Thiruvananthapuram: Ten out of 13 rabies victims in Kerala this year died without taking a single dose of anti-rabies vaccine, that is out of five fatalities four did not take the vaccine.

The alarmingly low rate of vaccination for one of the most deadly diseases affecting the central nervous system raises questions about the public response to massive awareness schemes being launched by Kerala's health department. According to the World Health Organisation (WHO), once clinical symptoms appear, rabies is virtually 100 per cent fatal.

According to information sourced from the Directorate of Health Services, out of 13 deaths till May 30, five people had not recalled any history of animal bite or scratch. Three people who died of rabies got bitten by domestic dogs. The five remaining were scratched or bitten by stray dogs. Till May 30, one confirmed rabies case was admitted to ICU. With pet dogs accounting for three rabies deaths this year, doubts surface over the efficacy of the anti-rabies vaccination drive for pets which was aggressively promoted in 2022 due to the rise in the number of rabies deaths in Kerala. Twenty-seven rabies deaths were reported in Kerala in 2022.

The latest rabies death was reported from Mannarkadu in Palakkad, where a woman died unvaccinated. Health officials who probed the cause of death reported that the woman kept a dog and a puppy. Recently, she took home a stray puppy and her close relatives recalled she had sustained a bite on her hand from the same puppy. She was known to use gloves while handling pets and there was no history of an injury resulting in bleeding. The officials said they couldn't verify if she was bitten with her gloves on. The mild nature of the injury would have prompted the person to ignore it, a health official said.

Among the 13 deaths, three people died even after getting vaccinated. All of them had, however, sustained bite wounds under category -- 3 (single or multiple transdermal bites or scratches) to their face, lips and earlobes. They had received rabies immunoglobulin and rabies vaccine as per the recommended post-exposure prophylaxis but they died of rabies mainly due to the nature of wounds. In the remaining cases, the wounds were not severe and proper vaccination could have saved their lives, health officials said.

The nature of the wound and its management are always crucial in preventing rabies, health experts said. When a person gets bitten, the virus load could be really high and if the nerve fibre gets exposed during the bite or there is a direct bite on the nerve, the virus enters the nerve fibre. Thorough washing of the wound using soap is advised following a bite because it reduces the initial load of the virus and it will take time to reach the threshold to enter the nerve. By that time, administering the vaccine could save the patient.

There are children aged between 10 and 12 among the rabies victims this year. Two children who died of rabies hailed from Palakkad. One of the officials who probed the deaths said the children tend to ignore bites or scratches. One child who died got bitten by a stray dog which had entered their place of residence from another area. However, the parents were unaware of the exposure history. In some cases, children may be scared of vaccination. "We have launched awareness programmes in schools using puppet shows to ward off the fear factor among children," the official said.

Even in 2023, when 25 deaths were reported in Kerala, a high percentage of victims had not been vaccinated. ''We need to keep reminding the public about the need to get vaccinated and not to ignore even mild bites or scratches from animals. This can be done only with sustained campaign,'' said Dr Harikumar, state nodal officer, national rabies control programme.

Kerala had spent Rs 51 crore for the purchase of rabies vaccine and recorded the loss of 67 lives to rabies between 2016 and 2022. Sixty-five per cent of rabies fatalities in 2021 and 2022 in Kerala did not receive a single dose of vaccine or serum, according to the data. The expenditure for intra-dermal rabies vaccine has increased from Rs 4.16 crore in 2016-17 to Rs 13.82 crore in 2021-22.