Rabies-On-The-Road

Apparently, rabies seems to be on rise, but the inflow of on-going fuss due to Corona Virus, quite a few issues have gone behind the curtain, Rabies being one on the list.

By Prof. Dr Abdullah G Arijo

The current wave of dog bitten victims in Sindh continues to be serious concerns as there is a paucity, if not un-availability of anti-rabies injection. During 2020, many cases of dog biting victims went into veins. In Larkana, the stronghold of PPP, a six-year-old boy, who was brutally bitten by a mob of dogs (may be rabid) could not get anti-rabies treatment, hence was made to move to the National Institute of Child Health (NICH), where the juvenile victim was subjected to intensive care for his safe survival.

On 1st  March 20, another minor dog-bite victim succumbed to his injuries in Sukkur allegedly after the hospital staff failed to administer him the anti-rabies vaccine on time. The boy, identified as four-year-old Hidayatullah, was a resident of a village in the Saleh Pat Tehsil in Sukkur District.

Earlier on 8th January 2020, a woman from rural Sindh died because of rabies after she was bitten by stray dogs. She was a resident of Hamza Khan Rind village in the Bajara Union Council – the electoral constituency of Sindh Chief Minister Syed Murad Ali Shah. The deceased was 30 years old and mother of four, including a 40-day-old infant. Her husband told the local media that he shifted his wife from Sehwan to Hyderabad because the Sehwan hospital did not have the anti-rabies vaccine.

On January 2, a teen from Shikarpur in Sindh developed full-blown rabies after he was bitten by a rabid dog. He was taken to Jinnah Postgraduate Medical Centre (JPMC) in Karachi for treatment, but he could not survive too.

Rabies in Sindh has been on the rise, and there seems to be top-level ignorance at government level. The WHO describes rabies as a neglected disease in Pakistan, although the incidence of dog bites in the country is very high. Research has revealed that most of the population are either unaware of the risk of rabies when bitten by rabid dogs, or do not seek the right treatment for its prevention. In recent days, it seems as if there has been a rise in rabies both in rural and urban Sindh. Almost every day, there are reports of a dog biting. The situation has become worst due to a chronic shortage of anti-rabies medicines.

In Sindh alone, 69,453 cases of dog bites were reported in the province Sindh as stated by health department only in the first five months of 2019 alone. Most of the cases have emerged in Larkana division were between January and May, a total of 22,822 people was bitten by dogs. Of these, 7,678 incidents occurred in Qambar-Shahdadkot, 4,381 in Kashmore, 4,364 in Shikarpur, 3,752 in Larkana city and 2,647 in Jacobabad.

In Hyderabad division toll of reported dog bite cases was 21,099, of which 6,989 became the victim in Dadu. A total of 3,383 dog bite incidents occurred in Badin, 2,811 in Jamshoro, 1,984 in Tando Allahyar, 1,590 in Matiiari, 1,490 in Thatta, 1,188 in Sujawal and 802 in Tando Muhammad Khan.

The situation was not better in Shaheed Benazirabad division, 12,175 cases were reported while in

Mirpur Kha’s division 6,774 cases have surfaced. A total of 6,263 cases were reported in Sukkur division. 315 dog bite cases surfaced only in Karachi, including 274 in Malir, 18 cases from Korangi district, 11 from Central district, 10 from East district and one case from districts West and South respectively.

This hospital data of provincial health department is about the reported dog bite cases at government health facilities only and does not include the number of cases at private hospitals, Armed Forces institutions and teaching hospitals in mega cities which may further swell the magnitude of the problem. Again, every dog bite shall not be considered a confirmed victim of rabies because a majority of them escape due to timely vaccination and only a small number may retrieve it either due to non-availability of vaccine or due to less effective vaccine.

Rabies once established with its obvious symptoms is virtually a fatal disease with no remedy anywhere in the world. There are only six known recorded cases of rabies who could escape death elsewhere in the world. There is no scientifically recorded case of a confirmed case of rabies ever in Pakistan who could be saved alive hence it is immensely important to consult immediately any medical authority in case of dog bite which can manage it scientifically. The victims are strictly advised not to practice any home remedy or traditional healing except to wash the wound with clean water and soap thoroughly for fifteen to twenty minutes.

Largely ignored and undermined, Rabies is a potentially fatal viral disease that affects bats and almost all canine animals, the dog is most reported. The Disease is zoonotic and may be spread to human if bitten by an infected rabid dog through saliva. The bite needs to tear the skin for the animal or human to be infected. WHO reports domestic dogs most commonly spread the virus to humans; about 99% of human deaths are caused by dog-bitten, however, in Sindh, most of the recent cases are due to the stray dog(s)?

Increased vaccination of dogs, dog bite prevention, post bite treatment, immediate and thorough wound washing with soap and water for a minimum of 15 minutes after contact with a suspect rabid animal is crucial and can save lives.

 

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Anti-Snake Venom/Anti Rabies Serology Laboratory at Sakrand-Benazirabad, Sindh.  Courtesy Saud

Rabies may be a medical emergency; the virus is not a joke. To survive the virus, soon after dog biting, a victim must be given a series of anti-rabies shots before any appearance of symptoms appear such as jolting around the bite, fever, headache, nausea, and fatigue.

The dark aspect of rabies is that, once symptoms appear, the victim is less likely to survive. However, there report rabies patients surviving the disease without being treated ahead of symptoms, but the rate of survivors is just negligible.

Recent reporting on rabies both in print and electronic media data has shown that rabies cases are higher than they’ve been in past years. Very wrongly, only dogs are blamed to pass on the deadly virus to humans. Little is known that any mammal can act as agent in transmitting the pathogen into humans including rats and bats.

Rabies may only be kept at bay if Vaccines and close attention are taken into practical consideration. For domestic animals, the rabies vaccine is the best way to protect against the disease. Most areas of the country require that domestic dogs be vaccinated at least every three years. And for humans, paying close attention is vital.

The current situation reveals that the Sindh government has failed to provide the vaccine to healthcare facilities even in urban hospitals. Authorities have only excuse about the lack of funds, which has resulted in a shortage of ARVs.

Taking notice of rising incidents of snake and dog-bite as well as an acute shortage of vaccines, Sindh government back in 2004 had finalized a proposal for the establishment of an anti-snake and anti-rabies vaccine serology laboratory at Mithi.

The National Institute of Health, Islamabad, which is the only official supplier of ASV and ARV vaccine throughout the country, is overburdened and cannot meet the demands hence the government had decided to establish a similar laboratory in Sindh which would not only reduce the burden on NIH and also supply vaccines at a cheaper rate, but typical delaying in fund releasing, the product cannot be made available to the poor masses of Sindh.

The government of Sindh has probably forgotten about anti-snake anti-rabies serology laboratory established at Sakrand. In its initial phase (Phase-1) the established laboratory is configured for production of ASV alone. Gradually it will be expanded to manufacture Anti-Rabies, Anti Tetanus, Anti Diphtheria and other Biological products of life-saving nature.

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Initially, Anti-snake venom injection has been successfully developed and duly accepted by WHO Iran office through Iranian Registry of Clinical Trials (IRCT) Tehran, but due to paucity of funds, the product may not be made available to needy masses. If funds are provided, anti-rabies treatment may also be developed to avoid the shortage. The government of Sindh in conjunction with health department must take practical measures to facilitate the team working on the task to fully utilize the established facility aimed at human welfare. This will be a great service to the people of Pakistan in general and Sindh in particular.

Author: Prof. Dr Abdullah G Arijo Chairman Department of Parasitology Sindh Agriculture University-Pakistan