Kerala girl dies of rabies despite vaccination: Doctor explains reasons

A Kerala girl who was undergoing treatment for rabies recently died despite receiving the preventive vaccination. As the number of stray dogs has dangerously increased in Kerala, the streets have become unsafe for passersby. Incidents of stray dogs entering homes and attacking people have been reported in the state. There have been numerous discussions about preventive methods and immediate responses to dog bites, aimed at raising awareness of proper wound care. Dr Rajeev Jayadevan, Research Cell Convenor of the Indian Medical Association, Kerala, recommends specific measures and guidelines that can help save lives in cases of dog bites or attacks by stray dogs.

Golden hours
The first step in the treatment protocol of dog bites is not getting the anti-rabies vaccine. The wound should be washed thoroughly, at least for a few minutes, using soap and water. This would remove the virus from the wound to a certain extent. Moreover, this step helps in lowering the risk of rabies. The anti-rabies vaccination should follow it. People are often unaware of the importance of washing a wound. There is a rare chance of getting infected even after receiving the anti-rabies vaccination, although this may depend on the location of the bite on the body.

Immediate treatment
The virus from the saliva of the rabid dog enters the human body through the bite wound, which could be just one or two centimetres big. The virus would then move through the nervous system to reach the spine and then the brain, infecting the patient with rabies. This slow but dangerous process might take a few days to happen, as the virus can move only a centimetre or two in a day. So, the virus could be destroyed using the vaccine before it reaches the brain. Treatment becomes difficult once the virus reaches the brain and symptoms begin to show.

Will the patient get infected despite taking the vaccine?
The risk of infection is grave if the dog bites on the head, nose, ear, lip, face, neck and finger tips where there are too many nerves. If the bite wound is on the legs or lower part of the body, the virus will take days to reach the brain, and it may even take up to a month. However, if the bite wound is on the head, the virus can reach the brain quickly. It could go the brain and cause infection before the vaccine or the antibodies kick in. This is why some patients get infected despite getting the vaccine. The little girl, who lost her life, had injuries both on her head and legs. 

More danger for kids
Adults often get bitten on the legs or lower parts of the body. They get bitten on the face or head only if they fall down. However, kids can easily get bitten on the head, face, or neck because they are short. So, the risk of rabies infection is higher in children than in adults.

Here is what to do to avoid a dog bite
The best way is to run to a safe spot if a rabid or stray dog charges at you. Try to run to a higher place like on top of a vehicle or a wall. If there is a gate nearby, run inside and lock the gate. You could also pull down the shutter or shut the glass door if it is a shop. Look for safe spots according to one’s circumstances.

In case you trip and fall, and are sure to get bitten by the dog, then cover both the ears using clenched fists and try to lie down in an arched position to protect your head, fingertips and ears.

Two types of vaccines
Two types of anti-rabies vaccines are available in hospitals: Intradermal Rabies Vaccine (IDRV) and an antibody or Immunoglobulin vaccine. The doctor will prescribe one of them depending on the depth of the wound.