Exposure Prophylaxis.
 Advocacy for states to adopt and implement Interdermal route of
Post exposure prophylaxis for Animal bite Victims and Pre
exposure prophylaxis for high risk categories.
 Strengthen Human Rabies Surveillance System.
 Strengthening of Regional Laboratories under NRCP for Rabies
Diagnosis.
 Creating awareness in the community through Advocacy &
Communication and Social Mobilization.
Programme components
The Programme had two components – Human and Animal
Components.
1) Human Component for roll out in the all States and UTs through
nodal agency National Centre for Disease Control (NCDC),
Ministry of Health & Family Welfare, Government of India
2) Animal Health Component for pilot testing in Haryana and
Chennai through nodal agency Animal Welfare Board of India
(AWBI) under the aegis of MoEF&CC, GOI.
Animal Health Component by AWBI has been ended with effect from
31.3.2017. The Human Health Component has been rolled out in 28
States and UTs.
The Strategies of the National Rabies Control Program are as follows:
 provision of rabies vaccine & rabies immunoglobulin through
national free drug initiatives

4.  training on appropriate animal bite management, prevention and
control of rabies, surveillance and intersectoral coordination
 strengthening surveillance of animal bites and rabies deaths
reporting
 creating awareness about rabies prevention
National Action Plan For Dog Mediated Rabies Elimination
Ministry of Health & Family Welfare and Ministry of Fisheries Animal
Husbandry & Dairying, Government of India jointly launched
‘National Action Plan For Dog Mediated Rabies Elimination (NAPRE)
from India by 2030’. The stray dog population control and management
of the stray dogs is the mandate of the local bodies. The Central
Government has framed the Animal Birth Control (Dogs) Rules, 2023
which is to be implemented by the local authority to control the
population of stray dogs. The main focus of the rules is on anti-rabies
vaccination of stray dogs and neutering of stray dogs as means of
population stabilization.
CONDITION
Rabies is an acute viral disease that causes fatal encephalomyelitis in
virtually all warm-blooded animals including man. The virus is found
in wild and some domestic animals and is transmitted to other animals
and humans through their saliva (following bites, scratches, licks on
broken skin and mucous membrane). In India, dogs are responsible for
about 95% human rabies, followed by cats (2%). jackals, mongoose
and others (1%). Therefore, the disease is mainly transmitted by the
bite of a rabid dog.
Rabies has terrified man since antiquity. The fear is by no means
unfounded since the disease is invariably highly fatal and perhaps the
most painful and dreadful of all communicable diseases in which the
sick person is tormented at the same time with thirst and fear of water
(hydrophobia). Fortunately, the development of Rabies can be
prevented to a large extent if animal bites are managed appropriately
and in time. In this regard, the post-exposure treatment of animal bite
cases is of prime importance.

5. National Rabies Control Programme (NRCP) is being implemented in
the country since the 12 Five Year Plan with an objective to prevent
deaths due to rabies in humans. National Centre for Disease Control is
the nodal centre for implementation of the programme. The key
strategies of the programme are:
 Strengthening surveillance of animal bites and human rabies
 Capacity building of health care professionals for appropriate
management of Animal Bite victims
 Strengthening laboratory diagnosis of Rabies
 Increase awareness about Rabies in the community
 Strengthening Inter-Sectoral Collaboration with other sectors
particularly veterinary and animal husbandry
National Centre for Disease Control (formerly National Institute of
Communicable Diseases), Delhi, WHO Collaborating Centre for
Rabies Epidemiology, organized an expert consultation in 2002 to
formulate National Guidelines for Rabies Prophylaxis to bring out
uniformity in post-exposure prophylaxis practices. These guidelines
were revised in expert consultations in 2007, 2013 and 2015. Recently,
the WHO position paper on rabies vaccines and WHO expert
consultation on rabies, third report (WHO Technical Report Series, No.
1012) published in 2018, has provided new recommendations for rabies
PEP. Consequently, an expert group meeting was called by NCDC,
NRCP programme, Division for Zoonotic Diseases Programmes on 8th
January 2019, to review the new recommendations of WHO. Based on
the recommendation of the experts, the National Guidelines on Rabies
Prophylaxis have been revised.
DECISION TO TREAT
In a rabies endemic country like India, where there is sustained dog-to-
dog transmission, every animal bite is suspected as a potentially rabid
animal bite, and treatment should be started immediately after
exposure. Post-exposure prophylaxis needs to be considered in the
following conditions:
 Bites by all warm-blooded animals.

