Eliminating Dog-Mediated Rabies in Sikkim, India: A 10-Year Pathway to Success for the SARAH Program

Abstract

A third of the world rabies burden is in India. The Sikkim Anti-Rabies and Animal Health (SARAH) program is the first state-wide rabies program in India and demonstrates a successful One Health model of dog-mediated rabies elimination. The SARAH program was created in 2006 as a collaboration between the Government of Sikkim and international non-government organizations—Vets Beyond Borders and Fondation Brigitte Bardot. Activities are directed to canine rabies vaccination, humane dog population control, community education, and treatment of sick and injured animals. In 2005, there were 0.74 human rabies deaths per 100,000 (4 deaths) within Sikkim, and from 2006 to 2015, there were no human rabies deaths. In 2016, two human rabies deaths were reported near the West Bengal border region. From 2005 to 2010, the incidence of animal rabies is unknown; from 2010 to 2016, eight cases of animal rabies were reported. Major challenges for the program are continued commitment to rabies control in the face of 0 to low human rabies incidence and the risk of rabies incursions. Effective intersectoral communication between Health, Veterinary, Forestry, and Police officers is essential to enable rapid response to animal bite incidents and possible rabies incursions. An integrated One Health approach needs to be maintained with enhanced active rabies surveillance. Other states must establish similar programs if India is ever to achieve a goal of eliminating dog-mediated human rabies.

Long term trends and spatial distribution of animal bite injuries and deaths due to human rabies infection in Uganda, 2001-2015

“…An effective strategy for combating rabies and dog bites in Uganda should focus on strengthening multi-sectoral collaboration and coordination through a “One Health” approach and strengthening rabies and animal bites surveillance as recommended during the 2015 global rabies conference [ 44 ]. Strong collaboration and coordination between human and animal sectors have been instrumental in successful control of human rabies in selected areas in Africa and Asia [ 43 , 45 ]. Poor surveillance and lack of collaboration among partners can lead to poor understanding and underestimation of the burden of rabies [ 4 , 6 ].…”

Reorienting rabies research and practice: Lessons from India

“…Mass antirabies vaccination (ARV) and neutering/animal birth control (ABC) programmes instead aim to establish healthy and stable dog populations as a means of preventing rabies. In principle, this One Health approach to rabies elimination also addresses cultural opposition to and ethical problems associated with the killing of dogs (Morters et al, 2013;Putra et al, 2013;Häsler et al, 2014;Byrnes et al, 2017).…”

Modelling the challenges of managing free-ranging dog populations

“…It is important to point out here that the scenarios mentioned above are highly conservative, and that in actuality both the proportion of inaccessible dogs, as well as immigration rates are likely to be much higher. This is because, unlike the situation in countries from the African continent (and other parts of the world), where most dogs are either wholly or partially owned by individuals or communities 36 , in India, a significant proportion of dogs may be unowned (between 18 and 42%) 37 – 39 . Interventions like ABC or mass vaccination require capture and handling of such dogs.…”