The recent rabies deaths among people who have taken anti-rabies vaccines on schedule have triggered concerns as cases of dog bites are being regularly reported in the state.
The state has reported 14 deaths due to rabies so far this year. The latest was the death of a 19-year-old college student Sreelakshmi in Palakkad. What is of much concern is that three of the deceased had completed their vaccination schedule.The fatality rate and the fact that the rabies infection can manifest even six years after suffering a dog bite have also added to people's worries.
Dr Sheeja Sugunan, a paediatric intensivist and assistant professor, Department of Paediatrics, Sree Avittam Thirunal Hospital Hospital in Thiruvananthapuram explains the safe procedures to be followed after an animal bite. She also clarifies the doubts regarding the vaccines.
Q. Is there any basis in doubting the quality of vaccines supplied in the state?
A. Were the vaccines ineffective, more rabies deaths would have been reported in the state considering the large number of animal bite cases. I have not seen a single case where the death occurred after the patient has completed the vaccines as per the schedule, though there were reports.
In previous cases when vaccines failed to prevent deaths, there were factors other than their quality.
All the vaccines available in the market are approved by WHO and DCGI.
Q. How do you explain the recent death of a college girl in Palakkad from rabies despite taking the full course of the anti-rabies vaccine ?
A. I am yet to get the full details of this particular case. But I learnt that she has taken all the doses. She suffered bites on her hand.
The vaccine will work only before the virus enters the nerves. In rare cases, the virus enters the nerve immediately after the bite. A bite on the hands and face are serious as the areas have more nerve concentration. The disease manifests when the virus reaches the brain. It moves through the nerves from the bite site to the spinal cord before reaching the brain. Once the virus enters the brain the person can potentially transmit the virus to others when they come in contact with eye drops, saliva of the infected person.
Q. What should a person do if they get an animal bite or a scratch?
It is important to wash the wound with soap in running water for 15 minutes. Three fourths of viral load there will be destroyed through washing. After the wash disinfect the wound with alcohol or an iodine solution if possible. The first dose of anti rabies vaccine shall be given on that day itself.
If the wound comes under category 3 (wound with blood) then anti rabies immunoglobulin shall be given on the wound directly. It is important that the immunoglobulin dose is given within 7 days of the bite. The disease usually manifests in one to three months. In rare cases it can take months or upto six years. So even if one could not immediately take the vaccine it should be done as soon as possible to get the protection.
Q. What are the categories of bites?
Category 1: touching or feeding animals, animal licks on intact skin (no exposure) - Washing of exposed skin surface, No vaccine
- Category 2 : Nibbling of uncovered skin, minor scratches or abrasions without bleeding (exposure) - Wound washing and immediate vaccination
- Category 3: Single or multiple transdermal bites or scratches, contamination of mucous membrane or broken skin with saliva from animal licks, exposure due to direct contact with bats (severe exposure) - wound washing, immediate vaccination and administration of rabies immunoglobulin
Q. Doctors sometimes say observe the animal for 10 days. So should I wait for 10 days before starting the vaccine?
No vaccine should be taken immediately. The animal usually die 7-10 days once the symptoms appear. It is only for confirmation. But we cannot take the risk by delaying the vaccination.
Q. Can I get lifelong immunity if I take anti-rabies once?
A. If another bite occurs within three months of taking the vaccine there is no need to repeat the doses. After three months two doses should be taken on Day 0 and Day 3.
Q. What kind of animals cause rabies
A. All pet and wild animals and their pups can be infected with rabies. The chances of transmission of rabies from rabbits, squirrels and rats to humans are rare.
Q. Do birds cause rabies
A. Birds cannot transmit rabies. But bats are an exception. No rabies cases from bats have been reported in India so far.
Q. If the pets are vaccinated should I get the protection?
A. A dog is considered immune only if current age is more than one year, first dose vaccine at more than 3 months age, two doses are taken six months apart, vaccination is conducted yearly and good quality vaccine is used. For all practical purposes one should take the vaccine even if bitten by a vaccinated pet.
Q. Is the vaccine harmful if my body does not have any rabies virus?
A. No. In fact it will give protection for us in future.
Q. So in that case can people take the vaccine as a precaution?
A. Yes. It will help people running pet shops, working in zoos or interacting with animals in laboratories. We call it pre exposure prophylaxis. They can take three doses in advance (D0, D7 and D28). The advantage of it is that in case of an animal bite in future they just need to take just two more doses to ensure protection.
Animals causing rabies (most common): Dog, Cat, Civet, Bandicoot, monkey
Incubation period 1 to 3 months ( minimum of 4 days to maximum of 6 years)
Prevention: Local wound care, anti-rabies vaccine and Immunoglobulins
For Intramuscular schedule, Five Doses ie on D0, D3, D7, D14 and D28 is the current schedule. one vial (0.5ml) given IM
For ID Schedule, Four doses ie 0.1ml each deltoid on D0, D3, D7 and D28 as per current schedule