International Journal of Infectious Diseases affirms what ANIMALS 24-7 has reported since 2012
GUANGZHOU, Guangdong, China––ANIMALS 24-7 was right all along that “official” estimates of human deaths from rabies are inflated by magnitudes of order.
The truth, the whole truth, and nothing but the truth about how and why the Global Alliance for Rabies Control, the World Health Organization, and legions of other agencies came to be citing inflated numbers for decades has yet to emerge in scientific and public health media.
However, The International Journal of Infectious Diseases, published by the International Society for Infectious Diseases and affiliated with the Program for Monitoring Emerging Diseases [ProMED–Mail], on November 4, 2022 took a gigantic step toward setting the record straight, publishing a study by 13 leading Chinese rabies researchers who affirmed––as third-party investigators having “no dog in the fight”–– that claims of from 55,000 to 60,000 human rabies deaths per year have no foundation in current medical and scientific data.
Read the numbers
The Chinese study is accessible at https://doi.org/10.1016/j.ijid.2022.10.046.
The study citation is “Gan H, Hou X, Wang Y, et al. Global burden of rabies in 204 countries and territories, from 1990 to 2019: Results from the Global Burden of Disease Study 2019. Int J Infect Dis. 2022.”
Only one of the 13 co-authors, Zheng Zhu, was previously known to ANIMALS 24-7.
Explains the study abstract, “Rabies is an acute lethal infectious disease caused by lyssavirus infection. In 2018, the World Health Organization proposed a global strategic plan to end human rabies deaths by 2030. However, systematic studies of the global rabies disease burden and epidemiological trends are scarce.”
For that reason, the Chinese team “extracted the disease burden and epidemiological data of global rabies in the preceding 30 years from the Global Burden of Disease (GBD) study 2019 and performed a comprehensive analysis.”
Estimated rabies deaths inflated four-fold
The outcome was that the team found only 13,744 human rabies deaths likely to have occurred worldwide in 2019, approximately 25% of the figures amplified for decades by the World Health Organization and more recently by the Global Alliance for Rabies Control.
“The incident cases, the number of deaths, age-standardized incidence rate, and death rate and disability-adjusted life years of rabies all showed downward trends,” the Chinese team found.
Further, the Chinese researchers discovered that the 10 nations “with the highest human rabies age-standardized incidence rate in 2019” were Nepal, Myanmar, Niger, Ghana, Chad, Mali, Somalia, Ethiopia, Nigeria, and Pakistan.
India, widely believed to account for the majority of human rabies deaths worldwide, is nowhere on the list––exactly as ANIMALS 24-7 has repeatedly reported.
Brazil vaccinated a million dogs in one day
The Chinese study also “addresses human-related measures as contributing to the “elimination” of rabies, namely, “extensive education and (human) vaccine availability,” summarized ProMED-Mail.
“Canine-addressed measures are mentioned for a single country, Brazil, where the low death toll was “inextricably linked to the introduction of canine vaccination campaigns and the expansion of post-exposure prophylaxis,” ProMED-Mail continued.
The Brazilian rabies eradication campaign, like similar successful campaigns elsewhere in South America, was directed by Oscar P. Larghi, M.D., who has argued via ProMED-Mail since 1994 that “The experience of Latin American countries should be applied” to eradicate rabies globally.
“In Brazil, for instance,” Larghi has repeatedly testified, “in 1988 one million dogs were vaccinated in a single day.”
Disease research diplomacy
The Chinese rabies researchers took note of two much-cited “earlier estimates of the global annual number of human deaths due to rabies,” published: in 2005 by D.L. Knobel et al in the Bulletin of the World Health Organization, and in 2015 by K. Hampson et al in the Public Library of Science online periodical Neglected Tropical Diseases.
Summarized ProMED-Mail animal health and zoonoses moderator Arnon Shimshony, “Knobel et al concluded that human mortality from endemic canine rabies was estimated to be 55,000 deaths per year. Hampson et al concluded that globally canine rabies causes 58,991 human deaths annually.”
The high estimates put the Indian rabies death toll per year at 20,847, while the Chinese researchers put the Indian rabies death toll per year at 5,206, a quarter as many.
“The differences are attributed by the 2022 authors to data resource variance and different statistical models,” wrote Shimshony.
“Hey hey, what we say?!”
Concluded Shimshony, “The global 59,000 fatalities estimate was subject to discussion in ProMED postings, mainly in 2015. This related, in particular, to the data from India.”
