The following article is a guest post from Dr. Shubha Nagesh and Ana Ortega. The opinions expressed here are their own. September…
A Call to Action on World Rabies Day and Beyond
Image by Rebecca Scholz from PixabayOn World Rabies Day, PLOS One Academic Editor Dr. Zinia T. Nujum shares her perspectives on this year’s theme, “Act Now: You, Me, Community”.
Dr. Zinia T. Nujum is an epidemiologist and public health professional engaging in teaching and research on neglected tropical diseases in Kerala, India. She works as Additional Professor, Community Medicine, Government Medical College, on deputation to the School of Public Health, Kerala University of Health Sciences. She has been a senior research fellow at London School of Economics and Political Sciences. A recipient of RSTMH Presidents’ award 2024 and the country ambassador for the society, she is currently working on the implementation of Integrated Bite Case Management (IBCM) as part of a One Health program for Rabies at Primary health care level in Kerala with a grant from the WHO-TDR.
This year’s World Rabies Day, I am making a call to ACT NOW!
“For a world free from the fear of rabies…
For a world free from the suffering the disease brings to all forms of life!”Zinia T. Nujum
I hail from a modest Muslim family in Kerala, India. In our community, keeping dogs was considered a taboo. Let alone keeping dog, even touching or feeding them was to be refrained from. We used to say, “You have to bathe in seven waters if you touch a dog.” Today, I have become someone who likes to interact with dogs, feed them and look at them with affection. My journey of being fearful of dogs to being a friend of these wonderful animals transforms my view towards management and prevention of rabies as well. Let me share some of my experiences and thoughts in honor of World Rabies Day.
I started working in a medical college as a health professional in 2004. Since then, I have witnessed countless people suffer after being bitten by animals. They are brought to the preventive clinic at my college for Rabies vaccination. Since the disease is fatal once symptoms appear [1], these patients come for the post-exposure vaccination against rabies. In severe cases, we give them immunoglobulin injected around the wound to prevent the virus from entering the nervous system. Once the virus reaches the nervous system, there is no medical intervention that can prevent death [2].
I still remember an incident in which a newborn, only a few hours old, was bitten on the face by a cat that leapt into the hospital ward. We had to give immunoglobulin close to the eyes of that tiny infant. Traumatic events like these deepened my fear of dogs and cats. Surprisingly, in our hospitals, more people now seek care for cat bites than dog bites. Globally, dogs are responsible for 96–99% of all human rabies cases [3]. Transmission can occur not only through bites but also through scratches or contact of mucous membranes and broken skin with the saliva of infected mammals [4].
“Get yourself—and enable others—to be vaccinated after a potential exposure. Rabies is PREVENTABLE.”
I look at myself with shame now, for not having thought of the other side of story, the animal behind the scenes. While I greatly acknowledge my experience from investigating the death of a tribal girl due to Rabies [5], I wish I never had to do that and sincerely wish no child ever dies of this disease. 40% of all rabies deaths occur in children under 15 years of age [6]. My heart burns at the thought that a disease as old as the humanity still has no cure. Rabies is as old or even older than Leprosy and Tuberculosis and today we have cures for both. It makes me wonder “Why don’t we still have a cure for rabies?” If the world could produce a COVID-19 vaccine and treatment options in record time [7], I believe we can and should try to find a cure for rabies. This is a disease of the poor and marginalized communities and investing in finding a cure for the disease is also a fight for social justice [8].
“There should come a time when we can stop saying – Rabies is 100% fatal- Can we invest in finding a cure for rabies? We must, if we CARE.”
In the tribal community we visited, each household had 4–5 dogs. The children looked malnourished, while the dogs looked well nourished. Why did they take so much care of dogs? They were their lifeline – to protect them from wild animals – while they go to forest to get the produce they needed for livelihood. The nights are dark, living in houses with no proper doors, these dogs are their saviour. To save such people from rabies, the dogs need to be protected too. Vaccinating dogs not only protects the dogs but also saves human lives and the lives of other animals. In Kerala, there are nearly 30 human and over 600 animal deaths reported annually [9]. Yet, these numbers represent only the tip of the iceberg. The global community aims to eliminate dog-mediated rabies by 2030 through the strategy of vaccinating 70% of dogs [10]. Eliminating rabies equitably and efficiently requires this One Health approach [11] [12].
