July 5: Today is World Zoonoses Day. The average reader may never have heard of the term, and if you ask medical students to define “zoonoses”, only a handful will be able to do so. The World Health Organisation describes zoonoses as being in a “no man’s land” between physicians and animal doctors. Medical doctors believe zoonoses is something that veterinarians should deal with while veterinarians think it is part of the job of physicians. And wildlife experts, who also have a role to play, prefer to think of it as a headache doctors and vets have to deal with.
No one wants ownership, yet some of the most deadly diseases of recent years are a result of zoonoses. Not caring to know enough about it causes death and heavy economic losses. Zoonoses (singular zoonosis) mean the diseases transmitted by vertebrate animals to man and vice versa. For instance, swine flu, rabies, HIV, plague, anthrax and Japanese encephalitis, all familiar diseases.
The Public Health Foundation of India, which conducted a survey of medical personnel and fresh medical graduates to find out how informed they are about zoonoses, was shocked to discover that 96 per cent of the respondents failed to define it accurately. Worse, 50 per cent of the students in private medical colleges and 23 per cent in government colleges could not link H5N1 (avian influenza) with birds. Says Dr Muralidhar, senior veterinarian, “It’s useless blaming our doctors and medical graduates. Zoonoses is a neglected area, its importance in human and animal health notwithstanding. India with 1.2 billion people does not have an advanced national centre for zoonoses research. Neither the Central government nor state governments give importance to this area of study.”
Not even the Medical Council of India has pushed for a postgraduate course in infectious diseases, despite the country suffering regular outbreaks of such diseases. If most of our doctors fail to diagnose rabies, and even if they diagnose it, they do not know that the person bitten by a rabid dog should be administered immunoglobulins and anti-rabies vaccine, the fault lies with the outdated medical teaching system and syllabus. It’s this lack of knowledge about immunoglobulins that led to the recent deaths due to rabies despite the victims being vaccinated.
Dr V.M. Katoch, director-general of the Indian Council of Medical Research, agrees that the medical syllabus should be “re-oriented” to suit modern needs. “What we need in the medical syllabus is applied studies like applied orthopaedics and applied microbiology,” he says. As the PHFI survey reveals, 60 per cent of students in public medical colleges and just 20 per cent in private colleges were able to correctly state all steps involved in the management of rabies. During clinical practice, 76 to 80 per cent of respondents did not think of zoonoses as differential diagnosis. Only 5.5 per cent of respondents were able to identify rabies as a disease transmitted by animals other than dogs.
“It’s true that zoonoses as a subject does not receive the attention it deserves. But now both ICMR and the Indian Council of Agricultural Research are closely working on it. I have been meeting the ICAR director-general every three months on zoonoses,” Dr Katoch said. Cooperation between practitioners of animal and human medicine is important as about 200 diseases fall under the category zoonoses and it’s mostly humans that suffer. “Zoonoses constitute about 60 per cent of all known human infections and 75 per cent of all emerging pathogens,” says a World Health Organisation report.
“The government acts only when there are outbreaks like novel human influenza, while there’s little research on neglected zoonoses including rabies. Diseases transmitted through meat, poultry, milk and fish claim lakhs of lives every year, and leave many others unhealthy. Brucollosis, which is transmitted through unpasteurised milk, for instance, causes infertility,” says zoologist M. Chakrapani.
According to WHO, about 75 per cent of the new diseases that have affected humans over the past 10 years have been caused by pathogens originating from an animal or from products of animal origin. Many of these diseases have the potential to spread through various means over long distances and to become global problems.
Yet the knowledge among medical students on all emerging and new infectious diseases is poor. “The average knowledge score was 64 per cent in the public medical college and 41.4 per cent in the private medical college. On an average, a medical student/graduate knows only 40-60 per cent of what he/she needs to know in order to diagnose, treat, report and control zoonotic diseases effectively,” points out the PHFI study conducted by Dr Manish Kakkar and his team.
Stating that lack of awareness, weak surveillance systems, infections falling in the “no man’s land” and absence of an inter-sectoral approach are the major challenges in understanding zoonoses, the WHO calls for active participation of multiple sectors — medical doctors, veterinarians and wildlife experts, besides government agencies.
Researchers argue that the importance of zoonoses can be gauged from the fact that new pathogens and diseases have evolved in recent times throwing up major health challenges for researchers and health planners. Added to this is the problem of drug resistance and emergence of superbugs.
With zoonoses failing to get the priority it deserves, many people do not even know that they are suffering from a zoonotic disease until the problem gets severe. This often proves quite dear, both in terms of economics and human and animal health. And if it is a zoonotic disease without known cure — rabies, Japanese encephalitis or HIV/AIDS — the ignorance always ends in death.
