THIRUVANANTHAPURAM: The death of a college girl in Palakkad from rabies despite taking the full course of the vaccine has triggered concerns even as cases of dog bites are reported in the state regularly. Though anti-rabies vaccines available in the market have saved thousands, a few deaths this year have sparked doubts regarding the quality of vaccines supplied and the effectiveness of their administration.
The state has reported 14 rabies deaths so far this year. What is concerning is that three had completed their vaccination schedule. The fatality rate and the fact that it can manifest even six years after a dog bite also have people worried.
The health department has vouched for the quality of the shots and immunoglobulin given to Sreelakshmi, 19, who died on Thursday. Palakkad DMO K P Reetha said proper cold chain storage was maintained and doses from the same batch were given to others without issues.
Vaccine failure should not be taken lightly: Doc
However, health experts have sought a probe into the potency of vaccines and techniques used in its administration. A health official said poor administration of intradermal rabies vaccine (IDRV) was a preliminary reason for the medicine’s failure. “Administering the dose in small quantities requires some expertise. Many staffers and doctors have skipped training sessions,” said an expert.
Wounds caused by animal bites or scratches are classified into three categories. A wound with blood oozing out requires an anti-rabies vaccine and anti-rabies immunoglobulin. The latter should be taken within seven days of the bite while the IDRV has four doses (day 0 to day 28 of the bite).
“Vaccine failure should not be taken lightly as it means death. We have been using intradermal rabies vaccine for 10 years with success. So the recent rise in deaths warrants a probe into vaccine potency and its administering techniques,” said Dr Purushothaman Kuzhikkathukandiyil, professor of paediatrics in MES Medical College, Malappuram.
Animal bites or scratches on the hands and face complicate vaccination, said health experts. “The vaccine will work only before the virus enters the nerves. In rare cases, virus enters the nerve immediately after the bite. A bite on the hands and face are serious as the areas have more nerve concentration,” said Dr Sheeja Sugunan, a paediatric intensivist and assistant professor, Department of Paediatrics, Sree Avittam Thirunal Hospital Hospital, which treats some of the complex diseases affecting children. “Were the vaccines ineffective, more rabies deaths would have been reported in the state considering the large number of animal bite cases. In previous cases when vaccines failed to prevent deaths, there were factors other than their quality,” she said. The state reported over 8 lakh stray dog attacks between 2016 and 2021.
Category of bite (Source: Dr Sheeja Sugunan)
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