From just two deaths due to rabies infection in 2016 to 11 such incidents in 2021. Fourteen so far this year. A total of 65,000 doses of anti-rabies immunoglobulins were purchased in 2018-19 while 1,40,000 doses have been bought for 2022-23.
These alarming figures along with the frequency of rabies deaths in vaccinated people have led public health experts to seek detailed scientific studies to find out the reasons behind the phenomenon.
There is a possibility of a rise in the number of stray dogs due to lack of proper waste management in the pandemic years, says T. Jayakrishnan, Professor and Head of the Department of Community Medicine, KMCT Medical College, Kozhikode.
He points out that 95% of people get rabies infection because of dog bite. There should be a survey to find out if the number of dogs and the number of people getting bitten by them have gone up.
“Rabies virus gets transmitted to dogs from wild animals, especially from foxes. There is a possibility of foxes mingling with dogs, which could have led to the spread of the virus. Because of a mutation in the virus, there could be a change in the virulence and transmission of the virus as well,” says Dr. Jayakrishnan.
There are three types of treatment for anti-rabies infection, according to the World Health Organization.
In the first category, if there are just animal licks on intact skin due to touching or feeding animals, there is no exposure to the virus. There is no need to take the vaccine and washing of the skin with soap and water will do.
The second category involves nibbling of uncovered skin by the animal that leads to minor scratches or abrasions without bleeding. The wound should be washed and anti-rabies vaccination should be immediately given.
The third category involves single or trans-dermal bites or scratches, contamination of mucous membrane or broken skin with saliva from animal licks and exposure due to direct contact with the animal. Wound washing, immediate anti-rabies vaccination, and administration of rabies immunoglobulin injection are suggested.
Equine rabies immunoglobulins, human rabies immunoglobulins, and monoclonal immunoglobulins are some of the antibodies being used against the virus. Three to five doses of the vaccines are given. There are two types of vaccinations available now — intradermal injections that are given to the skin layer below the upper skin, and intramuscular injections that are administered into the muscles.
“There is a need to ensure the quality of the vaccine. There could be something wrong with the way it is transported to hospitals and stored,” says K.K. Purushothaman, Professor of Paediatrics, MES Medical College, Perinthalmanna.
He claims that often the healthcare workers who administer the vaccine and the immunoglobulin may not be properly trained for the procedure too.
Dr. Jayakrishnan points out that each dose of the vaccine should have 2.5 international units of potency to be effective against rabies infection. Potency tests of the vaccine as well as random sample quality tests from pharmacies will be required. It should be ensured that the vaccine vials are kept at temperatures between 4 degrees Celsius and 8 degrees Celsius.
For the vaccine to be effective, a certain level of antibodies should be produced in the human body. Normally, this happens seven days after the injection is administered.
“A study should be conducted at periodic intervals to find out if the vaccines being used in the State right now are producing enough antibodies,” says Dr. Jayakrishnan.