Links to those postings, including six postings from ANIMALS 24-7, are as follow:
Rabies – Indonesia (10): (BA) comments: http://promedmail.org/post/20151028.3748032
Rabies – Indonesia (09): (BA) canine, comment: http://promedmail.org/post/20151022.3735706
Rabies (03): human, canine, comment: http://promedmail.org/post/20150423.3318372 (item 2)
Rabies (02): human, canine, comment: http://promedmail.org/post/20150420.3309817
Rabies: human, canine: http://promedmail.org/post/20150417.3304445
Rabies – India (05): (MH) human, canine exposure: http://promedmail.org/post/20150211.3160288
and Rabies, vulture die-off – India (02): link susp.: http://promedmail.org/post/20080818.2576
Semple & Harvey
The 1997 ProMED posting, also from ANIMALS 24-7, preceded the 2012 ANIMALS 24-7 discovery that every estimate of human rabies deaths in India published between 1911 and 2003 appeared to have been derived by multiplying the findings from a 1911 survey of Indian government hospitals done by post-exposure rabies vaccination pioneers Sir David Semple and Major William F. Harvey.
Harvey, then director of the Pasteur Institute at Kasauli, India, reported that out of 3,289 Indians bitten by rabid dogs or dogs suspected of being rabid, only 1,636 came for treatment.
Harvey also projected that only three out of every 17 bites by a rabid dog actually transmitted rabies to the human victim.
Founded by Semple in 1904, who had invented the nerve tissue culture post-exposure anti-rabies vaccine used worldwide for more than 90 years, the Pasteur Institute at Kasauli is now called the Central Research Institute.
(See New data shows decline of rabies in India.)
1911 assumptions no longer hold
Harvey’s estimate that as of 1911 only about half of rabid dog bite victims sought post-exposure treatment evolved into an oft-repeated but never substantiated claim by later researchers that only about half of all victims of bites by any dogs seek post-exposure rabies vaccination, and that therefore any numbers reported for human rabies deaths are low.
Harvey’s estimate that three out of 17 bites from a rabid dog transmit rabies appears to have been mingled with a subsequent guesstimate that about one dog bite in 10 is inflicted by a rabid dog. Multiplied by two million dog bites per year, another long-circulating guesstimate, this produces a figure of about 35,000 human rabies deaths per year.
Harvey’s total of 3,289 Indians bitten by rabid dogs or dogs suspected of being rabid, multiplied by the five-fold increase in Indian human population between 1911 and 2002, plus the 3,000 deaths that the Association for Prevention and Control of Rabies in India suggested at that time were occurring without diagnosis, comes to very nearly 20,847. This was the estimate of Indian rabies deaths per year used by Knobel and Hampson.
Global map has changed too
Also worth noting is that India under British rule, as it was when Semple and Harvey produced their data, included the territory now consisting of Pakistan, Afghanistan, Nepal, Sri Lanka, and Bangladesh.
Human rabies deaths in those nations also appear to have been projected from the Semple and Harvey numbers, without taking into consideration that Semple and Harvey did their research before post-exposure treatment using the Semple vaccine was made free to all dog bite victims by the Indian government, and before any widespread effort was made outside of England to vaccinate dogs against becoming rabid.
Even lower death estimate is likely far high
Responded ANIMALS 24-7 to Global burden of rabies in 204 countries and territories, from 1990 to 2019, “It is encouraging to see that the [Chinese researchers] have markedly lowered the often claimed annual human death toll from rabies in India, used to project a global human rabies death toll of from 55,000 to 59,000, to 5,206 as of 2019.
“However, this remains a projection presuming that rabies deaths in India are under-reported by magnitudes of order, absent any support in the form of an actual body count showing that any noteworthy number of human deaths from rabies are occurring but going unreported.
“Since post-exposure rabies treatment has long been provided free of charge at Indian government hospitals, which are reimbursed for their expenses by the central government, there is some evident financial incentive for possible over-reporting of rabies treatments and outcomes, but no evident financial incentive for under-reporting.”
(See Mad dogs & rabies follow Englishmen out of India)
Indian government data
The actual annual rabies death totals in India reported by the Indian government’s own Central Bureau of Health Intelligence hospital surveys since 2005 (see https://www.cbhidghs.nic.in/index.php) are as follow:
2005: 274 2006: 361 2007: 221 2008: 244 2009: 260 2010: 162 2011: 233 2012: 212 2013: 132 2014: 125 (up from first announced total of 98 due to late-arriving case reports)
2015: 113 2016: 86 2017: 97 2018: 116 2019 105 2020: 92 2021: 55 TOTAL: 2,888, or an average of 170 per year.
The low figure for 2021 is unfortunately likely to rise in 2022, as result of a rabies outbreak in Kerala state costing at least 21 human lives––more than the sum from Kerala in the preceding eight years.
(See India Supreme Court moves against “dog menace”.)
92 years between body counts
Also warranting mention was a 2003 hospital survey funded by the World Health Organization in which researcher M.K. Sudarshan found just 235 human deaths from rabies for the whole of India, consistent with the Central Bureau of Health Intelligence figures for subsequent years.
Since the Central Bureau of Health Intelligence data on every other health indicator that it tracks is usually taken at face value and cited as such, it is incumbent upon those who believe human rabies deaths are under-reported by orders of magnitude to demonstrate this with actual body counts.
