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Pup Vaccination Practices in India Leave People to the Risk of Rabies — Lessons from Investigation of Rabies Deaths Due to Scratch/Bite by Pups in Remote Hilly Villages of Himachal Pradesh, India

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World Journal of Vaccines 2014年第1期4卷 7-10页

作者： Omesh Kumar Bharti vidya ramachandran Sood Rajesh Kumar Archana Phull Daily Post Shimla India Epidemiologist Kangra at Dharamshala India Municipal Corporation Shimla India National Institute of Epidemiology Chennai India

Rabies, a zoonotic disease, kills 55,000 persons every year globally and 20,000 persons in India. Two years back, we learnt of two deaths due to Rabies in remote village Shiv Shankar Garh of Arki block of District Solan and decided to investigate the deaths. Method: A rapid response team was constituted to investigate the deaths. We interviewed the villagers & family to conduct verbal autopsy. A line list of entire population of village and household contacts of the patients, who died, were made along with the line list of dogs and cattle. Results & Discussion: A-month-old stray pup brought home by the family and had caused an abrasion with its toes on the hands of both the deceased on June 2, 2011 while playing. The lady developed paralysis of the arm on July 3, 2011 and 3 days later developed symptoms of hydrophobia. She died on July 9, 2011. Her son had developed hydrophobia 10 days after that and died on July 19, 2011. Assumption that bite or abrasion by a small pup of one month cannot be fatal proved otherwise. Lack of awareness regarding the fatality of even a scratch and lack of knowledge regarding local treatment of the wound & vaccination of both human and pups, were the main reasons for the deaths. While such incidents keep on happening, and the veterinarians in India are refusing to vaccinate pups before three months of age, as pups may not develop immunity before that age, leaving unsuspecting people to the risk of rabies. Conclusions: Humans can be exposed to rabies even by pups below 3 months of age. Recommendation: Pup vaccination schedule in rabies endemic countries like India need revision. Veterinarians and public health experts need to strongly consider vaccinating pups at first contact with humans even if they are less than 3 months of age. A booster to the pup can be given at three months of age with subsequent yearly boosters.

关键词： Rabies Pup Scratch Pup Vaccination

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High Immunization Coverage but Delayed Immunization Reflects Gaps in Health Management Information System (HMIS) in District Kangra, Himachal Pradesh, India—An Immunization Evaluation

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World Journal of Vaccines 2015年第2期5卷 69-78页

作者： Rajesh Kumar Sood Anjali Sood Omesh Kumar Bharti vidya ramachandran Archana Phull District Epidemiologist Kangra Himachal Pradesh India College of Home Science CSKHPKV Palampur India State Institute of Health & Family Welfare Parimahal India National Institute of Epidemiology Chennai India Daily Post Shimla India

Background: Complete and timely childhood immunization is one of the most cost-effective interventions in improving child survival in developing countries. Computerized HMIS has been recently introduced to collect aggregated data on service beneficiaries in Himachal Pradesh. HMIS provides coverage estimates for immunization while information on timeliness is currently not available. Hence we conducted a study to validate coverage and assess the timeliness of immunization in Kangra District of Himachal Pradesh. We surveyed mothers (224) of children aged 12 - 23 months (as on January 2008) and selected 32 clusters in the district between January and March 2008. Design/Methods: We conducted a cross sectional survey and selected 32 clusters by probability proportional to size method whereas seven eligible children per cluster were randomly selected. We interviewed mothers using a structured interview schedule, examined immunization card & looked for Bacillus Calmette Guierre (BCG) Scar. Vaccination after 30 days from national schedule was considered “delayed”. We computed proportions of children completely immunized, immunization delayed, frequency of reasons for delay and 95% Confidence Interval (CI) for significance of associated factors. We conducted a case control analysis of factors associated with timely immunization by taking timely immunized children as cases and delayed immunized ones as controls. Results/Outcome: Reported coverage was universal (100%). Validated full immunization coverage was 94.2% by card/record & 99% by history. Only 29.5% (CI = 20.6% - 37.4%) of children were fully immunized as per schedule (delay less than 30 days). Median delay was 21 days for BCG, 28 days for Diptheria Pertussis Tetanus (DPT 3) and 25 days for measles. Among those with delayed vaccinations, reasons were forgetfulness (36%), lack of correct knowledge (27%) & mother gone to parents’ home (27%) & insufficient children in a camp to open full dose BCG vial (22%). Our case con

关键词： Immunization Coverage Delay Gaps Information Technology Health Information Systems

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Breaking the Barriers to Access a Low Cost Intra-Dermal Rabies Vaccine Through Innovative “Pooling Strategy”

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World Journal of Vaccines 2012年第3期2卷 121-124页

作者： Omesh K Bharti Wim Van Damme Kristof Decoster Petros Isaakidis An Appelmans vidya ramachandran Archana Phull Government of Himachal Pradesh Shimla India Institute of Tropical Medicine Antwerp Belgium National Institute of Epidemiology Chennai India Working Journalist in Shimla Shimla India

Background: In India every year an estimated 20,000 patients die of Rabies. Major reason for poor compliance to anti-rabies prophylaxis is the high cost of anti-rabies vaccine being prescribed intramuscularly (IM) as a routine i.e. 44.5 USD per course of five injections. In 1992 WHO recommended low cost intra-dermal rabies vaccination (IDRV), which costs only 7.5 USD or less per animal bite course. Methods: Interviews with doctors revealed that they were not prescribing intra-dermal anti rabies vaccination as they were either not aware or were not confident of this route of rabies vaccination. Also the vaccine vial did not have the label for “intra-dermal use”. These barriers were removed by advocacy efforts with policy makers & drug companies, credit sharing & team building, which led to starting of first intra dermal anti-rabies clinic of North India on 2nd August 2008. Results: Within a month of start of intra-dermal rabies vaccination clinic, i.e. by 2nd September, 2008, there was an increase in the hospital patient load by 2.8 times, and poor patients load by 3.2 times. In just less than two-year time, 200,000 USD of poor patients were saved and 5769 patients vaccinated. Each patient was asked to bring one vial on first visit & rest of doses were given “free” by pooling strategy. Pooling strategy involved distribution of one vial of vaccine among four persons and keep the three vials for use one by one by all the four patients on subsequent three visits. Another offshoot of the strategy was to prevent wasting of even few drops of vaccine that used to remain in each vial of 1 ml after distribution among four patients (0.2 mL or less). Out of more than 5000 vials utilised, every time we would transfer the left out drops of vaccine to the next new vial and use it immediately on a new pool of patients waiting for vaccination. We would, however, discard the unused vaccine after eight hours of reconstitution at the end of the day. The vaccine so saved turned to be a

关键词： Intra-Dermal Route For Anti-Rabies Vaccination Rabies

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