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Background: Rabies being a preventable disease with no treatment available once onset starts but can be easily prevented by post-exposure among all animal bite victims. So it is essential to take the full course of vaccination for complete protection.Methods: The present study was a hospital based cross sectional study and was carried out in rural health training centre in Maner, Patna.Results: Our study included 340 patients who attended anti rabies clinic for post exposure prophylaxis. Among them 65% were children (<15 years) comprising mostly males (69%) and mostly of category III exposure. Direct cost of post exposure vaccination when compared with the cost of pre exposure prophylaxis is one-third (approx).Conclusions: Compliance to anti-rabies vaccination for post-exposure prophylaxis is still low and they are still at risk of developing rabies. Reasons being irregular supply of vaccine and immunoglobulin in government hospitals, loss of wages, forgotten dates, cost incurred to buy from outside and distance from the hospital if referred to other centre. Seeing the current scenario, planning and prioritizing areas to achieve our goal and lessen economic burden is need of the hour. We infer that pre exposure prophylaxis may be a cost effective strategy which can aid in the control and elimination of rabies in endemic settings.
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Background: WHO guidelines recommend for treating Cat III animal bite victims with local infiltration of Equine Rabies Immunoglobulin (ERIG) into and around animal bite wounds followed by anti-rabies vaccine (ARV).The main reason for non-use of ERIGs by medical profession is the fear of anaphylaxis and laborious process. The present study was taken up with the objectives to assess the clinical safety of a new ERIG, describe sociodemographic profile of ERIG recipients and compliance to Intra Dermal Rabies Vaccine (IDRV), who reported to Anti Rabies Clinic (ARC) of Mandya Institute of Medical Sciences (MIMS), Mandya.Methods: Descriptive study at ARC, MIMS, Mandya for a period of one year. The data was collected using structured questionnaire. The data was entered into Microsoft excel and results were expressed using descriptive statistics.Results: The study revealed that cat III animal bite victims were 3400 (56.3%), of these only 545 (16.0%) opted for the new ERIG. Skin Sensitivity Test (SST) showed positive results in 17 (3.1%) cases. Among the ERIG recipients 28 (5.1%) had mild adverse reaction to ERIG. The compliance rate was 49.2% for all 4 doses of IDRV.Conclusions: 3.1% showed positive result to SST. 5.1% had mild adverse reaction to ERIG.
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Background:Post-exposureprophylaxis(PEP) is the mainstay of prevention in suspected exposure to rabies virus.Exposedpatients are able to obtain anti-rabies vaccine in the anti-rabies clinicpro bono butthey have to pay forpassive immunization and cover otherassociated costs.Aim:To estimate and analyze the direct and indirect costs of rabies PEP.Methods: This study was conducted on 429 patients, who were exposed to bites from various animals and reported to Shri Mahraja Hari Singh Hospital (SMHS), an associated tertiary hospital of Government Medical College, Srinagar, Kashmir. Patient socio-demographic profile, details of animal bite exposure, the cost incurred for PEP wascollected. The data were analyzed using a descriptive statistic.Results: The study revealed a total median cost incurred on patients for receiving a PEP as 29.3 USD (United States Dollar), with an Inter-quartile Range (IQR) of 0.2 USD to 43.1USD. The direct median cost was 20.5 USD with an IQR of 6.2 USD to 29.4USD, while the indirect median cost was 20.3USD with an IQR of 13.5USD to 24.4USD.Conclusion:Post-exposure prophylaxis imposesa significant economic burden to bite victims especially those of low socio-economic strata for whom the cost issubstantial.Original ResearchArticle
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Aims: To evaluate the role of delayed primary suturing in prevention of sepsis and achieving better cosmetic appearance in animal bite injuries over the head and neck areas. Study Design: Prospective observational study. Place and Duration of Study: Department of Otorhinolaryngology at Govt. Medical College, Nanded, Maharasthra, (India) from a period of Jan 2009 to Dec 2013. Methodology: A prospective observational study of 70 cases of patients presented to us in the form of injury to head and neck area by animal bites. In all patients we followed the standard norm for delayed primary closure in form of: • Thorough wound toileting • Equine Rabies Immunoglobulin at the site of wound in all patients • Anti-Rabies vaccination • Daily dressing • Delayed primary suturing after 10 days All patients were routinely followed up and assessed for wound sepsis, cosmesis and function. Results: Among the animal bites, dog bite injuries were found to be most common facial injuries followed by swine and cat. In our study group of 70 patients which was dominated by males from second decade onwards showed a faint line of demarcation in sex distribution in children. Cosmetic outcome on comparing our study of delayed primary closure with Paschos NK et al. study healing by secondary intention, delayed primary suturing exhibited significantly better result with the mean score of (1.50) for VSS compared to healing by secondary intention group with mean score of (3.05) for VSS was recorded (p= 0.000) (95% CI 0.1516-0.1494). Conclusion: Delayed primary closure exhibited improved cosmetic appearance when compared with healing by secondary intention.