Death from rabies on the rise in Nepal

KATHMANDU, Oct 3: In July, Santaraj Praja, 46, from Chitwan was brought to Sukraraj Tropical and Infectious Disease Hospital in Teku after he struggled to drink water. Following an examination, he was diagnosed with rabies. Despite being admitted to the ICU, he passed away three days later. His relatives revealed that Praja had been bitten by a dog but only received one dose of the rabies vaccine, failing to complete the treatment, which ultimately led to his death.

Similarly, in August, Rinkesh Sarki, 36, from Dhading, was referred to the Teku hospital after showing symptoms such as difficulty in drinking water and fear. He died a few days after being admitted, with rabies confirmed as the cause. Sarki had been bitten by a dog while walking along the road. Despite receiving two doses of the rabies vaccine, he did not complete the full course. Three months later, he developed rabies symptoms, leading to his hospitalization.

In March, a 35-year-old man referred from outside the Kathmandu Valley also died at the Teku hospital four days after admission. Following a dog bite, he had received a tetanus shot but had not been vaccinated against rabies.

Data from Sukraraj Tropical and Infectious Disease Hospital shows that 21 people died from rabies in the first nine months of 2024, including the cases mentioned. The Epidemiology and Disease Control Division (EDCD) under the Ministry of Health and Population reported that 14 people died from rabies in the previous fiscal year. However, the actual number of deaths is likely higher, as data from non-government health facilities is unavailable, said Hemant Ojha, Head of Zoonotic at EDCD. He estimates that over 100 people die from rabies in Nepal annually.

Doctors note that most rabies-related deaths occur outside the Kathmandu Valley. In the fiscal year 2023/24, around 160,000 people were bitten by dogs, with 40 percent of victims under the age of 15.

According to Dr. Barun Kumar Sharma, chief of the Central Veterinary Laboratory, rabies can also affect cattle, such as cows and buffaloes, and even wild animals like antelopes, when bitten by rabid dogs.

What is rabies?

Rabies is a viral infection caused by the Lyssavirus, transmitted through the bite or saliva of infected animals, particularly dogs. It attacks the nervous system, and without timely vaccination, death can occur within a week to a year of infection. Doctors emphasize that rabies is 100 percent fatal if left untreated, but vaccination before the onset of symptoms can effectively prevent the disease.

Symptoms include difficulty in drinking water, hydrophobia (fear of water), inability to distinguish light from dark, memory loss, and fever. The onset of symptoms varies, from appearing soon after infection to up to a year later, depending on the viral load.

While rabies deaths have drastically decreased in developed countries, Nepal continues to grapple with the disease. Dr. Sujan Rana, senior veterinary officer at the Department of Livestock Services, noted that rabies is still widespread in Nepal due to factors such as poor public awareness, the uncontrolled stray dog population, and the absence of a comprehensive national strategy to combat the disease.

Key challenges in controlling rabies include improper stray dog management, concerns about the quality of imported vaccines, inadequate temperature monitoring for vaccine storage, and a lack of urgency in seeking medical care after dog bites.

Dr. Ojha pointed out that although the government offers free rabies vaccines at public health facilities, there is still insufficient public awareness. In the last fiscal year, 131,851 people were bitten by dogs and wild animals, with 16,242 cases involving dog bites.

Globally, 95 percent of rabies cases occur in Asia and Africa, with Nepal facing a particularly high burden. Controlling rabies requires more than the efforts of a single agency. Ojha highlighted that the large number of stray dogs in Nepal is a major reason the disease remains unchecked. A study by the World Health Organization two years ago found that Nepal has 2.9 million dogs.

Doctors stress that vaccinating stray dogs could significantly reduce rabies cases. To control rabies, coordinated efforts from municipalities, the Department of Drug Administration, the Department of Forests, and the Department of Health Services are essential, said Ojha.

The 18th World Rabies Day was observed on September 28, with the theme "Breaking Rabies Boundaries." The World Health Organization aims to eliminate rabies caused by dog bites by 2030.