Seven-year-old girl on ventilator despite receiving anti-rabies vaccine; concerns over quality of vaccine and storage protocols in Kerala 

THIRUVANANTHAPURAM: There is growing concern over cases of rabies infection even among those who have taken the anti-rabies vaccine. Doubts have been raised about the quality of the vaccine being administered in hospitals across the state.

The most recent incident was in Kollam, where a 7-year-old girl developed confirmed rabies infection despite having received three doses of the vaccine. Niya Faizal, the daughter of Vilakkudy native Habeera, was bitten by a dog on April 8th near her home. She is in critical condition and on a ventilator at the SAT Hospital.

Reports say 25 people have died from rabies infection within five years despite being vaccinated. Just last week, in Malappuram, a five-year-old girl named Siya Faris died after receiving the vaccine. In many cases, symptoms became evident while waiting for the final dose. This has led to questions about the efficacy of the vaccine.

In 2022, when similar concerns were raised, the vaccine and immunoglobulin were sent to Kasol, Himachal Pradesh, for testing, and their quality was confirmed. While the vaccine is generally effective, even small lapses in care can lead to severe consequences.

The rabies virus can enter the human body through dog or cat bites, scratches from claws, or wounds. If the vaccine is taken before the virus reaches the brain, it can be effective. However, if the virus enters a nerve, it can reach the brain quickly. Rabies infection can occur if antibodies haven’t formed yet through vaccination.

In the current case, the girl was bitten on her left elbow by a dog that came to attack a duck at home. She received the first dose on April 8th, followed by doses on April 11th and 15th. The final dose was due on Tuesday. It is suspected the bite may have damaged a nerve, allowing the virus to rapidly reach the brain.

Vaccine storage
The effectiveness of the IDRV vaccine and the immunoglobulin administered at the wound site depends on their quality. If there is any doubt, medicines from the same batch should be tested and verified. If proper storage and refrigeration protocols are not followed, the vaccine becomes ineffective. Power failures or refrigerators being turned off can ruin the medicine.

The IDRV vaccine is administered as 1 ml in each arm, on days 0, 3, 7, and 28. Until the first dose takes effect, immediate protection is provided by immunoglobulin injected at the wound site. This should be administered as soon as possible after the bite, said Dr. J.G. Ravikumar, former Head of the Department of Pharmacology, Thiruvananthapuram Medical College.

Vaccine and Immunoglobulin must be stored and handled with extreme care. If the cold chain fails, it can be dangerous.
— Dr. J.G. Ravikumar
Former HoD, Pharmacology
Thiruvananthapuram Medical College

After a bite, the wound should be washed for at least 20 minutes with soap and running water. This can eliminate up to 90% of the virus. Medical treatment should follow immediately.
— Dr. A. Altaf
Professor, Community Medicine
Thiruvananthapuram Medical College