HEALTH-INDIA: Treating Rabies with Banned Drug

By Ranjit Devraj Reprint | | Print |

Ranjit Devraj

NEW DELHI, Jul 6 2000 (IPS) - Three months after he was bitten by a stray dog while walking to school in the Indian capital, Ramesh, a bright seven-year-old, developed the unmistakable signs of rabies and died the agonising death caused by the disease.

Ramesh’s death would have been unremarkable in a country where some 50,000 people die every year after being bitten by rabid dogs. India accounts for three-fourths of all rabies-related deaths worldwide.

But his life could not be saved despite being treated at a government hospital for which medical experts blame the use of an obsolete nerve tissue vaccine produced commercially in the country since 1911.

Nerve Tissue Vaccine developed at the Central Research Institute (CRI) at Kasauli, an alpine retreat in northern Himachal Pradesh state has saved thousands of lives over the last century.

However, the international medical science community has since lost trust in the medicine which is known to fail and can cause paralysis.

“Unfortunately nerve tissue vaccine remains the mainstay of rabies treatment in India despite the World Health Organisation (WHO) banning it,” says M.K. Sudarshan, President of the Association for Prevention and Control of Rabies in India.

In 1973, a WHO expert panel on rabies recommended that no vaccine containing live virus such as the one produced at the Kasauli facility should be used in humans.

The Indian government is yet to comply with WHO recommendations which demand the use of a variety of safer, modern alternatives including the human diploid cell vaccine, the vero cell vaccine and the chick embryo cell vaccine.

According to Prof. Sudarshan the WHO alternatives are expensive as these are not made in the country. Treatment with human diploid cell vaccine can cost more than 500 U.S. dollars. The drug can be bought only with prescriptions from a doctor in the exporting country — usually Singapore.

The nerve tissue vaccine produced at Kasauli that is banned by WHO, costs just seven dollars for the entire course of 14 shots on the abdomen at government hospitals.

The cheapest imported vaccines based on tissue culture cost 40 dollars for a course of five shots. Although said to have no side effects, these are not yet approved for use in government hospitals. Their use is limited to private medical clinics used by the rich.

Leading medical experts also do not approve of the way the anti- rabies drug is used in India. Doctors usually do not follow the WHO recommendation of infusing the anti-rabies serum into the site of the wound partly because of the high cost of the treatment, says leading medical expert Amlan Goswami.

Doctors often stitch up a dog bite wound when it is better to leave it open, says Goswami, who runs an anti-rabies clinic at the Pasteur Institute in the eastern city of Calcutta. He advises thorough washing with disinfectants before administering the anti-rabies serum.

“Too many doctors in India also follow a wait and watch approach which is dangerous because by the time the biting dog is proved to be rabid, valuable time would have been lost,” he says.

In many cases patients die because they fail to take the full course of the vaccine, he adds.

About 60 percent of dog bite cases involve children, with most of the victims being boys. Because the incubation period for rabies is shorter in children than in adults, proper wound treatment and serovaccination should begin as soon as possible, say experts.

Rabies control association chief Sudarshan estimates that with 25 million dogs in the country, there is one dog to every 25 human beings in India’s towns and cities. He advises the government to either check the canine population or immunise dogs.

Every dog bite must be treated for rabies although the costs would be enormous, says Anil Dutta, an Indian rabies expert who works as director for Aventis Pasteur SA in Paris.

“But equally, it is time that a calculation of the phenomenal financial burden in terms of loss of life and disease management caused by rabies in India is made – not to mention the emotional burden to society,” he adds.

“Rabies is hundred percent fatal but is also hundred percent preventable,” he asserts.