Daijiworld Media Network – New Delhi

New Delhi, Sep 9: Bhutan has become the first country in the World Health Organization’s South-East Asia Region to eliminate dog-transmitted rabies as a public health problem, after recording its last death from dog-mediated rabies in June 2023. The achievement was validated by WHO on Saturday.

While Bhutan has reached the significant public-health milestone, rabies continues to pose a serious threat in India. Official estimates put India’s annual rabies deaths at around 20,000, accounting for a substantial share of the nearly 59,000 deaths reported globally each year. Around 96 per cent of rabies deaths in India are associated with dog bites, according to the National Rabies Control Programme’s operational guidelines.

However, rabies transmission is not limited to bites. Scratches and contact with infected animal saliva can also pose a risk if the virus enters the body through broken skin or mucous membranes.

Dr Santosh Kumar Agrawal, director of internal medicine at Yatharth Super Speciality Hospital, Faridabad, said rabies can occur without an obvious bite, provided infected saliva gains access to the body through damaged skin or areas such as the eyes, mouth or nose.

Rabies is primarily transmitted through the saliva of an infected animal. Although bites are the most common route, scratches can also be dangerous, particularly when saliva from an infected animal contaminates the damaged skin. Simply touching, feeding or standing near an animal does not transmit rabies, as healthy and intact skin acts as a protective barrier.

Even a minor scratch should not be ignored. According to WHO, minor scratches or abrasions without bleeding are classified as Category II exposure and require immediate rabies vaccination. A scratch that penetrates the skin is considered a Category III exposure and may require prompt wound care, vaccination and, where indicated, rabies immunoglobulin or monoclonal antibodies.

An animal lick on healthy, unbroken skin is generally not considered a rabies exposure. However, the risk changes if infected saliva comes into contact with an open wound, broken or abraded skin, the eyes, inside of the nose or mouth.

Similarly, merely touching an animal, its fur or an object contaminated with saliva does not ordinarily transmit rabies. The concern arises when fresh infected saliva directly reaches broken skin or a mucous membrane.

Following any possible exposure, experts advise washing and flushing the affected area immediately with soap or detergent and plenty of running water for about 15 minutes. Medical attention should be sought without delay, even if the injury appears minor.

“Since rabies is fatal once clinical symptoms appear, anyone with a possible exposure should seek medical care as soon as possible. Timely post-exposure prophylaxis can prevent the disease,” Dr Agrawal said.

Rabies is preventable when appropriate treatment is provided promptly. Therefore, bites, scratches and possible contact with infected animal saliva should never be dismissed simply because the injury appears small or does not bleed.