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.
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.”
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.
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.