Investigating
Rabies deaths due to scratch/ bite by pups in remote hilly villages of Himachal
Pradesh, India.
Pup vaccination practices in India leave
people to the risk of rabies
Kumar
Omesh*, Ramachandran V **
National Institute of
Epidemiology, Chennai, India
* Corporation Health
officer, MC Shimla, HP, India, ** Deputy Director NIE, Chennai, India
Background:
Rabies, a zoonotic disease, kills 55,000
persons every year globally and 20,000 persons in India. Two years back, we learnt of
two deaths due to Rabies in remote village Shiv Shankar Garh of Arki block of District Solan and decided to
investigate the deaths.
Method:
A rapid response team
was constituted to investigate the deaths. We interviewed the villagers &
family to conduct verbal autopsy. A line
list of entire population of village and household contacts of the patients,
who died, was made along with the line list of dogs and cattle.
Results
& Discussion: The
death of 14 years old male patient due to suspected rabies was reported on July
19, 2011. A woman aged 22 years in the same household had died of symptoms of
rabies 10 days ago. A month old stray pup had caused an abrasion with its toes
on the hands of both the diseased on June 2, 2011 while playing. The lady
developed paralysis of the arm on July 3, 2011 and 3 days later developed
symptoms of hydrophobia. She died on July 9, 2011. The boy developed
hydrophobia 10 days after that and died on July 19, 2011. All 24 human contacts
were immunized with intra-dermal anti-rabies vaccine. Two dogs were vaccinated
and villagers were requested to vaccinate all the 33 cattle heads listed in the
village.
Assumption that a small pup of one
month cannot be fatal proved otherwise. Lack
of awareness regarding the fatality of even a scratch; and lack of knowledge
regarding local treatment of the wound &vaccination, was the main reasons
for the deaths.
Last year (April 2012) a 62 years old
woman of village Panjgain in District Bilaspur was referred to medical college
Shimla and investigated by the author for symptoms of rabies. She was bitten by
a two month old stray pup in her right leg a month ago and died of rabies.
“Mail Online” reported on November
2012, that Saranjit Ubhi, 58, died in UK of rabies after puppy bite in India1.
While such incidents keep on happening,
the veterinarians are refusing to vaccinate pups before three months of age as pups
may not develop immunity before that age. Although the product manual2
of widely used vaccine in dogs in India, does not prohibit use before three
months advising a booster in such cases at three months of age, yet veterinarians
in India do not follow any such practice leaving unsuspecting people to the
risk of rabies.
Conclusions: Humans can be exposed to rabies even
by pups below 3 months of age.
Recommendation:
Veterinarians and
public health experts need to strongly consider vaccinating pups at first
contact with humans, especially in endemic countries like India. A booster to
the pup can be given at three months of age with subsequent yearly boosters.
Also studies need to be planned to
make pup vaccination more potent, to enable them to be given at birth.
Keywords : Rabies, pup scratch, pup
vaccination
References:
1. "Grandmother who died
from rabies after puppy bite in India was turned away from UK hospital twice
before she was diagnosed” web document,: http://www.dailymail.co.uk/news/article-2239764/Grandmother-died-rabies-turned-away-UK-hospital-twice.html#ixzz2bYNB9Shj
2. Raksharab
Profile, Indian Immunological Ltd, vaccination regimen.
