More than 20 people have died of rabies in Kerala this year, and five of them were affected despite being vaccinated. A seven-member committee was formed to study the effectiveness of the vaccine. But this was not enough to cure the growing anxiety levels among the public in the state.
Onmanorama turned to several health experts to gather some thoughts on the matter.
The rabies virus is an RNA virus that enters the body through the bite of a vector organism. It remains around the wound for some time and then migrates through the nervous tissues to the central nervous system and causes encephalitis.
“The first hours after a dog bite are very important. “Washing the wound thoroughly can remove 80 percent of the virus,” said Dr Presoon Kuruvilla, Consultant Physician, Caritas Hospital and Institute of Health Sciences, Kottayam. Onmanorama.
“After a dog bite, it is necessary to wash the wounds with running water for 15 minutes. Apply soap to clean the wound and wash away germs. After washing, apply ethanol and iodine to sterilize the wound.
It bites critical parts of the body
A death audit report released by the Department of Health said all five vaccinated rabies victims had third-degree wounds to critical parts of the body, such as the face, neck and fingers.
Kozhikode District Cooperative Hospital Chief Consultant Pathologist Dr. “Critical parts of the body have more nerves and bites to these areas can increase the growth of the virus inside the body,” says Aravindan KP.
“The vaccine takes at least 2 weeks to develop antibodies. “If the bites are applied to critical parts such as the face, the virus will reach the brain before the vaccine takes effect.”
Application of serum, immunoglobulin
Hospitals offer immunoglobulin or serum to the patient during the first visit if the type of injury is classified as serious.
“Proper application of serum after a dog bite is critical for any wound that causes bleeding. All the serum should be injected into the wound. It is not easy when the bite is close to the eye or other sensitive organs. Staff should also be trained for this,” says Dr Aravindan.
“When the serum is extracted from the horse, the immunoglobulin includes humanized antibodies,” Dr Presoon said.
“Although immunoglobulin is more effective than serum, it is usually the latter because it is cheaper,” he said.
Vaccine doses increase antigenicity
When asked why the vaccine is given in successive doses, Dr Presoon said that the spacing between doses increases the antigenicity of the vaccine. Antigenicity is a term used to describe whether and how well a substance binds to the immune cells that initiate the immune response process.
“Serial doses allow the body to develop antibodies with a minimum incubation period. Booster doses are then given to boost immunity,” said Dr Presoon.
Meanwhile, Dr Aravind said India should consider the option of administering rabies vaccines to high-risk people before they are bitten, as opposed to the standard convention.
If not stored at the correct temperature, the quality of the serum may deteriorate.
KP from Dr Aravin
It is important to store the vaccine and serum
Although the rabies vaccines procured through Kerala Medical Corporation Limited (KMCL) have the Centre’s quality standard certificate, serious questions have been raised about the efficacy of the rabies vaccine. Health experts reject this possibility.
“Initiatives should be taken to verify that vaccines and sera are properly stored and administered. The quality of vaccination is not the issue here. If it is not stored at the right temperature, the quality of the serum may deteriorate,” said Dr Aravindan, adding that adequate training is required for intradermal rabies vaccination.
Any irregularities in the production, purification, handling and storage of vaccines will reduce their effectiveness.
Although there are currently no naturally occurring rabies mutations, health experts believe that genome sequencing will be necessary to observe the ultimate behavior of the rabies virus.
Food waste creates an ecosystem for dogs to thrive
The number of dogs infected with the deadly rabies virus has almost doubled in the last five years, according to Kerala’s Animal Husbandry department’s test reports. 168 out of 300 samples collected from domestic dogs and dead animals had a positive effect on the disease.
Cases of infection in other animals, including cats, have also doubled in the past five years.
The main reason for the significant increase in rabies cases is the discontinuation of vaccinations, which were previously provided by sterilization activities. Failure to administer rabies vaccines on time has resulted in the spread of disease among domestic animals.
A large amount of untreated food waste lying around is another reason for the explosion of dog population in Kerala.
“Food waste creates an ecosystem for these animals and insects to thrive,” said Dr Aravindan.
Authorities should look at immediate options such as limited extermination along with long-term options such as animal birth control to address the problem.
“We don’t have enough animal shelters to house these dogs, nor do we have the trained human resources to handle them. Birth Control in Animals is an exercise that can take effect only in a few years,” he added.
Meanwhile, experts argue that the administration’s efforts will be wasted if not balanced with public awareness and education.
“It is more worrying that the majority of those who die from rabies do not receive the vaccine. Misinformation about the ineffectiveness of vaccines must be stopped. The public should be educated about the importance of getting rabies vaccinations,” said Dr. Aravindan.