Central panel blames knowledge gaps for rabies deaths in Kerala, calls for uninterrupted supply of vaccines 

A three-member central panel has found that numerous deaths caused by rabies in Kerala hadn’t resulted from ineffective vaccines or virus variants escaping immunity, blaming instead knowledge gaps on the part of health personnel.

“An expert committee was set up by the Health Ministry to look into how effective rabies vaccines are as the state government raised doubts about it. The committee has said that the rabies vaccines are very much effective,” a health ministry official told MoneyControl.

The three-member panel, which visited Kerala, in its report to the Centre, said the number of deaths caused by rabies, a viral disease spread to people from the saliva of animals like stray dogs, in the state had doubled this year from the previous year.

The Health Ministry deputed the team of experts from the Zoonotic Disease Programme of the National Centre for Disease Control to visit Kerala.

Kerala Health Minister Veena George urged central Health Minister Mansukh Mandaviya to direct experts to examine the quality of anti-rabies vaccines administered in Kerala.

George said in the state assembly that the number of dog bite cases in Kerala had gone up from 135,000 in 2017 to 183,931 this year until August 30.

The minister said that in the same period, the rabies vaccine uptake had jumped by 57%, while the requirement for rabies immunoglobulin serum (equine) had gone up by 109% in Kerala.

“There were 20 human rabies deaths, of whom 15 were unvaccinated,” she added.

Knowledge gaps 

The committee said wound assessment was the most critical step in prevention of rabies following animal bite.

“Knowledge gaps on wound washing with soap and water, antiseptic and not applying any chillies, turmeric etc on wounds were found. IEC on importance of wound washing to target audience and staff of Anti Rabies Clinics must be done,” the panel’s report said.

IEC is short for information, education and communication.

The panel said the knowledge gaps were related to decision making in treating various categories of animal bite victims, especially the administration of rabies immunoglobulin in so-called Category 3 patients, which is a critical factor in mortality reduction.

“The use of Monoclonal Antibodies as an alternative to Human Rabies Immunoglobulin (HRIG) or Equine Rabies Immunoglobulin (ERIG) need to be closely monitored,” the report said.

Also read: Cadila in talks with Centre, states for supply of three-dose rabies vaccine

Public health expert Dr Suneela Garg said the assessment of wounds in animal bites is a very crucial point in treating patients.

"The wounds always have to be examined properly for the treatment of animal bite cases; they need to be washed properly. Often, this is not done in a proper way, which compromises the situation," she said.

When asked about reports questioning rabies vaccine quality, Garg said the quality of vaccine and serum being used by the government was good.

"The vaccines being given in India are of the best quality, and raising questions on them is not right. One has to understand that the current rabies vaccine regime of five doses spans across a month, so we often see some people not completing their full course," she added.

Uninterrupted supply of vaccine 

The three-member panel, in its report, advocated an uninterrupted supply of Anti-Rabies Vaccine and Anti- Rabies Serum, adding that their availability must be ensured through regular monitoring of state portals.

The panel recommended strengthening of inter-sectoral coordination and sharing of animal bite data and deaths due to rabies between the health and state veterinary departments and veterinary department of municipal and rural local bodies.

The panel said it didn’t find evidence to support reports doubting the efficacy and potency of vaccines and circulation of rabies virus variants escaping protection provided by vaccines.

“Intensive information, education and communication is required for all target audiences about do's and don'ts for animal bites management,” said the committee’s report.