Why so Least Research and Much ignorance about Rabies - Editorial

It took 12 years for the new guidelines on rabies to reach Maharashtra. Even today, these principles are only on paper in Maharashtra.

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Researcher Louis Pasteur invented a vaccine against the deadly disease rabies 130 years ago. But even today, rabies kills about 20,000 people in India every year. India has the highest rate of dog bites in the world. There is a great deal of ignorance among ordinary citizens, the government and even doctors about how to use this vaccine effectively to prevent the death of rabies after dog bites.

On July 16, 2019, an eight-year-old boy from a well-to-do family in Malad, Mumbai, died of rabies. The dying condition caused by rabies and the death that occurs, in fact, Undertaker will also tremble. While there were no obvious signs of dog bites, the boy was only talking about being bitten by a stray dog. The boy was not vaccinated against rabies even after being examined by two or three doctors. If this is the case in Mumbai, the financial capital of the country, then the situation across the country can be estimated.

Rabies is the only disease that has a 100 percent mortality rate, but it is also 100 percent preventable. But for many years now, the World Health Organization (WHO) has been blindly implementing a rabies vaccine schedule based on old research. Last year, however, Dr. Omesh Bharti, a doctor living in a rural area of ​​Himachal Pradesh, after 30 years of tireless research on rabies, revealed many flaws in the World Health Organization's guidelines for years. It also reduced the cost of treatment. For this, Dr. Omesh Bharti was awarded the 2019 Padma Bhushan. But unfortunately, our country and state are still unaware of this new guideline.

Another public health researcher, Dr. Ashok Kale, won a battle against rabies in court. He asked the court on behalf of the public interest litigation that one-tenth of the rabies vaccine we give through the skin is given in Thailand and Switzerland. With so many cases of dog bites, why aren't these cost and vaccine saving principles used in India? After winning this court battle in 2006, the Union Ministry of Health and Family Welfare was forced to issue a government decision to give a dose of 0.1 ml through the skin. In Maharashtra, however, it took 12 years to accept these principles. These guidelines are still on paper in Maharashtra and there is still a great deal of depression in terms of implementation.

Some of the basic facts about rabies research and dog bites that these two doctors put into their lives are still not understood by many. Understanding this research by doctors in the government, government service and private businesses, and the general public will reduce these easily preventable deaths from rabies. The rabies death in Malad was not vaccinated despite the possibility of dog bites.

Dog bites are divided into three categories, followed by vaccination and immunoglobulin. Whether or not the skin was pierced during this division is a question that creates ambiguity. A simple spirit test can be done to determine if you have been vaccinated and if the bite has penetrated the skin. Spirit was poured on the place where the dog was bitten. If it feels like burning after applying the spirit, then the skin should be recognized as pierced. It is possible to make a decision by verifying the category of the patient by taking complete information about the dog bite.

If only the dog has been scratched and the skin has been pierced or the skin has already been lightly bitten on the non-injured skin, the vaccine must be given. However, there is no need to give immunoglobulin. However, if the skin has been peeled off in one or more areas, and the dog has already been bitten, it is important to take immunoglobulin with the vaccine. Earlier, the World Health Organization (WHO) said that immunoglobulin should be given by weight. But since Dr. Omesh Bharti was working in a rural area, there was no abundant availability of immunoglobulin. Since there was no alternative, they just started giving immunoglobulin around the wound. When they did research on this, they found that even if a small amount of immunoglobulin was given around the wound instead of giving per milliliter of weight, it could save the patient from rabies death.

No patient was taking immunoglobulin before due to weight gain and was dying as a result. Now immunoglobulin can be given to many from a single capsule. As a result, the cost of rabies treatment went from Rs 60,000 to Rs 1,000. As Dr. Bharti is from Himachal Pradesh, the government immediately started implementing these guidelines. As a result, the number of rabies deaths in Himachal has dropped dramatically. In Maharashtra and other states of the country, however, these guidelines are not yet well known.

Doctors need to be trained to explain these principles. From the primary health center in rural areas to the sub-center, sub-district hospital, civil hospital, many dog ​​bite patients come daily. Every nurse and doctor there should follow these guidelines. Also, rabies vaccine and immunoglobulin should always be available in those health centers. Because today the unavailability of immunoglobulins and vaccines is a big issue in the government health system.

Pune researcher Dr. For many years, Ashok Kale gave only one ml of the vaccine to the skin instead of giving 1 ml of the vaccine deep into the muscles, but he toured all over the country to spread the word. This has two benefits. It is easier to vaccinate and less painful to the patient. With proper training, paramedics can also provide the vaccine. Also, the cost of vaccine is reduced by 0.1 ml instead of 1 ml. Despite the court order, the protocol has not been properly adopted in the state.

Pet dogs are vaccinated. Vaccination is often avoided after the bite of such a vaccinated dog. In China, a dentist died of rabies after being bitten by a similarly vaccinated pet dog. Therefore, even vaccinated pets should be vaccinated. Another observation is that dogs up to three months of age are not vaccinated after being bitten. It is a common misconception that rabies does not occur after a bite because the dog is small. It is important to convey the fact that rabies can occur even after the bite of such a newborn dog.

Dogs, paramedics and stray dog ​​catchers are expected to vaccinate dogs beforehand. But now the number of stray dogs is so high that everyone should get vaccinated beforehand. If you get a dog bite after taking this vaccine, don't you need to get vaccinated? So it is not. But vaccine doses are reduced. Also, even if the next vaccination is delayed, the chances of rabies are lower and immunoglobulins are not needed, so the cost is lower.

Vaccination of stray dogs and their neutering is a neglected issue in addition to post-dog vaccination. Even if dogs are vaccinated, the effects can be severe throughout the year. If you have a rabid or colloquially called a stray dog ​​in your area, it needs to be arranged. We don't even have the awareness that citizens will call a helpline for this. Also, such a reliable helpline is not available. If the municipality is informed, immediate action is expected. The number of stray dogs is increasing day by day due to neglect of neutering. There is a need to raise awareness about rabies deaths and vaccines at all levels, including the medical sector, the general public, the government's public health department, and the media.