The Hindu : Serum shortage hits anti-rabies unit in G.H.

Online edition of India's National Newspaper
Tuesday, Mar 11, 2003

Southern States

Southern States - Kerala-Thiruvananthapuram

Serum shortage hits anti-rabies unit in G.H.

By M. Dinesh Varma

THIRUVANANTHAPURAM March 10. A critical dearth of life-saving anti-rabies serum at the anti-rabies treatment unit in the General Hospital here is hampering the functioning of what is the only referral refuge for rabies victims in the southern districts.

There have been six rabies deaths in as many months and with the arrivals of dog-bite victims expected to increase in the summer months ahead, the erratic availability of serum is a cause for anxiety among hospital authorities.

The rabies treatment unit had been shifted from the Public Health Laboratory (PHL) to the General Hospital in November last year to provide better care for victims. Earlier, patients were being examined at the PHL and sent over to the General Hospital for vaccination or administration of serum. But the carry-over stocks of equine (horse-derived) serum obtained from the PHL have run out.

According to sources, the supplies of human serum from the Kasauli-based National Serum Institute had stopped since November last year. An interim arrangement had been put in place to help the poor patients by arranging serum using the funds of the Hospital Development Society. The HDS had already spent Rs. 1.50 lakhs on local purchases made from the fair price shop within the hospital complex.

The high cost of the serum is also an impediment. An adult weighing 50 kg, would require a minimum of 1,000 units of serum, which costs around Rs. 10,000. Since the HDS does not have the means to make local purchases on a long-term basis to help poor patients, the only alternative is to evolve a mechanism for the uninterrupted supply of serum, it is pointed out.

According to random estimates, over 150 dog-bite victims, including 50 new cases, arrive daily at the anti-rabies unit. Of these, at least 25 per cent of the patients require serum administration.

The referrals are from such far-off places as Ernakulam, Punalur and Pathanamthitta as well as the border district of Tamil Nadu. Referrals are also made from the anti-rabies unit at the Medical College, which does not have the facility for rabies immuno-globulin treatment.

Dog-bite victims are usually categorised as class one, two and three depending on the severity of the bite and the proximity of the site to the head and neck. The stock position of anti- rabies vaccines, which are effective prophylactic modalities for class one and class two categories of dog-bite victims, is stated to be comfortable.

The poor awareness among the public on the importance of seeking medical help for dog-bites, is also cause for concern.

Doctors attribute the mortality rate to the fact that most victims initially neglect the incident or seek help from practitioners of alternative medicines, reaching the hospital only when it is very late.

While, vaccination immediately after a dog-bite occurs offers prophylactic protection of class one and two victims, most patients neglect to take an anti-rabies vaccine and go on to develop rabies. The non-availability of serum could potentially choke the lifeline of class three victims.

The shifting of the anti rabies treatment unit to the General Hospital was expected to provide a full-fledged centre with adequate trained staff, vaccine storage facility, and uninterrupted supply of vaccines for timely and effective anti- rabies management.

However, to add to the woes of the staff-starved unit, of the two assistant surgeons who were deputed from the PHL to the anti-rabies unit, one has been redeployed at the parent department.

Sources say that trained personnel are essential for examining the history of a suspected rabies patient and for providing proper counselling for the family of the victims, both of which are important in rabies management.

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