Abstract
BackgroundIt is estimated that India has more deaths from rabies than any other country. However, existing estimates are indirect and rely on non-representative studies.Methods and Principal FindingsWe examined rabies deaths in the ongoing Million Death Study (MDS), a representative survey of over 122,000 deaths in India that uses enhanced types of verbal autopsy. We estimated the age-specific mortality rates of symptomatically identifiable furious rabies and its geographic and demographic distributions. A total of 140 deaths in our sample were caused by rabies, suggesting that in 2005 there were 12,700 (99% CI 10,000 to 15,500) symptomatically identifiable furious rabies deaths in India. Most rabies deaths were in males (62%), in rural areas (91%), and in children below the age of 15 years (50%). The overall rabies mortality rate was 1.1 deaths per 100,000 population (99%CI 0.9 to 1.4). One third of the national rabies deaths were found in Uttar Pradesh (4,300) and nearly three quarters (8,900) were in 7 central and south-eastern states: Chhattisgarh, Uttar Pradesh, Odisha, Andhra Pradesh, Bihar, Assam, and Madhya Pradesh.Conclusions and SignificanceRabies remains an avoidable cause of death in India. As verbal autopsy is not likely to identify atypical or paralytic forms of rabies, our figure of 12,700 deaths due to classic and clinically identifiable furious rabies underestimates the total number of deaths due to this virus. The concentrated geographic distribution of rabies in India suggests that a significant reduction in the number of deaths or potentially even elimination of rabies deaths is possible.
Highlights
Rabies has been recognized for many millennia in India, long before Aristotle recognized the disease in the Graeco-Roman era [1]
As verbal autopsy is not likely to identify atypical or paralytic forms of rabies, our figure of 12,700 deaths due to classic and clinically identifiable furious rabies underestimates the total number of deaths due to this virus
The ancient Vedic text ‘‘Sushruta Samhita’’ contains graphic descriptions of rabies in animals and in humans: ‘‘If the patient becomes exceedingly frightened at the sight or mention of the very name of water, he should be understood to have been afflicted with Jala-trsisa and be deemed to have been doomed’’ [2]
Summary
Rabies has been recognized for many millennia in India, long before Aristotle recognized the disease in the Graeco-Roman era [1]. A non-representative survey based on case detection of rabies, and verbal autopsies of identified furious rabies cases, estimated about 17,000 human rabies deaths for the whole country [3]. This total was further expanded by 20% to account for paralytic and atypical forms and resulted in the widely quoted final figure of just over 20,000 rabies deaths per year. In 2004, a dog-bite probability model was used to re-evaluate the burden of rabies in Africa and Asia This method yielded an estimate of about 20,000 human deaths from rabies in India [4]. Existing estimates are indirect and rely on non-representative studies
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