Manimajra girl Sadia’s death due to rabies on Wednesday night has raised questions on the potency of the vaccine. Experts, however, term it a serious vaccination failure leading to the six-year-old girl’s death.
From the doctors treating her to experts in the field, most say that when a patient is given immunoglobulin (an injection of antibodies) within 24 hours, it is the “rarest of the rare” occurrence that the dog bite victim contracts rabies. What made it worse was that the child was bitten on her lips, face and scalp, which increased the danger to begin with, say experts. Possible reasons behind a vaccination failure are break in the cold chain or she may have been bitten directly in the nerve, they say.
Dr Atul Prashar, the plastic surgeon who first examined Sadia, said the child had a “type 3” bite with multiple bleeding wounds on the scalp, face and lips. He said as per the current guidelines of Centres for Disease Control (CDC), USA, the child received appropriate wound care as well as the rabies vaccine (rabipur) and anti-rabies immunoglobulin within 10-12 hours of the bite. “I have never seen a case in which rabies develops in 10-12 hours of the dog bite,” said Dr Prashar. Head of the neurology department at the PGI Dr Vivek Lal said: “It sounds like a case of vaccine failure. In my career of three decades, I have never seen a patient developing rabies after administering immunoglobulin within the stipulated time.”
Experts say dog bite on the face is considered dangerous as it is close to the brain. Also, such a bite also has a high risk of treatment failure and progression to rabies encephalitis. Unfortunately, despite the best post-exposure prophylaxis (consistent with international recommendations), the child succumbed to rabies.
Former director, Central Research Institute (CRI), Kasauli, Dr Rakesh Shegal said: “There are occasional human rabies cases reported despite post-exposure treatment due to various factors such as negligence and individual health status. Most cases have been reported due to delayed vaccination or non-use of rabies immunoglobulin in category III exposure, or incomplete course of vaccination.”