Rabies is the deadliest disease. It has a 100 percent mortality rate anywhere in the world. The fact that no one is alive to tell the story of rabies reveals the terrifying situation. The only way to avoid rabies if bitten by an animal is to get vaccinated. However, the recent deaths of four children in Pathanamthitta, Kollam, Malappuram and Kannur despite being vaccinated has led to criticism and discussions. Experts say that there is no basis for blaming the vaccine, citing investigations and study reports.

Evidence to prove vaccine is effective

The scientific method to know if the vaccine is effective is to check whether antibodies against the virus have been formed in the body of the person who has taken the vaccine. A detailed study was conducted by an expert committee in the state in 2022. Blood samples of those who had taken the intradermal rabies vaccine from various health institutions in Kerala were tested. It was found that all of them had antibodies according to international standards. Dr S Chinta, Associate Professor of Community Medicine at Kollam Medical College, conducted a detailed study in collaboration with the State Institute of Animal Diseases. Using the registry of the Preventive Clinic of Thiruvananthapuram Medical College, blood tests were conducted on those who had been vaccinated in the past 20 years. The study was conducted on those who had been vaccinated from centres such as PHCs and Taluk Hospitals and later came to the Medical College for other purposes. If the anti-rabies antibody in the vaccinated people is above the level of 0.5 International Units/mL recommended by the World Health Organization, it means that they are protected. One hundred percent of those who were vaccinated five years ago had sufficient levels of antibody. It was found that 93 percent of those who were vaccinated 15 years ago had safe levels of antibodies. The vaccine is administered in the dermis, the second layer of the skin. There are more antigen-presenting cells, which are immune cells, here. Therefore, a small amount is sufficient. The intradermal vaccine is administered by trained nurses. A small blister will appear on the skin where the injection was given. This way, you can tell if the injection was given at the right place.

Do vaccinated people get rabies?

When bitten by a rabid animal, the virus sticks to the wound. It slowly travels through the nerves and reaches the brain. Before that, the vaccine and immunoglobulin are given to build immunity. However, when the face and hands, where there are more nerves, are injured, the animal's saliva is more likely to come into contact with the nerves. The virus will quickly enter the nerves. Washing the area with soap and water can eliminate as much of the virus as possible and reduce the risk of it reaching the nerves. If that is not possible, the virus can reach the nerves by the time the patient reaches the hospital.

Up to 14 days for antibodies to form

No vaccine is effective in a single dose. Immune cells do not recognise the antigen. That is why it is given in multiple doses. It is only when subsequent doses are received that the immune system is stimulated and responds. The intradermal rabies vaccine is given on the day of the bite, and then on days 3, 7 and 28 after the bite. The World Health Organization says that it takes an average of 14 days for antibodies to form and immunity to develop, says Dr T S Anish Kumar. It can take seven to 14 days depending on each person's immunity. More than 95 percent immunity is achieved with three doses of the vaccine. However, since it is not possible to wait for 14 days, immunoglobulin is given to provide immediate protection in case of large wounds in category three. This helps in achieving immunity quickly. The antibody itself is injected into the injured area through rabies immunoglobulin. The virus is produced either by injecting it into other animals (for example, horses) or through genetic technology. When injected around the wound caused by an animal bite, the virus is neutralised there. This does not provide long-term protection. The vaccine takes days to produce antibodies in the body. Immunoglobulin is given to provide protection during that interval. It is an expensive drug.

Vaccine saves thousands

“The basic reason why rabies deaths are lower in Kerala compared to other parts of India is because people get vaccinated immediately after being bitten by animals. Timely vaccination has saved thousands of people from this deadly disease. Its effectiveness has been proven.” said Dr S Chinta, Associate Professor, Community Medicine, Kollam Medical College.

Three important things

Wash the wound as soon as possible with soap and running water for 15 minutes. This is to neutralise the viruses hidden in the saliva in the wound. Do not touch the wound with bare hands. Seek medical attention immediately. The only way to prevent rabies is through vaccination. Get all doses of the intradermal rabies vaccine (IDRV). If you have a large wound in category 3, you should get immunoglobulin. Make sure that all bleeding wounds are treated with immunoglobulin.