Online lecture delivered on 26th March 2021 Organized by Hamdard Institute of Medical Sciences and Research, Delhi Speaker: Dr Amir Maroof Khan, Honorary Secretary, Consortium Against Rabies, Delhi

1. National Rabies Control Program
Dr Amir Maroof Khan
Professor, Community Medicine, UCMS and GTBH, Delhi &
Honorary Secretary, Consortium Against Rabies

2. Introduction
• Rabies is an acute viral disease that causes fatal
encephalomyelitis in virtually all the warm-blooded animals
including humans.
• It is transmitted to other animals and to humans through their
saliva (following bites, scratches, licks on broken skin and
mucous membrane).
• In India, dogs are responsible for about 97% of human rabies,
followed by cats (2%), and others (1%).
• Almost 100% fatal, diseases in which the sick person is
tormented at the same time with thirst and fear of water
(hydrophobia).

3. Burden of dog bites and pattern of
management of dog bites to prevent rabies
• 1.75 million dog bites per year
• 25.2 bites/1000 population per year – Delhi slum (Sharma S et al.
2016)
• Around a decade back, it was 4/1000 in Delhi (Lai et al, 2005) and
17/1000 in India (Sudarshan MK et al 2003)

4. …contd…
• Two-fifths of the dog bite patients did not wash the wound with soap
and water.
• The practice of washing the wound with soap and water was
significantly higher in urban than rural slum.
• One-fifth of the patients did not receive anti-rabies vaccine.
• There was lower coverage in rural than urban slum. A majority
(79.0%) of the patients did not receive anti-rabies serum.

5. NRCP
• Funds under NRCP are only provided for training, surveillance,
laboratory strengthening and advocacy etc.
• To include Anti- Rabies vaccine (ARV) and Anti Rabies serum ( ARS
) under essential drug list under NHM
• Drug Controller General of India (DCGI) monitors the pharmaceutical
firms producing ARV for ensuring regular supply of ARV to the
States.
• Note: Funds are not provided under NRCP to purchase ARV

6. • Human component – NCDC is the nodal agency
• Animal component – Animal Welfare Board of India, MoEF, GoI

7. Decision to treat
• Warm blooded animals
• Rabbit, hares, rodents – Not recommended
• Bats – not recommended
• Human to human transmission not recorded except by
transplantation, e.g. cornea

8. Observation period
• The 10 day observation period
• Applicable on dogs and cats only
• Convert PEP to PrEP

9. What to do if the biting animal is vaccinated?
• Vaccinate

10. WHO wound
category

11. PrEP
• Days 0, 7, 21/28 earlier
• Now it’s 0 and 7 only as per WHO guidelines
• 1 ml i/m or 0.1 ml id
• Administered at one site only

12. PEP
• Any time after the exposure d/t variable incubation period
• I/m – 1-1-1-1-1 – Days 0,3,7,14, 28
• i/d – 2-2-2-0-2 – Days 0,3,7, 28
• Current WHO recommendation
• i/m – 1-1-1-1 – Days 0,3,7,14
• i/d – 2-2-2 - Days 0, 3, 7

14. RIG
• Equine – 40 IU/kg BW
• Human – 20 IU/kg BW
• Current WHO guidelines – No upper limit defined
• Not recommended after the 7th day of the first dose of ARV
• To be administered at the site of wound
• Monoclonal antibody (RmAb) – 3.33 IU/kg BW

15. Questions
consortiumagainstrabies.com
consortiumagainstrabies@gmail.com