Oft-claimed figures high by magnitudes of order
NEW DELHI, NAGPUR––Newly published data from the Central Bureau of Health Intelligence and the Nagpur Municipal Corporation has added statistical weight to the likelihood that the most widely cited estimates of human rabies deaths in India are magnitudes of order high.
The accuracy of the estimates matter because if human rabies deaths are relatively few, this is strong evidence that the national Animal Birth Control program introduced by the Animal Birth Control (Dogs) Rules, 2001 is succeeding in eradicating rabies from India.
As few as 104 deaths in 2014
The 2015 Health Profile of India, latest edition in a series compiled annually by the Central Bureau of Health Intelligence, an Indian federal agency, lists just 104 human rabies deaths for the whole of the nation in 2014, down from 132 in 2013, and consistent with the the longterm trend.
From 2005 through 2011, the Central Bureau of Health Intelligence found, India had 274, 361, 221, 244, 260, 162, and 223 verified human rabies deaths, respectively, for an annual average of 249.
These numbers are low enough to suggest that targeted intensive dog vaccination could rapidly eliminate human rabies deaths entirely.
Global Alliance claims high numbers
Alleging persistent under-reporting, the Global Alliance for Rabies Control, based in Edinburgh, Scotland, argues that the actual numbers should be in the range of 12,700 to 20,565, based on theoretical and extrapolated data, rather than confirmed body counts.
Much of the input data for the extrapolated numbers favored by GARC appears to originate with a national survey of government hospitals published in 1911 by David Semple and William F. Harvey, preliminary to their introduction of post-rabies exposure vaccination to India.
Studies funded by the World Health Organization have supported both the high and the low numbers––the high number coming from literature reviews tending to recycle the older estimates, the latter from an actual hospital study done in 2003 by M.K. Sudarshan, who found 235 human rabies deaths for the whole of India.
Amid a political dispute over the allocation of rabies control resources in Nagpur, the capital city of Maharashtra, data obtained by local activist Abhay Kolarkar has produced yet another data point.
Reported Vaibhav Ganjapure and Shivani Damle on November 6, 2015 for the Times of India, “Over 45,000 cases of dog bite took place in last five years, in which 84 citizens lost their lives due to rabies, says the reply to an RTI query submitted to Nagpur Municipal Corporation’s nodal medical officer.”
The Nagpur metropolitan area has a human population of about 2.5 million people, a little less than 1/500th of the population of India.
Nagpur & CBI data compared
During this same 5-year time frame the Central Bureau of Health Intelligence recorded only 12 confirmed human rabies deaths from the whole of Maharashtra state.
The Nagpur death total, if representing only Nagpur, would project to 8,400 human rabies deaths for the whole of India.
However, since only government hospitals knowingly admit and treat rabies cases, and those hospitals that do receive rabies victims often draw from a much larger surrounding region, the Nagpur data might more accurately reflect Maharashtra as a whole (or a region of equivalent size): about 9% of the population of India.
In that case, the projected total number of human rabies deaths for the nation would be about 185.
Possible range of under-reporting
It is also possible to estimate a possible range for alleged under-reporting of human rabies deaths from the contrast between the Central Bureau of Health Intelligence data and the Nagpur data.
If the Nagpur data only pertains to rabies cases originating in Nagpur, the ratio of alleged under-reporting by the Central Bureau of Health Intelligence would be 1/55, projecting a total of 5,720 human rabies deaths for India as a whole.
If the Nagpur data represents an area the size of the whole of Maharashtra, the ratio of alleged under-reporting would be 1/7, projecting a total of 728 human rabies deaths for the nation.
The high range, 5,729 to 8,400, averages 7,020 per year.
The low range, 185 to 728, averages 456.5 per year.
The average of the high and low range is 3,838.25.