Kerala rabies deaths not due to ineffective vaccines: Govt panel
The deaths in Kerala due to rabies were not because of ineffective vaccines but improper and delayed treatment, an expert panel constituted by the central government to investigate the deaths has found.
The deaths in Kerala due to rabies were not because of ineffective vaccines but improper and delayed treatment, an expert panel constituted by the central government to investigate the deaths has found, according to people familiar with the matter.
“The committee has confirmed in its report that the vaccines are effective and the deaths have not been because of failure of vaccination,” a central government functionary said, requesting anonymity. “The problem is related to management on ground that needs to be corrected, and has been duly conveyed to the state government.”
The three-member committee that visited the state to probe the cause of deaths after allegations of rabies vaccines being ineffective were levelled submitted its report to the Union health ministry on Tuesday.
“Supportive evidence on media reports such as issues in antirabies vaccine efficacy/potency and circulation of rabies virus variants escaping protection provided by vaccine could not be found,” the investigators said in their report that HT has accessed.
Kerala reported nearly 2 million dog bites and 21 deaths this year. At least six of the dead have been reported to receive anti-rabies serum (immunoglobulin) and rabies vaccines.
The majority of deaths were preventable and could be attributed due to low awareness in the community about what to do in the event of animal bites, the report stated.
The central team comprising officials from the National Centre for Disease Control was sent to Kerala last month to undertake a clinical and epidemiological investigation of all 21 mortalities in 2022.
“There has been delay in seeking time and appropriate animal bite management in the cases examined, which might be attributed to not recognising the importance of timely and full rabies post exposure prophylaxis,” the report said. “Intensive information education and communication activities are required for all target audiences about do’s and don’ts for animal bites management.”
The investigators found knowledge gaps on washing of wounds with soap and water, applying antiseptic and not applying chilies, turmeric, etc., on wounds. They recommended aware drives on the importance of washing bite wound to the target audience and staff of anti-rabies clinics. “All anti-rabies clinics should have areas delineated for proper wound washing with availability of soap and running water,” they recommended in their report.
The standard guidelines have been shared with the state authorities.
The panel also found limited availability of rabies vaccine and serum at peripheral health facilities, with only 30% primary health centres and urban health centres found to have vaccine stocks available and only 3.5% had the serum.
Kerala has reported a consistent increase in the incidence of animal bites, mostly by dogs, and subsequent deaths due to rabies over the past six years. In 2022, the number of deaths reached almost two times to date compared with the deaths in 2021. The most recent death was of a 12-year-old girl, who died in Pathanamthitta district after three doses vaccination.
The central team thoroughly scrutinised all case records of the dead on presenting clinical symptoms, type of exposure, vaccination history and laboratory test results.
“The investigation revealed a history of dog bite exposure in 16 out of 20 cases, and a total of six cases with history of exposure died despite vaccination,” their report said. “On detailed investigation, out of these six cases, three had fatal exposure and died even before completion of the vaccination schedule.”
One case with fatal exposure had five hours delay in getting rabies immunoglobulin due to non-availability at a nearby health facility. One case was defaulter for vaccination and another was again with significant delay in seeking treatment, the committee found.
“Significant knowledge gap among health care professionals regarding decision to treat different categories of animal bite victims, case diagnosis, laboratory aspects such as optimum sample in ante-mortem and postmortem cases also need to be addressed through capacity building,” the investigators said.
The team also recommended awareness drives, provision of vaccines and serums at all health facilities, strengthening of laboratories and use of standard protocols, capacity building and periodic refresher training of physicians, strengthening of rabies inpatient facilities , strengthening of intersectoral coordination and strategic planning for formulation of State Action Plan for Rabies Elimination on the lines of the National Action Plan for Dog Mediated Rabies Elimination by 2030.
HT tried to reach out to a Kerala government official for a response on the matter but did not get one immediately.