World Zoonoses Day: Only four per cent of medical students know about the diseases transmitted by animals to man
Syed Akbar Hyderabad: Today is yet another World Zoonoses Day. And if you ask medical students andfresh medical graduates to define the term, "zoonoses", you may get the answer accurately from only ahandful of them. Don't be surprised, just four per cent of our medicos and medical graduates know whatexactly the term, zoonoses, denotes in the medical context. No wonder then, the World Health Organisation describes zoonoses as a "no man's area".Medical doctors believe zoonoses is something which veterinary doctors should deal with, whileveterinarians think it's part of the job of physicians. And wildlife experts, whose role is nonetheless important, donot venture into this grey area, believing that zoonoses is the headache of physicians and veterinarians. Theresult is ignorance, death and heavy economic loss. The Public Health Foundation of India, which conducted a survey of medicos and freshmedical graduates to find out how best they are informed about zoonoses, was shocked that 96 per cent ofthe respondents failed to define it accurately. Worse, 50 per cent of the students in private medicalcolleges and 23 per cent in government colleges could not link H5N1 (avian influenza) with birds. Well, before you think that zoonoses is something from out of this world and the hardestterm to define, let's know what it stands for. Zoonoses (singular zoonosis) means the diseases transmitted byvertebrate animals to man and vice versa. For instance, swine flu, rabies, HIV, plague, anthrax and Japaneseencephalitis. Says Dr Muralidhar, senior veterinarian, "it's useless blaming our medicos and medicalgraduates. Zoonoses is a neglected area, its importance in human and animal health notwithstanding. Indiawith 1.2 billion people does not have an advanced national centre for zoonoses research. Neither theCentral government nor State governments give importance to this area of study". Ironically, even the Medical Council of India has not recognised postgraduate course ininfectious diseases, though they are known for regular outbreaks as in the case of novel human influenza orswine flu. If most of our doctors fail to diagnose rabies and even if they diagnosed the disease do not knowthat the person bitten by a rabid dog should be administered immunoglobulins and anti rabies vaccine, the faultlies with the age- old medical teaching system and syllabus. It's this lack of knowledge aboutimmunoglobulins that had led to recent deaths due to rabies despite the victims being vaccinated. Dr VM Katoch, director-general of the Indian Council of Medical Research, agrees that themedical syllabus should be "re-oriented" to suit the modern needs. "What we need in medicalsyllabus is applied studies like applied orthopaedics and applied microbiology," he added. As the PHFI survey reveals, 60 per cent of students in public medical colleges and just20 per cent in private colleges were able to correctly state all steps involved in the management ofrabies. During clinical practice, 76 to 80 per cent of respondents did not think of zoonoses as differentialdiagnosis. Only 5.5 per cent of respondents were able to identify rabies as a disease transmitted by animalsother than dogs. "It's true the zoonoses subject did not receive the attention it deserves. But now bothICMR and Indian Council of Agricultural Research are closely working on it. I have been meeting the ICARdirector-general every three months on zoonoses," Dr Katoch pointed out. Cooperation between practitioners of animal and human medicine is important as about 200diseases fall under the category zoonoses and it's mostly humans that suffer. And yet the medicalcurriculum is not updated to keep students abreast of emerging diseases, infections and pathogens."Zoonoses constitute about 60 per cent of all known human infections and 75 per cent of all emergingpathogens," says a WHO report. "The government acts only when there are outbreaks like novel human influenza, whilethere's little research on neglected zoonoses including rabies. Diseases transmitted through meat, poultry, milkand fish claim lakhs of lives every year, and leave many others unhealthy. Brucollosis, which istransmitted through unpasteurised milk, for instance, causes infertility in people," says zoologist MChakrapani. According to World Health Organisation, about 75 per cent of the new diseases that haveaffected humans over the past 10 years have been caused by pathogens originating from an animal or fromproducts of animal origin. Many of these diseases have the potential to spread through various meansover long distances and to become global problems. Yet the knowledge among medical students on all emerging and new infectious diseases ispoor. "The average knowledge score was 64 per cent in the public medical college and 41.4 per centin the private medical college. On an average, a medical student/graduate knows only 40-60 per cent ofwhat is needed by him or her in order to diagnose, treat, report and control zoonotic diseaseseffectively," points out the PHFI study conducted by Dr Manish Kakkar and his team. Stating that lack of awareness, weak surveillance systems, infections falling in ‘noman’s land’ and absence of intersectoral approach are the major challenges in understanding zoonoses, the WHOcalls for active participation of multiple sectors - medical doctors, veterinary doctors and wildlifeexperts, besides government agencies. Researchers argue that the importance of zoonoses can be gauged from the fact that newpathogens and diseases have evolved in recent times throwing up major health challenges for researchersand health planners. Added to this is the problem of drug resistance and emergence of superbugs.Change in environment and farming practices as also food habits create new health issues. Whileveterinary colleges observe world zoonoses day, medical colleges do not bother even to organise specialclasses for students, leave alone public awareness. With zoonoses failing to get the priority it deserves, many people do not even know thatthey are suffering from a zoonotic disease until the problem gets severe. This often proves quite dear, bothin 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. ========== Box ========== * Ignorance about a zoonotic disease may often lead to death. When Crimean CongoHaemorrhagic Fever struck Gujarat earlier this year, it claimed more number of medical staff than patients.Attending doctors failed to diagnose the disease. Doctors even did not know the precautions they shouldtake. Only after the ICMR intervened did doctors know what the real problem was. But it was too late by then. * The Public Health Foundation of India has suggested "one health" concept to bridge thegap between medical and veterinary doctors on zoonotic diseases. There should be an organised efforts at the national level. * The government wakes up only when there are outbreaks of zoonotic diseases. It forgetsthe moment the problem subsides. Research on zoonoses is quite poor.
* Some of the notorious zoonoses are swine flu, rabies, leptospirosis, Crimean-Congohemorrhagic fever, Japanese encephalitis, avian influenza, plague, anthrax, enterhaemorrhagic E coli, andbovine spongiform encephalitis. * Those at risk of contracting zoonotic ailments are old people, pregnant women, smallchildren, and people with compromised immunity. * With no clear cut demarcation on zoonoses authority, unscrupulous researchers have beenclaiming funds from both the Indian Council of Medical Research and the Indian Council of AgriculturalResearch without actually doing any concrete work.