Recitations of what others previously claimed based on previous projections, many and perhaps all of which appear to derive from the Semple and Harvey data published in 1911, are not credible evidence in absence of a body count.
The Semple and Harvey count appears to have been the only actual body count produced by anyone prior to the Sudarshan study of 2003.
Rebecca Husted (Gimenez) says
Thank you for pulling this together – I have wondered about those statistics for SO MANY YEARS and this is great!
Tomas and I did a paper for AAEP in 2003 on the subject of managing a rabid horse –
We witnessed this and it was AWFUL. That is why we did the paper.
Thank you for elucidating so many things!
Merritt Clifton says
Rebecca Gimenez Husted, BS, PhD, according to her own official biography, “is the primary instructor and president of Technical Large Animal Emergency Rescue. Her first book, Technical Large Animal Emergency Rescue, was published in 2008. She is an internationally sought instructor in technical rescue techniques, procedures, and methodologies, and she has published numerous critiques, articles and journal submissions on horse safety, technical large animal rescue and horse handling issues.”
Rebecca also has “28 years of military experience including active duty mobilizations (Ft. Bragg) and combat deployments (Iraq & Kuwait),” she notes, giving her considerable background in public and animal health issues in rabies-endemic environments.
Jamaka Petzak says
When people work together for a common cause, great things can happen.
Now for universal feline spay/neuter.
S. Chinny Krishna says
For over 15 years – at least since 2007 – I have been saying at all meets at which I have spoken the same thing – rabies deaths in India are, far below those mentioned by WHO on their website even today. I have been supported in this by General Dr. R. M. Kharb who was Chairman of the Animal Welfare Board of India (AWBI) for 10 years and Dr. Abdul Rahman former Secretary of the Commonwealth Veterinary Association and Dr. V. N. Appaji Rao, Retired head of Clinical Studies at the Madras Veterinary College and also Vice Chairman of the AWBI.
I did mention in a talk in Bangalore about 15 years ago Chaired by Dr. M. K. Sudarshan that the figures given by the CBHI, Government of India, may be very slightly on the lower side but that WHO’s figure for India was certainly wrong.
Chennai (Madras) where the ABC – AR programme for street dogs was first proposed over 58 years ago by the Blue Cross of India was declared rabies-free in 2010 after three consecutive years on no rabies cases. With the great expansion in the city limits after this, an occasional rabies case has surfaced from time to time, but the Chennai Corporation declared in September this year that there have been no rabies cases in Chennai for the last five years.
I have wondered where the figures for rabies deaths have originated.
Some rabies deaths in the USA have not been diagnosed. Years ago a woman received a corneal transplant and died of rabies because the corneal donor had died of rabies.
Another person who was believed to have died of a stroke was used for organ donation and had actually died of rabies. The organ recipients also died of rabies.
There was a third rabid person used as an organ donor. I believe one organ recipient died of rabies. The other recipients were treated with rabies vaccine and survived.
A teenaged girl was showing neurologic signs and was hospitalized. She was improving and released in about three days. She made a good recovery and was found to have been infected with rabies. I imagine the definitive diagnosis of rabies was likely due to a rising titer to rabies.
While a student at Purdue in the early 1970’s a farmer brought in a sick cow. The vet students were all over that cow even though the farmer said she was rabid. The farmer was correct. The students had already received rabies vaccine and did not develop rabies.
Canine distemper in raccoons and dogs can resemble rabies so it is generally recommended for wild life rehabbers to receive rabies vaccine.
Rabies can mimic other diseases such as strokes. Autopsies are not routinely done with many deaths if the deaths appear to have been caused by natural diseases. Thus, a diagnosis of rabies may not have been made.
Merritt Clifton says
Concerning the U.S. cases in which transplants from undiagnosed rabies victims led to further deaths, see Trapper died from undiagnosed rabies, transmitted rabies via organ donationTrapper died from undiagnosed rabies, transmitted rabies via organ donation. The two most recent human deaths from canine rabies contracted within the U.S. were a seven-year-old girl, bitten by a rabid dog in Texas in June 1979, and a 13-year-old boy who was bitten by a rabid dog in Kansas in 1968. All human deaths in the U.S. from canine rabies occurring since then were contracted from dog bites suffered abroad. Most other deaths of humans from rabies since June 1979 have resulted from bites by rabid bats. In most of these cases the victim did not know he or she had been bitten.
Summarized Mike Stobbe of Associated Press re the recovery case mentioned above, “In October 2004, a 15-year-old Wisconsin girl, Jeanna Giese, was hospitalized a month after she was bitten by a bat in church. She recovered after Milwaukee doctors used drugs to induce a coma and then gave her antiviral medications including ribavirin, ketamine and amantadine.
The success of the so-called Wisconsin protocol was reported in the New England Journal of Medicine. But treatment based on the same protocol did not succeed in at least three children who developed symptomatic rabies.”