Assessment of current burden of human rabies at Sir Ronald Ross Institute of Tropical and Communicable Diseases (Government Fever Hospital) – Five year study

Human rabies has been still endemic in India. There are an increasing number of studies estimating the burden of human rabies, but the true incidence of the disease and endemicity were rarely reported in the literature. The main objectives of the present study were to determine the endemicity and to estimate the current burden of human rabies in and around Sir Ronald Ross Institute of Tropical and Communicable Diseases (SRRIT & CD), Nallakunta, Hyderabad. All cases admitted at SRRIT & CD with signs and symptoms of rabies were studied during the period of January 2009 and December 2013. The annual incidence of human rabies in this hospital was estimated to be 152. It is endemic mainly in urban areas that include many areas in Hyderabad and Secunderabad and also adjacent districts. The majority of the patients were children and adult male, from urban areas, and had not taken post exposure prophylaxis (PEP) i.e. wound care, active immunization (ARV) and passive immunization (RIG). The main animals responsible for bites were dogs (99%), most of which were stray and the most common bite sites were the extremities. Most common clinical feature was hydrophobia. About 92.76% of these patients had not taken PEP. Human rabies continues to be a dreadful disease in India and the dogs are the principal reservoir, mainly stray dogs. This study provides strong evidence that human rabies is still an endemic disease even in urban areas. This is mainly due to lack of awareness about proper PEP. Improved coverage with modern rabies vaccines, control of rabies due to dogs and other animals and intensifying public education about the disease play main role in the reduction of the disease.