Two-leaves and many bites: Profiling dog-bites and adherence to rabies prophylaxis in tea-estate communities of Udalguri District, Assam, India

Harish Kumar Tiwari, Parimala Mohanty, Rasika G Shirke, Aina Unnikrishnan Kurup, Chalasani Satwik, Shanti Priya Kindo, Riya Shigwan, Karma Wangdi, Jully Gogoi-Tiwari, Laura Cunha Silva and Salome Dürr

PLOS Neglected Tropical Diseases, 2025, vol. 19, issue 12, 1-17

Abstract: Background: Dog-mediated rabies disproportionately affects marginalised and socioeconomically disadvantaged communities. Tea estate (TE) communities in India exemplify one such vulnerable population. Despite their vulnerability, limited research has explored rabies epidemiology within TE settings. This retrospective study uses secondary data to evaluate the incidence of dog bite and their determinants amongst the TE communities in the Udalguri district of Assam state of India. Methods: Secondary data from 17 to 29 months (January 2022 to May 2024) were retrieved from the hospitals and dispensaries of 11 TE of Udalguri district, Assam. The collected information included dog-bite victims’ demographics and adherence to post-exposure prophylaxis (PEP). Data were analysed using R software, employing descriptive statistics, chi-square tests, odds ratios and mixed-effect logistic regression. Administrative approval was obtained prior to data collection. Results: A cumulative annual incidence of 11.8 bites per 1,000 individuals was recorded across 11 TE in Udalguri. Children aged ≤15 years accounted for 35% of cases, and dependents were the most affected occupational group (32%). Most exposures involved dogs (66%), and 76% of incidents were bites. Less than half (43%) of victims completed the full PEP regimen of five doses, although 71% received at least three doses. Chi-square analysis indicated that males and children aged ≤ 15 years were more likely to be bitten by dogs compared to other animals than females and the older residents. Children aged ≤ 15 years and non-workers had higher odds of receiving any PEP, while females and children aged ≤ 15 years are more likely to receive at least three doses. In multivariable analysis, females were less likely than males to be bitten by dogs compared to other animals (aOR = 0.4, 95% CI: 0.3–0.7), older individuals had higher odds of completing PEP (aOR = 1.8, 95% CI: 1.2–2.8), and children (≤15 years) were more likely to receive at least three doses of PEP (aOR = 1.9, 95% CI: 1.1–3.3). Temporal analysis showed no clear seasonal pattern, although spikes were observed during winter and monsoon months. Conclusion: This retrospective study contributes to build the foundation for community-based approach to control dog-mediated rabies in TE by highlighting key epidemiological patterns, demographic vulnerabilities and limitations of the existing intervention implementation delivery among TE communities. We recommend further in-depth investigations to inform the context specific interventions designed to address the unique vulnerabilities, thereby reducing the risk of rabies specifically in tea -estate populations. Author summary: This retrospective study analysed secondary data of hospital and dispensary records from 11 tea estates in Assam’s Udalguri district between January 2022 and May 2024 to estimate the incidence of dog bites, profile affected individuals, and assess access to and completion of post-exposure prophylaxis (PEP). The findings bring to light the gaps in rabies prevention, particularly in remote areas and underserved tea -estate communities, where delayed or incomplete PEP administration significantly increases the risk of rabies-related fatalities. The study highlights the pressing need to expand rabies surveillance to include marginalised populations, strengthen health systems in remote areas, improve PEP availability and adherence, and design community-specific strategies. By identifying barriers to timely and complete adherence to PEP, this study provides actionable insights such as expanding the research base to include vulnerable communities such as tea-estate communities, developing tailormade strategies, and better adherence to post-bite prophylaxis to guide policy-making and the implementation of targeted interventions to reduce the burden of rabies in such high-risk populations.

Date: 2025
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DOI: 10.1371/journal.pntd.0013791

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