Background:Rabies is a zoonosis transmitted via the bites of various mammals,primarily dogs and bats.Known since antiquity,this disease may have the deadliest human fatality rates and is responsible for approximately ...Background:Rabies is a zoonosis transmitted via the bites of various mammals,primarily dogs and bats.Known since antiquity,this disease may have the deadliest human fatality rates and is responsible for approximately 65,000 deaths worldwide per year.Case presentation:We report the case details of a 13-year-old boy from India belonging to a South Asian ethnicity,who presented with altered sensorium one month following a dog bite.He did not receive the active rabies immunization and was managed with supportive therapy.The patient had extensive T_2 weighted(T_2W)/fluid attenuation and inversion recovery(FLAIR) hyper intensities involving the deep gray matter of the cerebral hemispheres,hippocampus,brainstem,and cerebellum.The diagnosis was confirmed by the demonstration of the rabies antigen from a nuchal skin biopsy and a corneal smear.The patient had a slow but significant recovery over four months and was discharged from the hospital in stable condition with severe neurological sequelae.Conclusion:We report a unique case of survival after infection with a universally fatal disease.展开更多
Background: In India every year an estimated 20,000 patients die of Rabies. Major reason for poor compliance to anti-rabies prophylaxis is the high cost of anti-rabies vaccine being prescribed intramuscularly (IM) as ...Background: In India every year an estimated 20,000 patients die of Rabies. Major reason for poor compliance to anti-rabies prophylaxis is the high cost of anti-rabies vaccine being prescribed intramuscularly (IM) as a routine i.e. 44.5 USD per course of five injections. In 1992 WHO recommended low cost intra-dermal rabies vaccination (IDRV), which costs only 7.5 USD or less per animal bite course. Methods: Interviews with doctors revealed that they were not prescribing intra-dermal anti rabies vaccination as they were either not aware or were not confident of this route of rabies vaccination. Also the vaccine vial did not have the label for “intra-dermal use”. These barriers were removed by advocacy efforts with policy makers & drug companies, credit sharing & team building, which led to starting of first intra dermal anti-rabies clinic of North India on 2nd August 2008. Results: Within a month of start of intra-dermal rabies vaccination clinic, i.e. by 2nd September, 2008, there was an increase in the hospital patient load by 2.8 times, and poor patients load by 3.2 times. In just less than two-year time, 200,000 USD of poor patients were saved and 5769 patients vaccinated. Each patient was asked to bring one vial on first visit & rest of doses were given “free” by pooling strategy. Pooling strategy involved distribution of one vial of vaccine among four persons and keep the three vials for use one by one by all the four patients on subsequent three visits. Another offshoot of the strategy was to prevent wasting of even few drops of vaccine that used to remain in each vial of 1 ml after distribution among four patients (0.2 mL or less). Out of more than 5000 vials utilised, every time we would transfer the left out drops of vaccine to the next new vial and use it immediately on a new pool of patients waiting for vaccination. We would, however, discard the unused vaccine after eight hours of reconstitution at the end of the day. The vaccine so saved turned to be a stock of more than 100 vials in less than two years that we were able to give free to more than 225 rag pickers, garbage collectors and newspaper hawkers on World Rabies Day, Sep 28, 2010. Conclusions: With intra-dermal clinic, we were able to successfully introduce the new cost effective intra-dermal method of rabies vaccination despite all odds & vested interests of companies & old mindset of doctors that had blocked this technique till now. This will go a long way in reducing the burden of disease & death due to rabies from India.展开更多
文摘Background:Rabies is a zoonosis transmitted via the bites of various mammals,primarily dogs and bats.Known since antiquity,this disease may have the deadliest human fatality rates and is responsible for approximately 65,000 deaths worldwide per year.Case presentation:We report the case details of a 13-year-old boy from India belonging to a South Asian ethnicity,who presented with altered sensorium one month following a dog bite.He did not receive the active rabies immunization and was managed with supportive therapy.The patient had extensive T_2 weighted(T_2W)/fluid attenuation and inversion recovery(FLAIR) hyper intensities involving the deep gray matter of the cerebral hemispheres,hippocampus,brainstem,and cerebellum.The diagnosis was confirmed by the demonstration of the rabies antigen from a nuchal skin biopsy and a corneal smear.The patient had a slow but significant recovery over four months and was discharged from the hospital in stable condition with severe neurological sequelae.Conclusion:We report a unique case of survival after infection with a universally fatal disease.
文摘Background: In India every year an estimated 20,000 patients die of Rabies. Major reason for poor compliance to anti-rabies prophylaxis is the high cost of anti-rabies vaccine being prescribed intramuscularly (IM) as a routine i.e. 44.5 USD per course of five injections. In 1992 WHO recommended low cost intra-dermal rabies vaccination (IDRV), which costs only 7.5 USD or less per animal bite course. Methods: Interviews with doctors revealed that they were not prescribing intra-dermal anti rabies vaccination as they were either not aware or were not confident of this route of rabies vaccination. Also the vaccine vial did not have the label for “intra-dermal use”. These barriers were removed by advocacy efforts with policy makers & drug companies, credit sharing & team building, which led to starting of first intra dermal anti-rabies clinic of North India on 2nd August 2008. Results: Within a month of start of intra-dermal rabies vaccination clinic, i.e. by 2nd September, 2008, there was an increase in the hospital patient load by 2.8 times, and poor patients load by 3.2 times. In just less than two-year time, 200,000 USD of poor patients were saved and 5769 patients vaccinated. Each patient was asked to bring one vial on first visit & rest of doses were given “free” by pooling strategy. Pooling strategy involved distribution of one vial of vaccine among four persons and keep the three vials for use one by one by all the four patients on subsequent three visits. Another offshoot of the strategy was to prevent wasting of even few drops of vaccine that used to remain in each vial of 1 ml after distribution among four patients (0.2 mL or less). Out of more than 5000 vials utilised, every time we would transfer the left out drops of vaccine to the next new vial and use it immediately on a new pool of patients waiting for vaccination. We would, however, discard the unused vaccine after eight hours of reconstitution at the end of the day. The vaccine so saved turned to be a stock of more than 100 vials in less than two years that we were able to give free to more than 225 rag pickers, garbage collectors and newspaper hawkers on World Rabies Day, Sep 28, 2010. Conclusions: With intra-dermal clinic, we were able to successfully introduce the new cost effective intra-dermal method of rabies vaccination despite all odds & vested interests of companies & old mindset of doctors that had blocked this technique till now. This will go a long way in reducing the burden of disease & death due to rabies from India.
