title: Human rabies in India: an audit from a rabies diagnostic laboratory.
abstract: OBJECTIVE
  Rabies, an acute progressive encephalomyelitis, continues to be a serious public health problem in India and many other countries in Asia and Africa. The low level of commitment to rabies control is partly attributable to challenges in laboratory diagnosis and lack of adequate surveillance to indicate the disease burden. A laboratory audit of human rabies cases was undertaken to disseminate information on the clinical, demographic, prophylactic and most importantly the laboratory diagnostic aspects of rabies.
  
  
  METHODS
  A retrospective analysis of all clinically suspected human rabies cases, whose samples were received at a rabies diagnostic laboratory in South India in the last 3 years, was performed. Clinical and demographic details of patients were obtained. The clinical samples included cerebrospinal fluid (CSF), serum, saliva and nuchal skin biopsy collected antemortem, and brain tissue obtained post-mortem. Various laboratory tests were performed for diagnosis.
  
  
  RESULTS
  Clinical samples from 128 patients with suspected rabies, from 11 states in India, were received for diagnostic confirmation. About 94% of the victims reported dog-bites, more than a third of them were children and most of the victims did not receive adequate post-exposure prophylaxis. Antemortem confirmation of rabies by a combination of laboratory diagnostic assays (detection of viral RNA in CSF, skin and saliva, and neutralising antibodies in CSF) could be achieved in 40.6% cases.
  
  
  CONCLUSIONS
  Increasing awareness about adequate post-exposure prophylaxis, additional rabies diagnostic facilities, and enhanced human and animal rabies surveillance to indicate the true disease burden are essential to control this fatal disease.
authors.affiliation: Department of Neurovirology, National Institute of Mental Health and Neurosciences, WHO Collaborating Centre for Reference and Research on Rabies, Bangalore, India.
authors.forename: Reeta Subramaniam
authors.initials: RS
authors.lastname: Mani
authors.affiliation: Department of Neurovirology, National Institute of Mental Health and Neurosciences, WHO Collaborating Centre for Reference and Research on Rabies, Bangalore, India.
authors.forename: Ashwini Manoor
authors.initials: AM
authors.lastname: Anand
authors.affiliation: Department of Neurovirology, National Institute of Mental Health and Neurosciences, WHO Collaborating Centre for Reference and Research on Rabies, Bangalore, India.
authors.forename: Shampur Narayan
authors.initials: SN
authors.lastname: Madhusudana
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001733:Bites and Stings / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000592:standards*; D004285:Dogs; D005260:Female; D006296:Health Services / Q000592:standards*; D006801:Humans; D007194:India / Q000453:epidemiology; D007753:Laboratories; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011159:Population Surveillance; D056990:Post-Exposure Prophylaxis; D011787:Quality of Health Care; D012367:RNA, Viral; D011818:Rabies / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D012367:RNA, Viral
keywords: Rabia; carga de la rabia; charge de morbidité de la rage; diagnostic de la rage; diagnostic de laboratoire de la rage humaine; diagnóstico de la rabia; diagnóstico de laboratorio de rabia humana; laboratory diagnosis of human rabies; rabies; rabies burden; rabies diagnosis; rage