Analysis | Kerala panel suggests rabies vaccines for kids across India but is that practical?

Representational image. (Photo: Anil Sharma via Unsplash)

A Kerala government-appointed panel to suggest vaccine policy for the state has recommended introducing pre-exposure prophylaxis vaccine against rabies for the most vulnerable population groups, including kids across India, in the wake of rising instances of dog bites.

If the state government accepts the report and implements its findings, it will be the first state in India to introduce PrEP against a disease. About 21 people have died of rabies in Kerala so far this year.

There is no public record of the number of dog bites in the country overall but a total of about 1.2 lakh cases have been recorded in Kerala this year, as per government figures.

The panel in Kerala, headed by Dr B Ekbal, a public health activist and neurosurgeon, has said that PrEP against rabies is recommended for individuals at higher risk of dog bites due to occupations like animal handlers, pet owners, and veterinary doctors and for the children in rabies-endemic countries like India.

“With the increase in the number of the stray dog population, cases of rabies and rabies deaths it is worthwhile to introduce pre-exposure prophylaxis, which can avoid the need for rabies immunoglobulin and reduce the doses needed for post-exposure prophylaxis to two in case of subsequent accidental exposure,” the panel noted.

The growing menace of rabies
Rabies is a fatal but preventable viral disease that can spread to people and pets if they are bitten or scratched by a rabid animal.

The rabies virus infects the central nervous system and if a person does not receive appropriate medical care after a potential exposure the virus can cause disease in the brain, ultimately resulting in death.

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Rabies can be prevented by vaccinating pets, staying away from wildlife, and seeking medical care after potential exposures before symptoms start.

As per the World Health Organization data, rabies -- caused mainly due to dog bites-- claims the lives of more than 55,000 people each year, mostly in Asia and Africa.

India is endemic for rabies and accounts for 36 percent of the world’s rabies deaths and while the true burden of rabies in India is not fully known, available information suggests that it causes 18,000-20,000 deaths every year.

Also, about 60 percent of reported rabies cases and deaths in India occur in children under the age of 15 years as bites that occur in children often go unrecognised and unreported.

The Union health ministry has set the target of eliminating rabies deaths due to dog bites by 2030 but experts say that it may be a tough target given the growing intermixing of humans and animals such as dogs.

The current treatment regimen
As of now, anyone bitten by animals such as dogs, cats or monkeys is recommended to wash the wound with soap and water for nearly 15-20 minutes before getting injected with rabies antibodies-also called immunoglobulins—at the wound site.

Thereafter, five doses of rabies vaccine are recommended on days 0,3,7, 14 and 30. However, as it takes about 7 days for a good number of antibody-triggered immunity in the body to get effective against viruses, sometimes even those who receive the treatment die.

Most such people either have very deep wounds, delay or lack of access to proper treatment or have been bitten in nerve intense areas such as the face, neck or hands, explained Dr Rajeev Jayadevan, a clinician and medical researcher from Kerala, which makes it easy for the pathogen to reach and infect the brain.

Latest suggestion
The Kerala panel, in its report, has suggested pre-exposure prophylaxis for population groups identified as the most vulnerable apart from kids.

Jayadevan, who has written extensively on the rise of dog bites and human rabies deaths and the reasons behind them, pointed out that children, indeed, are particularly susceptible to dog bites.

“I think it may be a good idea to vaccinate kids against rabies in Kerala given the high instances of dog bites. However, whether all kids across India need a pre-exposure vaccine against rabies may need local analyses and a blanket decision may not be cost-effective,” he said.

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Immunologist Dr Dipyaman Ganguly, too, said that while there is a definite need for pre-exposure vaccines for rabies, he is not sure whether it should be part of the Universal Immunization Programme, given the present risk propensities.

“Personally I shall be more in favour of animal surveillance and vaccinations,” he said. “Long-term data on the possible sequels of the available anti-rabies vaccines for kids should be available before taking any relevant decision.”