“Get your pets vaccinated, and support vaccination of free-roaming dogs. Rabies—and the suffering it causes can be, ELIMINATED.”
Not every dog that bites is rabid. In our experience, about 6% of biting dogs are suspected to be rabid, and only about 3% are probable and confirmed. Improved animal surveillance helps prevent unnecessary killing of animals and unnecessary vaccination of humans. One such strategy is Integrated Bite Case Management (IBCM), which allows targeted interventions and education in high-risk areas [13].
Of course, observing domestic dogs for 10–14 days after a bite is feasible, but monitoring free-roaming dogs is challenging. Many of these so-called “stray” dogs can instead be considered “community-owned,” and cared for collectively. If we feed them responsibly (perhaps we can leave alone the ownership) instead of letting them scavenge on waste, we can peacefully co-exist. It will also make the surveillance of these dogs possible.
“Caring for not just fellow human beings but also for animals and our shared environment is the true spirit of ONE HEALTH. Let us nurture it.”
There is light ahead at the end of the tunnel. Let us not allow deaths to continue in the dark. Let us join hearts and hands to eliminate rabies efficiently, equitably, and compassionately. Dogs are not our enemies. They deserve care and affection from us. Let us target the virus and not the animals.
Act now – Rabies prevention and elimination require conscious efforts from me, from you, and from the entire community!
References
1.World Health Organization. Rabies. WHO Fact Sheet. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/rabies
2. WHO. Rabies vaccines: WHO position paper. Weekly Epidemiological Record. 2018 Apr; 93(16): 201–220..
3. Hampson K, et al. Estimating the Global Burden of Endemic Canine Rabies. PLoS Negl Trop Dis. 2015;9(4):e0003709.
4. OIE (World Organisation for Animal Health). Rabies (Infection with Rabies Virus). OIE Terrestrial Manual, 2021.
5. Nujum ZT, Indu PS, Ramesh J, Philip RR, S S, A R S, N LR, Balaram NA. Rabies death in an adolescent tribal girl diagnosed postmortem, in Kerala – the precious life, preventable loss and equity concerns. Int J Equity Health. 2024 May 23;23(1):104. doi: 10.1186/s12939-024-02164-w. PMID: 38783326; PMCID: PMC11112861
6. World Health Organization. Zero by 30: Global Strategic Plan to End Human Deaths from Dog-Mediated Rabies by 2030. WHO, 2018.
7. COVID-19 clinical management: living guidance, 25 January 2021. Geneva: World Health Organization; 2021. (WHO/2019-nCoV/clinical/2021.2). Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021.2
8. World Health Organization. (2019, September 28). Rabies elimination: An opportunity for social justice. Retrieved September 21, 2025, from https://www.who.int/news/item/28-09-2019-rabies-elimination-an-opportunity-for-social-justice
9. Directorate of Health Services, Government of Kerala. Integrated Disease Surveillance Programme: Annual Surveillance Report 2023. Thiruvananthapuram: DHS Kerala; 2023. Available from: http://dhs.kerala.gov.in/public-health/idsp/
10. Global Alliance for Rabies Control. End Rabies Now campaign. 2024. Available from: https://rabiesalliance.org/
11. Asaria M, Nujum Z. Working with dogs in India is the only way to tackle one of the most fatal diseases in the world [blog entry]. London School of Economics Global Health; 28 September 2023. Available from: https://blogs.lse.ac.uk/globalhealth/2023/09/28/working-with-dogs-in-india-is-the-only-way-to-tackle-one-of-the-most-fatal-diseases-in-the-world/
12. Nujum ZT, Asaria M, Kurup KK, Mini M, Mazumdar S, Daptardar M, Tiwari H. Cost-effectiveness of One Health interventions for rabies elimination: a systematic review. Trans R Soc Trop Med Hyg. 2023;118(4):223-233.
13. WHO & OIE. Integrated Bite Case Management (IBCM): A tool for rabies elimination. WHO Technical Note. 2019.
Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.