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Published Date: 2011-07-26 16:54:31
Subject: PRO/AH/EDR> Rabies - India (15): (AP), human, vaccine failure
Archive Number: 20110726.2256

RABIES - INDIA (15): (ANDHRA PRADESH), HUMAN, VACCINE FAILURE
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Date: Fri 22 Jul 2011
Source: The Hindu [edited]
http://www.thehindu.com/todays-paper/tp-national/tp-andhrapradesh/article2283847.ece

Tribal boy dies of rabies
-------------------------
A tribal boy died of rabies at the district headquarters. The
9-year-old boy was a native of Bhagavathveedu Tanda in Kusumanchi
mandal [sub-division].

The boy, a student at a Hyderabad-based school, had arrived at his
home village along with his parents, both daily wage labourers working
in Hyderabad, on Tue 5 Jun 2011. He was bitten by a stray dog at his
village the same day. His parents rushed to Hyderabad soon after the
incident and tried to get him vaccinated at a government hospital in
the city the same night but in vain. The next morning they got the boy
treated [with immunoglobulin?] at a private hospital in Dilsukhnagar.

As an additional precaution, they took him to IPM at Narayanguda in
Hyderabad where he was reportedly administered anti-rabies vaccine.
When the boy suddenly developed symptoms of hydrophobia during [a]
visit to home village on Thursday [21 Jul 2011], his parents rushed
him to the district headquarters hospital here in the afternoon.
However, the boy died a few hours later.

"The boy had received all the prescribed doses of anti-rabies vaccine
except for one dose, which is due on the 28th day, at the IPM in
Hyderabad," said District Coordinator for Hospital Services Papa Lal.
"He was also administered the costly human rabies immunoglobulin at a
private hospital in Hyderabad as he had suffered injuries on his face.
Strangely, the boy contracted rabies and died of the disease," Dr Papa
Lal said.

On 29 May 2011, a 16-year-old youth of Danavaigudem village in Khammam
rural mandal died of rabies after being denied anti-rabies vaccine.

--
Communicated by:
Merritt Clifton
Editor, Animal People
P.O. Box 960
Clinton, WA 98236, USA
<anmlpepl@whidbey.com>

[Merrit Clifton comments that: "Popular perception of this case will
be that the post-exposure vaccine failed, which might have happened if
the cold chain was broken in storing it. However, the victim suffered
a facial bite. If neural links to the brain were directly infected,
the victim may have had a very brief window of time within which
post-exposure vaccination could have been effective."

According to Elkin (A Course in Epidemiology, Pergamon Press,1961) 6.2
percent of rabies bites involve the head of victims and 24.9 percent
of such bites on the head result in death (a greater proportion than
at any other site). The proximity of the site of virus entry to the
central nervous system (CNS) increases the likelihood of a short
incubation period. The estimated speed of virus migration in neurons
is 15-100 mm per day which implies that dissemination of virus from
the periphery to the the CNS is rapid. Active cerebral infection is
followed subsequently by passive centrifugal spread of virus to
peripheral nerves (Lahane Sunil R.l, Rautmare S.S.,l Ganvir P.T.l and
Bhuktar VMi! Western Regional Disease Diagnostic Laboratory, Pune).
Consequently the delay in administering anti-rabies immunoglabulin to
the victim might have allowed the virus to reach the central nervous
system rapidly thereby reducing the effectiveness of vaccination in
combating the infection.

Kusumanchi is a mandal in Khammam District of Andhra Pradesh. A
description of the Khammam district and a map locating it in the
Indian state of Andhra Pradesh can be accessed at:
http://en.wikipedia.org/wiki/Khammam_district#Divisions_in_Khammam_district.
- Mod.CP]

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