Foreign visitors to India are unaware of rabies risk
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7511.255 (Published 28 July 2005) Cite this as: BMJ 2005;331:255
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Dear Editors,
Disorganized health services, absence of wildlife vaccinations and lack of funds have made Greece lose its rabies-free status after 25 years! [1][2][3][4][5]
Millions of tourists, that visit Greece every year, might choose a different destination next year, after reading international rabies warnings. [1][4]
The amount of the economic damage to Greece’s tourism industry could rise to several billion pounds.
If big numbers of Greek farmers and villagers are vaccinated against rabies, blood donated in Greece could be at risk for Creutzfeldt-Jakob disease (CJD). [6]
References
[1] https://www.nathnac.org/pro/clinical_updates/rabies_greece_231012.htm
[2] http://www.jordbruksverket.se/swedishboardofagriculture/engelskasidor/an...
[3] http://www.defra.gov.uk/animal-diseases/files/poa-rabies-fox-greece.pdf
[4] http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1317136644107
Competing interests: No competing interests
In India, modern medicine and traditional medicines have officially
equal status. There are some herbal medicines of demonstrable efficacy but
most herbal treatments, good trial of efficacy are lacking.2
There are herbalists in India claiming to cure rabies or prevent
developing rabies once bitten by rabid dogs. Adding to the confusion of
apparently curing hysterical rabies by herbal remedies, according to
available statistics, only around a fourth of one percent of the people
bitten by rabies infected dogs catch rabies. A bite by the rabid dog
during incubation period does not necessarily carry a risk of rabies
because the virus is not in saliva. Such a tricky situation gives an
opportunity for the herbalists to claim that they have cured the remaining
people bitten by the rabid dog who will not develop rabies anyway, whether
treated or untreated. This makes herbal medicines look successful for
rabies treatment and the herbalists get a favourable propaganda. Injection
with anti-rabies vaccine into the abdominal muscles can be scary. The
death due to rabies is horrific and should be prevented at any cost.Some
of the deaths I had to witness in my medical scool days in the isolation
ward of Kottayam Medical college in Kerala still loom in my mind and
compell me to publish this write up.
It looks as though the current situation for foreign tourists getting
infected with rabies from rabid dogs in India is not posing any serious
concern. There are westerners who are highly passionate about Indian
herbal medicines and they visit India frequently for herbal remedies.
There is a hypothetical possibility that such a vulnerable western tourist
could get trapped into receiving herbal treatment in the event of a rabid
dog-bite.
It is high time that Indian medical hierarchy should look into the
prevailing misuse of herbal remedies for rabies and take necessary steps
to ban such a dangerous practice as it could even discredit other
effective herbal treatments. My own Indian grand mother practised
traditional treatments but never tried them on rabies patients.
Reference:
1.Mudur Ganapati.Foreign visitors to India are unaware of rabies risk. BMJ
2005;331:255
2. Fermer and Beard. Regulating Herbal medicines in U.K. BMJ 2005; 331: 52
-63.
Competing interests:
None declared
Competing interests: No competing interests
The article by Ganapati M, is alarmist; in warning foreigners of a
‘lurking serious health problem’ in India in the form of rabies, the
writer has cited statistics, which at best only show the risk is minimal.
The 22 India-exported cases of rabies in U.K. are, as he himself writes,
from records spread over one hundred plus years. It is prudent to recall,
that in well nigh half of this hundred year period, it was the Raj in
India, with thousands from the British Isles here, not as tourists, but as
residents, leading life and pursuing livelihood in this corner of the
empire.
Even here, as is evident from a closer look at the statistic
provided, death from rabies is only to the tune of around a fourth of one
percent of dog-bite cases. While one does readily accept that, rabies, as
a scourge is a bigger problem in the subcontinent than in the west, it is
neither as widespread, nor as sinister, as some ‘imported’ diseases in
India such as HIV-AIDS exposing far higher risk to the foreign visitor
than rabies.
On its part, the state and central governments are doing their best
to raise public awareness in on rabies – but in a country with a huge
population, with a high percentage of illiteracy and a higher one of
poverty, coupled with the ethos of ‘ahimsa’ sanctioned by dharmic and
religious tenets – the task is gigantic. However, free administration of
anti-rabies vaccine is available in many government managed hospitals, not
only for the indigent and illiterate local, but also for the ill-informed
foreign tourist.
Competing interests:
None declared
Competing interests: No competing interests
In my medical school days in India, the lecturer of infectious
diseases gave a demonstration on a young patient supposedly suffering from
rabies. He cleverly elicited hydrophobia and pharyngeal spasms. As the
patient did not die after several weeks, the diagnosis turned out to be
hysterical rabies; a case example illustrating the difficulty in
diagnosing rabies.
The point is that in rural India there are herbal specialists who
claim to cure rabies and they do apparently cure hysterical cases of
rabies much to the satisfaction of the general public. They themselves are
innocently surprised that they could cure rabies excelling their modern
medical rivals without knowing the existence of an entity like hysterical
rabies. Unfortunately, their practice has grave consequences in the
treatment of true cases of rabies. Instead of getting modern medical help,
the illiterate Indians seek the help of the herbalists and die; some of
the deaths that could have been otherwise prevented with timely rabies
vaccination.
Competing interests:
None declared
Competing interests: No competing interests
Re: Foreign visitors to India are unaware of rabies risk
I refer to the rapid response from our Greek colleague. He raises the risk of CJ disease from blood transfusions IN GREECE, if large numbers are immunised in Greece. Surely, in this day and age, rabies vaccine used in Greece is sourced from human cells, NOT from sheep?
JK Anand
Competing interests: No competing interests