Rabies treatment will be managed better now with the Union health ministry issuing fresh guidelines, stressing on the use of readymade antibodies called rabies immunoglobulines (RIG) to treat patients. The guidelines assume significance in Pune city, which reported 20 deaths due to rabies last year. While RIG was not properly administered in some cases, in others it wasn't given at all to the patient.
The 'National Guidelines on Rabies Prophylaxis', issued recently, has stressed on the use of RIG not only in category III dog bite cases (that currently prevails) but also in category II dog bite cases, if the patient has weak or impaired immune system arising out of conditions such as HIV/AIDS, pregnancy or even cancer wherein the patient is undergoing chemotherapy or radiation therapy. Other conditions, such as genetic disorders, can also lead to poor immunity. Doctors avoided administering the antibody in such cases.
But the guidelines, if followed, will change that. "Post exposure prophylaxis (PEP) against rabies takes preference over any other consideration as it is a lifesaving treatment. Moreover, rabies vaccine does not have any adverse effect on pregnant woman, course of pregnancy, foetus or lactating mother. Hence, complete PEP should be given depending on the category of the exposure," the guidelines state.
The guidelines have also clearly underlined that anti-rabies treatment should not be denied to patients who report late for treatment.
"Bite by all warm blooded animals necessitates post-exposure prophylaxis. As rabies is practically 100% fatal, bites by dogs and cats in particular must be considered as a "medical emergency" and the "life-saving" post exposure prophylaxis must be provided immediately," the guidelines state.
The guidelines also note that whether a dog bite was provoked or not should not be considered a guarantee that the animal is not rabid and so PEP should be immediately instituted.
Pune city reported an average of 1,000 dog bite cases every month last year and doctors said the guidelines will help set a treatment protocol. "The guidelines are important as they will sensitise doctors about proper methods of post exposure prophylaxis in dog bite cases. The guidelines have stressed on the important role of infiltrating rabies immunoglobulines in and around the wound and is good that the revised guidelines have broadened the scope of rabies immunoglobulines in fighting rabies," said physician Vilas M Dhere.
As rabies is nearly a 100% fatal disease, the guidelines have also made it clear there is no contraindication to post exposure prophylaxis (PEP), a preventive medical treatment which in case of dog bite is given immediately in the form of anti-rabies vaccinations and rabies immunoglobulines to fight the disease-causing rabies virus.
In the last six years, there have been newer developments in rabies prophylaxis and a need was felt to review and revise the guidelines to ensure uniformity in preventive treatment or post-exposure prophylaxis (PEP). Taking this in account, National Centre for Disease Control of the Union health ministry issued the guidelines.
The guidelines read: "Because of long and variable incubation period, which is typical of most cases of human rabies, it is possible to institute PEP to protect the individual. This must be started at the earliest to ensure that the individual is immunized or protected before the rabies virus reaches the nervous system. However, people who present for treatment even months or years after a possible rabies exposure should be evaluated and treated as if the event had occurred recently."
In a rabies endemic country like India where there is sustained dog-to-dog transmission, every animal bite is suspected as a potentially rabid one, and treatment should be startedFact sheet
- Rabies is an acute viral disease that causes fatal encephalomyelitis in virtually all the warm blooded animals including man
- The virus is found in wild and some domestic animals, and is transmitted to other animals and humans through their saliva (i.e. following bites, scratches, licks on broken skin and mucous membrane)
- In India, dogs are responsible for about 97% of human rabies, followed by cats (2%), jackals, mongoose and others (1%)
- Rabies is invariably fatal and perhaps the most painful of all communicable diseases
- As many as 20 people succumbed to rabies last year in Pune city
- Of them, 6 were local residents. In majority of the cases, relatives had alleged that the victims were NOT administered the antibody
- The guidelines stress upon the use of readymade antibodies called rabies immunoglobulines (RIG) not only in category III dog bite cases (that currently prevails) but also in category II dog bite, if the person who has suffered the dog bite has weak or impaired immune system
- People with serious dog bites should be injected with the fast-acting RIG near the wound to deactivate the virus, but in many cases, a calculated dose of the antibody is injected intramuscularly rather than into the wound
- The guidelines have also clearly underlined that anti-rabies treatment should not be denied even if the patient reports late for treatment
- Guidelines clearly state that the antibody can be administered even if the patient is pregnant, lactating, is an infant or an elderly
Category Type of Contact
- Touching or feeding of animals
- Licks on intact skin
- Contact of intact skin with secretions/excretions of rabid animal
- Nibbling of uncovered skin
- Minor scratches or abrasions without bleeding
- Single or multiple transdermal bites or
- Scratches, licks on broken skin
- Contamination of mucous membrane with saliva (lick)
Times of India
07 Jan 2014,
by - Umesh Isalkar