International Journal of Surgery Open 56 (2023) 100638
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International Journal of Surgery Open
journal homepage: www.elsevier.com/locate/ijso
Editorial
Human exposure to Rabies due to dog menace: An evolving concern
A R T I C L E I N F O
Keywords
Rabies
India
Elimination
Dog menace
Vaccine
On May 20, 2023, the death of a buffalo calf due to suspected rabies
spread panic among the villagers in a village in Kumaram Bheem Asi­
fabad district of Telangana [1]. According to community members, a
dairy farmer’s buffalo was attacked by a dog a few days ago, but he
failed to get vaccinations for rabies [2]. The farmer continued to supply
buffalo milk to residents in the region. Meanwhile, a calf dependent on
the mother buffalo’s milk died. This alarmed the residents, who rushed
to the gram panchayat office in fear of rabies infection. On May 20,
2023, health officials organised a vaccine camp and distributed
anti-rabies vaccine to around 300 people in district headquarters as soon
as the event became known [1].
In the three months preceding the aforementioned incidence, four
children had died in Telangana. A pack of stray dogs mauled three of
them to death, and the fourth child had rabies as a result of the dog bite
[1]. A similar incident occurred in Madhya Pradesh in March 2022,
when a buffalo and its calf were killed after being bitten by a rabid stray
dog [3]. Hundreds of people found that the raita they had eaten the day
before at a religious ritual was prepared from the same buffalo milk
curd. State health officials administered anti-rabies vaccine to some
people. Similar incident was reported by Oklahoma State Department of
Health (OSDH) late back in December 2005 [4]. Since 1996, there have
been two reports of possible mass rabies exposures through drinking
unpasteurized milk in 1996 and 1998 [5]. These two cases were re­
ported in the Worcester County farm Holstein dairy cows and the lab­
oratory diagnose of rabies was confirmed by antigen detection in cow’s
brain tissue with monoclonal antibodies. In both incidents mass
administration of anti-vaccine vaccine was done [5].
Rabies cases in humans caused by non-bite exposures are extremely
rare. Non-bite exposures comprise abrasions, scratches, open wounds
and mucus membrane contaminated with saliva of rabid dog or other
highly infectious material (like brain, spinal cord tissue) of rabid animal.
Laboratory workers are at high risk for exposure to aerosolized rabies
virus than other individuals. There are no published research studies
indicating the presence of rabies virus in cow’s milk. Rabies virus is heat
sensitive; hence pasteurization effectively destroys the virus. However,
consumption of unpasteurized milk may lead to the transmission if
https://doi.org/10.1016/j.ijso.2023.100638
Received 6 June 2023; Accepted 10 June 2023
Available online 13 June 2023
2405-8572/© 2023 The Author(s). Published by Elsevier Ltd on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
viewed theoretically in case of young children, immunosuppressed in­
dividuals, people with mucous membrane breach due to palate abnor­
malities, open sores, mucus ulcers in the mouth, and upper
gastrointestinal tract [4]. To date, not a single human case of rabies has
ever been reported with transmission in this way [6].
Rabies is a vaccine-preventable virus that is transmitted by canines
and other mammals. The disease induces brain and spinal cord inflam­
mation. It is transmitted to humans through the saliva of rabid dogs and
is known to cause convulsions and even mortality. Rabies affects more
than 3,3 billion people worldwide and is estimated to cause approxi­
mately 60,000 deaths annually, 40% of whom are children younger than
15 years. According to the World Health Organization (WHO), Rabies is
one of the most neglected diseases in low-income countries [7]. India is
estimated to have the highest rabies burden with both higher annual
deaths and disability-adjusted life years (DALYs) [8]. India accounts for
around 36% of global rabies deaths and nearly 67% of rabies deaths in
Asia annually [9]. Elimination strategies have remained limited in Af­
rica and Asian countries due to lack of large-scale dog vaccination and
increasing dog menace. A recent study from Goa State, India has shown
an 92% decrease in monthly canine rabies cases from 2013 to 2019 by
utilizing a data-driven approach smartphone technology to locate the
teams to achieve 70% vaccination coverage in defined areas and the
facilitating the education teams to reach 1.5 lakh children annually
[10].
Although health organizations including WHO, the World Organi­
zation for Animal Health (OIE), and the Food and Agriculture Organi­
zation (FAO) have collectively committed to eradicating dog-
transmitted human rabies by 2030 on a global scale, there are still sig­
nificant challenges to be overcome. National Action Plan for the Elimi­
nation of Dog-Mediated Rabies in India by 2030 (NAPRE) was developed
by the National Centre for Disease Control in collaboration with other
stakeholders. NAPRE is predicated on averting human deaths from
rabies by guaranteeing to provide all animal bite victims with post-
exposure treatment and creating a responsive public health system [11].
Rabies has over ninety-nine percent death rates following contact
with a rabid dog. Recent guideline for rabies management emphasizes
Editorial International Journal of Surgery Open 56 (2023) 100638

