KOCHI: The recent deaths of two vaccinated youngsters from rabies have called into question the treatment procedures adopted in Kerala.
Health experts warn that there are several risk factors associated with rabies. According to them, children are at greater risk, as they are more likely to be bitten on the head and face. Healthcare workers who handle patients should ensure that all the wounds are accounted for and treated to prevent complications, they add.
As many as 13 rabies deaths have been reported in the state this year. In the whole of 2024, the official number stood at 22.
Dr Rajeev Jayadevan, convenor of the IMA research cell, said that dog bites to the head, face and fingertips involve more risk because of the rich nerve supply. Children, because of their size, are more prone to be severely bitten on the neck, head and face. The virus has only a short distance to travel from the face to the brain,” he said.
Public health expert Dr K K Purushothaman echoed the view. “Dog bites to the face and head are more dangerous. Moreover, children may not inform parents about licks or bites, making early detection difficult,” he said.
Administering the rabies vaccine requires skilled health workers and the cooperation of patients. “It is relatively difficult to administer vaccines intradermally – that is precisely into the top layer of the skin – in children, as they have thin skin and may be agitated and restless.
In addition, to prevent the entry of the virus into the nerves, wounds should be washed immediately and thoroughly, even before proceeding to the hospital. This is a critical step in reducing the total viral load. Inadequate first aid or delayed first aid and the failure to administer the serum or immunoglobulin into deep wounds are other risk factors,” Dr Rajeev said.
Dr Purushothaman added that health workers should not miss even small injuries while administering injections. “Jabs should cover every wound, even smaller ones, even scratches. At times, patients, as well as health workers, may not be aware of certain wounds. Parents should be more careful when the children engage with animals,” he said.
The proper transport, handling and storage of vaccines is essential. Pitfalls can affect efficiency. “Vaccines should be stored at a temperature of 2-8 degrees Celsius. The cooling facility should have power backup to reduce the chances of variation in temperature. It is extremely dangerous to not take the vaccine following a dog bite. Studies have shown that nearly eight out of 10 people who are bitten by a rabid dog and do not take a vaccine go on to contract rabies,” Dr Rajeev pointed out.
IntraDermal Rabies Vaccination
1st dose: Same day of the bite
2nd dose 3rd day
3rd dose 7th day
4th dose 14th day
5th dose 28th day
Immunoglobulin
Once immediately after the bite
Immediate steps after a dog bite
Wash the wound thoroughly with soap and running water
Provide first aid without delay
Inject anti-rabies serum or immunoglobulin into deep or severe wounds
Complete the full course of anti-rabies vaccination without missing any dose
Pain and Loss
The state has seen a series of incidents involving children attacked by dogs — both stray and pet — resulting in multiple deaths and serious injuries. A look at the recent incidents
February 10 (Alappuzha)
Savan D Krishna, a 9-year-old boy from Charumoodu, succumbed to rabies while undergoing treatment at a private hospital in Tiruvalla. He was reportedly chased by a dog while riding bicycle two weeks before his death but did not inform his family about the incident.
April 9 (Pathanamthitta)
B Bhagyalakshmi, a 12-year-old girl from Pullad and a Class VII student, died of rabies despite receiving an anti-rabies vaccination. She had been bitten by an unvaccinated pet dog belonging to a neighbour while waiting for her school bus on December 13, 2024.
April 29 (Malappuram)
Five-and-a-half-year-old Ziya, a Malappuram native, was mauled by a stray dog while playing outside her home at Peruvallur on March 29. Her father found her in a pool of blood and rushed her to the Tirurangadi Taluk Hospital and then to Kozhikode Medical College Hospital, where she died.
Kollam
A 7-year-old girl from Vilakudy is in critical condition at SAT Hospital, Thiruvananthapuram, after being attacked by a stray dog on April 8. She was admitted on April 29 with severe injuries to her hands.