Sunday, 11 August 2013

Pup vaccination practices in India leave people to the risk of rabies

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

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

1.    "Grandmother who died from rabies after puppy bite in India was turned away from UK hospital twice before she was diagnosed” web document,:
2.    Raksharab Profile, Indian Immunological Ltd, vaccination regimen.