the importance of integrating human, animal, and environmental vari­ References

ables inside a “One Health” framework [11]. A One health approach
ensures the participation of multiple sectors and local communities in
order to raise awareness and conduct extensive dog vaccination cam­
paigns. Ideally a 70% percent anti-rabies vaccination coverage among
dogs is essential for animal health, in a specific area for three years. The
prevention and control of rabies using the “One Health Approach” shall
be difficult in the Indian context due to the diverse administrative
structures and priorities among the sectors involved at the national and
sub-national levels.
Ethical approval
Not applicable.
Sources of funding
No funding received.
Author contribution
KZ and SM have designed and drawn the original draft whereas AM,
SA and RS have reviewed the literature and critically edited the
manuscript.
[1] Telangana. Panic in Asifabad’s village after calf dies of rabies. https://www.siasat.
com/telangana-panic-in-asifabads-village-after-calf-dies-of-rabies-2594562/.
[2] Panic in Telangana village after calf dies of rabies. https://www.thenewsminute.
com/article/panic-telangana-village-after-calf-dies-rabies-177458.
[3] Buffalo bitten by rabid dog dies, hundreds rush for rabies shots in Madhya Pradesh.
https://timesofindia.indiatimes.com/city/bhopal/buffalo-bitten-by-rabid-dog-di
es-hundreds-rush-for-rabies-shots-in-madhya-pradesh/articleshow/90451923.cms.
[4] Rabies in a dairy cow. Oklahoma, https://www.cdc.gov/rabies/resources/news/
2005-12-23.html.
[5] Centers for Disease Control and Prevention. Mass treatment of humans who drank
unpasteurized milk from rabid cows–Massachusetts, 1996-1998. MMWR Morb
Mortal Wkly Rep 1999;48:228–9.
[6] Can rabies be transmitted through food (i.e. by eating milk or meat)?. https://canin
erabiesblueprint.org/5-1-3-4-Can-rabies-be-transmitted.
[7] Giesen A, Gniel D, Malerczyk C. 30 Years of rabies vaccination with Rabipur: a
summary of clinical data and global experience. Expert Rev Vaccines 2015;14:
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[8] Hampson K, Coudeville L, Lembo T, Sambo M, Kieffer A, Attlan M, et al. Estimating
the global burden of endemic canine rabies. PLoS Neglected Trop Dis 2015;9:
e0003709.
[9] Rabies in India. https://www.who.int/india/health-topics/rabies. [Accessed 3
June 2023].
[10] Gibson AD, Yale G, Corfmat J, Appupillai M, Gigante CM, Lopes M, et al. Elimi­
nation of human rabies in Goa, India through an integrated One Health approach.
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[11] Rupprecht CE, Freuling CM, Mani RS, Palacios C, Sabeta CT, Ward M. Chapter 1 - a
history of rabies—the foundation for global canine rabies elimination. In:
Fooks AR, Jackson AC, editors. Rabies. fourth ed. Boston: Academic Press; 2020.
p. 1–42.

Conflicts of interest Kamran Zaman

Department of Microbiology and Molecular Biology, Indian Council of
No conflicts of interest. Medical Research - National Institute of Traditional Medicine Belagavi
(ICMR-NITM Belagavi), Karnataka, India
Research registration Unique Identifying number (UIN) E-mail address: kamran3zaman@gmail.com.
Shailendra Mishra
1. Name of the registry: N/A.
Scientist-C, DHR-Model Rural Health Research Unit, (ICMR-NIRRCH),
2. Unique Identifying number or registration ID: N/A.
Dahanu, Maharashtra, India
Hyperlink to your specific registration (must be publicly accessible
E-mail address: shailendramphd@gmail.com.
and will be checked): N/A.
Aroop Mohanty
Guarantor Department of Microbiology, All India Institute of Medical Sciences,
Gorakhpur, India
Ranjit Sah. E-mail address: aroopmohanty7885@yahoo.com.
Suraj Adhikari
Consent
Department of Microbiology, Manipal College of Medical Sciences, Pokhara,
Nepal
Not applicable.
E-mail address: adhikarisuraj012@gmail.com.
Declaration of competing interest Ranjit Sah*
Tribhuvan University Teaching Hospital, Kathmandu, Nepal
No conflicts of interest. Dr. D.Y Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil
Vidyapeeth, Pune, Maharashtra, India
Provenance and peer review Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and
Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, 411018, Maharashtra, India
Not commissioned, externally peer reviewed.
*
Corresponding author. Tribhuvan University Teaching Hospital,
Acknowledgements Kathmandu, Nepal.
E-mail address: ranjitsah@iom.edu.np (R. Sah).
None.