Save Lives- Implement Annual Rabies Titre Testing for those in Animal Welfare

To: State Department of Health , Karnataka

From: Priya Chetty Rajagopal, Trustee, CJ Memorial Trust

Date: July 01 2025

Subject: Proactive Proposal: Implementing Annual Rabies Titre Testing for Animal Welfare Personnel

SAVE LIVES! It’s  just Rs 750 per test to check for an annual test.

We commend the Department's ongoing commitment to public health and the safety of those on the frontlines. We propose a simple, highly cost-effective intervention with profound potential: mandating or strongly encouraging annual rabies virus neutralizing antibody (RVNA) titre testing for all professionals in the Animal Welfare sector. This proactive measure directly safeguards our courageous animal welfare workers and enhances our state's public health resilience against rabies, a universally fatal disease, at minimal expense.

The Rationale & Impact

1. Closing the "Immunity Gap": While rabies pre-exposure prophylaxis (PrEP) vaccination is standard, immunity can wane variably between individuals over the long intervals (often years) between recommended booster checks (typically triggered only by exposure). Annual titre testing (e.g., RFFIT or FAVN) provides an objective measure of protective antibody levels before an exposure occurs.

2. Preventing Tragedies Proactively: Rabies is nearly 100% fatal once symptoms appear. Workers handling animals, especially in shelters, rescue, or field operations (trapping, investigations), face daily, often unrecognized, scratch/bite risks. Knowing their antibody levels are adequate before an incident provides immediate peace of mind and ensures they are genuinely protected. If titres are suboptimal (<0.5 IU/mL by WHO/CDC standards), a timely booster can be administered, restoring protection before it's needed.

3. Empowering Workers & Boosting Morale: This intervention directly addresses a significant occupational fear. Knowing they have verified protection allows animal welfare workers to perform their vital, often emotionally taxing, duties with greater confidence, safety, and focus, enhancing both their well-being and effectiveness.

4. Significant Public Health Benefit: Protecting these high-risk workers prevents potential human rabies cases, avoids the immense costs and stress of urgent post-exposure prophylaxis (PEP) regimens, and strengthens the vital animal welfare infrastructure that contributes significantly to rabies control in the community (through vaccination drives, stray management, etc.).

5. Highly Cost-Effective: As evidenced by the attached screenshot from NIMHANS, the cost of the critical RFFIT test is approximately ₹750. Compared to the significant financial burden (often thousands of dollars/euros) and logistical complexity of PEP treatment after a potential exposure, and especially compared to the incalculable cost of a human life lost to rabies, this annual test is an extraordinarily efficient investment in prevention. The alternative FAVN test is even more economical at ~₹250.

Global Precedents & Guidance

This approach aligns with international best practices for high-risk groups:

• World Health Organization (WHO): The WHO 2018 Expert Consultation on Rabies explicitly states that for individuals with continuous or frequent exposure (Category III, which includes animal welfare workers), "Periodic testing for RVNA every 6 months to 2 years is recommended, and booster vaccination should be administered if the titre falls below 0.5 IU/mL." (WHO Technical Report Series, No. 1012, 2018, pg. 39).

• United States (CDC): The CDC's Advisory Committee on Immunization Practices (ACIP) recommends PrEP for high-risk groups, including animal handlers. While booster schedules vary, the CDC emphasizes that titre checks are an alternative to routine boosters and should be considered, especially for those at highest risk or where exposure might go unrecognized. Facilities like major veterinary teaching hospitals and animal control agencies often implement regular titre monitoring (e.g., every 2 years) for staff.

• European Union: Countries like France, the UK, and Germany have guidelines or common practices within veterinary medicine, wildlife management, and animal control sectors involving periodic titre checks (often every 1-3 years depending on risk assessment) for personnel with occupational exposure.

• Laboratory & Research Personnel: Globally, personnel working with live rabies virus in labs are universally subject to strict protocols including mandatory initial PrEP and regular titre checks(often annually) with boosters as needed. This model of proactive verification is well-established for the highest-risk occupations.

Proposed Path Forward & Resources

We urge the State Department of Health to:

1. Formally Recommend/Require Annual Titre Testing: Issue guidance or update occupational health regulations to strongly recommend or mandate annual RVNA titre testing for all professional animal welfare workers (shelter staff, field officers, veterinarians, animal control, wildlife rehabilitators).

2. Establish Clear Protocols: Define the acceptable titre level (≥0.5 IU/mL), the pathway for administering boosters if needed, and standardized reporting.

3. Explore Partnerships & Access: Collaborate with facilities like NIMHANS and other accredited labs to ensure accessible and affordable testing state-wide. Consider potential subsidy programs or insurance coverage given the clear occupational health justification.

4. Pilot Program: Consider initiating a state-funded pilot program targeting high-volume shelters or field units to demonstrate feasibility and impact.

5. Education Campaign: Partner with animal welfare organizations to educate workers about the importance and availability of this testing.

Key Research Resources

1. World Health Organization (WHO):

   • WHO Expert Consultation on Rabies: Third report (TRS No. 1012, 2018) - Primary guidance on PrEP, titres, and boosters.

   • WHO Position Paper on Rabies Vaccines (WER No. 16, 2018).

2. US Centers for Disease Control and Prevention (CDC):

   • Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies (MMWR, 2010).

   • Human Rabies Prevention - United States, 2008: Recommendations of the Advisory Committee on Immunization Practices (MMWR, 2008) - Details risk categories & PrEP/titre guidance.

3. World Organisation for Animal Health (WOAH/OIE):

   • Terrestrial Animal Health Code: Chapter on Rabies - Emphasizes control strategies intersecting human/animal health.

4. National Centre for Disease Control (NCDC), India: National Rabies Control Programme Guidelines - Contextualizes within the Indian framework.

5. Peer-Reviewed Literature:

   • Studies on rabies antibody persistence and booster response (e.g., work by Briggs, Dreesen, Moore, et al.).

   • Studies on occupational rabies risk and prevention programs (e.g., in veterinary medicine, animal control).

Conclusion

Annual rabies titre testing for animal welfare workers is a demonstrably effective, low-cost, and life-saving preventive measure. It directly addresses a critical vulnerability faced by a courageous workforce essential to both animal well-being and public health rabies control efforts. By implementing this proactive strategy, grounded in WHO guidance and global best practices, our state can significantly reduce the risk of rabies fatalities among these dedicated individuals, boost their morale and safety, and strengthen our overall public health defence against this deadly disease. We strongly urge the Department of Health to champion this vital initiative.

We stand ready to assist in further research, stakeholder engagement, or program development.