6.  Exposure to wild animals: Exposures to all wild animals should
be treated as Category Ill exposure.
 Rodent Bites: Exposure to domestic rodents, hare and rabbits do
not ordinarily require PEP. However, rodent bites in forest areas
necessitate institution of PEP.
 Exposure to bats: Bat rabies has not been conclusively proven in
India and hence, at present, exposure to bats does not warrant
PEP.
 Human-to-human transmission: The risk of human-to-human
transmission is minimal and there are no well-documented cases,
other than the few cases resulting from infected organ/tissue
(cornea) transplant. However, people who have been exposed
closely to the secretions of a patient with rabies may be offered
PEP as a precautionary measure. Organ/ tissue (cornea) for
transplantation should not be collected from suspected/confirmed
rabies or Rabies-like encephalitis cases.
VACCINATION STATUS OF BITING ANIMAL:
An observation period of 10 days is necessary as no information is much animal
about animals other than dogs and cats. Animals vaccinated against rabies
do not suffer and transmit the disease. The history of animal vaccine
failures may occur because of improper administration, inadequate
doses, poor quality of the vaccine or poor health status of the animal.
Rabies vaccination in an animal does not guarantee that the biting
animal is not rabid. Therefore, in the absence of laboratory
documentation of immunization (antibody titre), it cannot be presumed
that a vaccinated dog is actually protected, given the variable efficacy
of various anti-rabies vaccines in animals or health status of animals.
Hence, irrespective of the vaccination status of the biting animal, the
PEP should be given.
PROVOKED VERSUS UNPROVOKED BITE:
A bite by a provoked animal does not mean that the animal is not rabid.
Therefore, a provoked dog bite should also be managed as exposure
and PEP should be started immediately.
CONTRAINDICATIONS AND PRECAUTIONS:

7. As rabies is a nearly 100% fatal disease, there is no contraindication to
PEP. Pregnancy, lactation, infancy, old age and concurrent illness are
not the contraindications for Rabies PEP in the event of an exposure.
Moreover, rabies vaccine does not have any adverse effect on pregnant
woman, course of pregnancy, foetus or lactating mother. Hence,
complete PEP should be given depending on the category of exposure.
People taking Chloroquine for Malaria treatment or prophylaxis may
have a reduced response to Intradermal (1D) Rabies vaccination. These
patients should receive the rabies vaccine by Intramuscular (IM) route.
As with all other immunizations, vaccinated persons should be kept
under medical supervision for at least 15-20 minutes following
vaccination. Previous reaction to any component of a vaccine is a
contraindication to the use of the same vaccine for PEP or PrEP. The
long and variable incubation period, which is typical of most t human r
rabies cases, provides a window of opportunity to initiate PEP and
protect the individual.This must be started at the earliest to ensure that
the individual is immunized or protected before the rabies virus reaches
the nervous system. However, people who present for treatment even
months or years after a possible rabies exposure should be evaluated
and treated as if the event had occurred recently. Risk assessment of
potential rabies exposure can be complex and confusing. When in
doubt PEP should be initiated and the attending physician should
consulta specialist at Anti Rabies Clinics (ARC)
APPROACH TO POST-EXPOSURE PROPHYLAXIS (PEP)
PEP is a three-pronged approach as given below. All three carry equal
importance and should be done simultaneously as per the category of
exposure.
1Management of animal bite wound(s)
2 Passive immunization with Rabies Immunoglobulin (RIG)
3 Active immunization with Anti-Rabies Vaccines (RABIES
VACCINE)
DURATION OFIMMUNITY
Modern Rabies Vaccines establish immunological memory that is
assumed to persist for the life of the individual, even after titres of

