Efficacy of anti-rabies vaccine doubted after Perambra tragedy

Chandrika (53); Stray dogs. File Photo

Kozhikode: Serious concerns are raised about the efficacy of the anti-rabies vaccine administered in Kerala as yet another death of a vaccinated person has been reported. These deaths pointing to vaccine inefficacy come close on the heels of allegation that Kerala government procured anti-rabies vaccine which has not undergone the mandatory tests.

Significantly, the company which supplied the vaccine had even warned that only the Kerala Medical Services Corporation Limited (KMSCL) will be responsible for any adverse effects caused by it.

Perambra, Palakkad incidents

The latest incident affirming the fears about the vaccine quality was the death of 53-year-old Perambra native P Chandrika. She was bitten on her face by a stray dog on July 21. She had completed four doses of the vaccine after being bitten by an infected dog. Besides Chandrika, the same dog had bitten eight others in the same locality.

Chandrika was admitted to the Kozhikode Government Medical College Hospital here early last week after she developed some health issues but died on Saturday midnight.

In late June a 19-year-old girl, Sreelakshmi, hailing from Mangara in Palakkad district, died of rabies after she was bitten by a dog while going to college. Her life could not be saved even though she took four rounds of anti-rabies vaccine. 

Unsafe storage, transportation?

The Equine anti-rabies vaccine was reportedly administered to Chandrika. It was from the batch of a 5,000-vial consignment procured from Tamil Nadu last month when Kerala faced a shortage of anti-rabies vaccines.

Healthcare personnel suspect whether the storage protocol was strictly followed while transporting the vaccine from Coimbatore by train to Palakkad and then while distributing it to hospitals in Kerala.

Chandrika's treatment regime

Chandrika, who was bitten by a rabid dog on July 21, went to the Perambra Taluk Hospital for treatment and was administered Intra-Dermal Rabies Vaccination (IDRV). As the bite injuries on her face were severe, she was referred to the Kozhikode Medical College Hospital. On reaching there, she was administered the Equine Anti-Rabies vaccine on the same day. Two more doses were given on July 24 and 28, respectively.

On August 7, Chandrika developed a fever and has other physical discomforts following which she visited the Cooperative Hospital and was later admitted to the Medical College Hospital. She was shifted to the ICU within 6 hours. Though her last dose was due on August 18, as she was on the ventilator, that dose was not administered. 

After Chandrika started showing symptoms of rabies in an unconscious state, the doctors collected saliva samples and sent it for a rabies test. However, the test report came out to be negative. Samples have been sent after her death also. It can be confirmed only after getting the results.

Why vaccine was procured in haste

The three-month delay in the tender proceedings of the Kerala Medical Services Corporation Limited (KMSCL) in the procurement of the Equine Anti-Rabies Vaccine led to its shortage across the state.

After the vaccine completely ran out of stock, KMSCL General Manager directed the vaccine manufacturer to send the vaccine without waiting for the Central Drug Testing Laboratory’s final report, on July 14. The vaccine consignment reached Kerala on July 16 night. However, the distribution of the vaccine was stalled within two days following the row. 

As many as 5,000 vials of the vaccine, with batch number 21020, were procured from Tamil Nadu and the consignment reached Palakkad on July 19, two days before Chandrika was admitted.

Why Chandrika's treatment is circumspect

The efficacy and safety of IDRV and Equine Anti-Rabies Vaccine is now doubted over Chandrika's death.  The latter was procured by Tamil Nadu for distribution after it was endorsed by the Central Drug Testing Laboratory. The same vaccine was brought to Kerala too, but it is suspected whether it was compromised with unsafe transport and storage. 

Though the quality of the vaccine was tested, the storage and transportation protocol in the way it was brought by train from Coimbatore to Palakkad and later stored in the hospitals are to be looked into.

Even the atmospheric temperature may affect the quality of the vaccines. Such vaccines are to be stored at a temperature of +2 – +8 degrees celsius.  Although the vaccine is stored in coolers in KMSCL warehouses, the variation in temperature during transportation to the respective hospitals may affect the quality of the vaccine, experts point out.

26,000 vaccine vials arrive

Kerala has so far procured 26,000 vials of IDRV which have completed the testing at the Central Drug Testing Laboratory. More vaccine consignments are set to reach the State as and when the testing for each batch is completed.

Of late there has been a big rise in the number of people reaching hospitals for getting vaccinated after being bitten by cats and dogs.

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