CHENNAI: The Directorate of Public Health and Preventive Medicine (DPH) has issued a rabies health advisory after two children in Kerala died of the disease, despite being vaccinated.
The main reason for the fatalities even after vaccination was delay in starting post exposure prophylaxis (PEP), improper wound cleaning, skipping doses or not completing the schedule.
Perhaps the child had deep bleeding wounds (category III exposure), and was given improper vaccines, or maybe it was improper RIG (Rabies Immunoglobulin) storage or administration could be other reasons.
All health officers in the city and districts were reminded that rabies was a deadly viral infection that affects the brain and nervous system. They were told to follow the guidelines and share the knowledge with healthcare workers for strict adherence.
“It’s almost always fatal once symptoms appear. So, PEP must be administered correctly and promptly,” the press release from DPH said. “Standard guidelines for rabies vaccination after a suspected or confirmed dog bite should be strictly followed. Children are at higher risk as immature immune systems may also respond less robustly.”
PEP for rabies involves immediate first aid. There are three categories to assess the bite. Category 1 is touching /feeding animals, licks on intact skin, PEP is not required. Category 2 is minor scratches/abrasions without bleeding and only a vaccine is needed. Category 3 is transdermal bites or scratches, licks on broken skin. Then a vaccine and RIG is needed.
RIG for category 3 must be infiltrated around the wound site on Day 0, as much as anatomically feasible. Not to be given later than 7 days after the first vaccine dose. Training to the healthcare workers to identify bite categories of bites and administer RIG correctly.
“Rabies PEP is lifesaving only if done properly. Correct wound care, timely and complete vaccination, and RIG (if indicated) with storage of vaccines at the proper temperatures (recommended by the manufacturer) are all crucial,” said TS Selvavinayagam, director, DPH, in the release.