8. neutralizing antibodies decrease or are no longer measurable. Clinical
data confirm that people vaccinated by modern Rabies Vaccine respond
to booster immunization within 7 days, even if the initial course of PrEP
or PEP was administered a decade back and regardless of the route of
priming or booster immunization (IM or ID), and regardless of
presence or absence of detectable titres of RABV-specific antibodies at
the time of the booster.
In addition, published data indicate that periodic booster doses of
vaccine are not required after primary rabies vaccination, except as an
additional precaution in people with documented immune-deficiency
should be evaluated individually. Patients with immune-compromised
conditions (HIV/AIDS, patients on chemotherapy, long term steroid
therapy, cancer etc.) may have a significantly lower or no detectable
neutralizing antibody response to Rabies Vaccine In most of the
settings, it is not possible to determine the severity of immune
suppression when patients consult for PE. Therefore, in all Immune
compromised individuals, in whom the presence of immunological
memory is no longer assured, the following protocol should be
followed:-
• Proper wound management followed by local infiltration of RIG
in both Category Il and Ill exposures.
 After this, a complete course of Rabies Vaccine by IM route in
both the category II and III exposures should be undertaken.
 Preferably, if the facilities are available, anti-rabies antibody titre
estimation should be done 14 days after the completion of the
course of vaccination to assess the need for additional doses of
vaccine
Prevention
Paved floors, walls and permanent standings were disinfected by
burning litter straw over the surface and by using blow lamp on the
walls followed by washing thrice with 5 % solution of carbolic acid and
10% chlorinated lime coating. Soil surface of day standings occupied
by infected animals were scrapped off and burnt using litter straw.
Mangers, drains and day standings were sprinkled with chlorinated
lime, blow lamped and exposed to sunlight for a fortnight. Water

9. troughs and sidewalls were painted with chlorinated lime. All bedding
or excrements in contact with suspected animals were destroyed by
incineration. All the disinfection procedures were repeated on
fortnightly basis. The vehicle used for transportation of carcasses was
thoroughly disinfected using sodium hydroxide solution, blow lamp
and exposing to sunlight. Animal handlers and veterinary staff were
educated on risk of transmission of disease and precautions to be
adopted.
Movement restriction and liaison
Restriction on movement of animals and animal attendants were
imposed till the completion of prophylaxis. Stables have been kept
under active surveillance for a period of one year. Additional fencing
was also constructed to surround the animal stables to prevent any entry
of carnivores to animal premises. Veterinary bodies of States and
District are communicated about the incidence of Rabies for strict
monitoring and adoption of measures to check transmission of the
zoonotic disease in civil population and close liaison with veterinary
and livestock development office has been maintained.
Discussion
One health approach employed can be a guiding source for control of
any public health emergencies occurring in any developing or
underdeveloped country in future. Due to repeated re-emergence of this
viral disease and consequent threat to human and animal lives and
economic losses involved, on the recommendation of veterinary
authorities prophylactic anti-rabies vaccination has been added in the
schedule of annual vaccinations/inoculations of army equines. The
controlof zoonotic diseases such as Rabies requires inter-disciplinary
and inter-sectoral collaboration. This fact is recognised globally by the
concept of ‘one-Health agenda’ currently encouraged by the Food and
Agriculture Organization (FAO), World Health Organization (WHO)
and World Organization for Animal Health (OIE) (Adomako et
al.,2018). Rabies represents an economic burden globally for all
countries due to huge expense of human post-exposure treatment,
diagnosis, surveillance and immunization of domestic animals and
wildlife, requires more attention towards control of the disease and

10. research on its various aspects (Toloueiand Mostofi, 2017). As in other
warm-blooded animals, equine. Rabies is a severe and rapidly
progressive neurological disease (Wilkins and Del Piero, 2007).
Although Rabies in horses is low (around 5% of the total cases
reported) and relatively uncommon, it’s potential for human exposure
makes it lethal (Fernanda, 1914). WHO recommends that
immunizing70% of dogs will be sufficient to prevent or control
outbreaks of dog Rabies (Coleman and Dye,1996). One need not be
clairvoyant to state that ‘one health approach’ is only the effective
approach to prevent or control zoonotic diseases such as Rabies.
Conclusion
The dreaded Rabies outbreak is controlled through multipronged
approach which involves coordinating the efforts of veterinarians,
medical practitioners, laboratory, local population and administrators
to tackle a public health problem. And thus is an approach towards
ONE HEALTH APPROCH towards the spread of the disease which
should be understood and motivated by all as the extreme priority .