Six out of 27 rabies victims in Kerala died despite being administered with anti-rabies vaccine (ARV) this year and an analysis of vaccine samples by the Central Drugs Standards Control Organisation (CDSCO) showed that all the doses met with requisite standards. A team comprising experts from the National Centre for Disease Control, CDSCO, Health department, State Public Health Lab and District Surveillance Officers probed the cases.
According to the information furnished by the Health Minister Veena George in the assembly, the nature of wounds resulted in the deaths of people, although they were given ARV. In April, the death of a six-year-old girl, Ziya Faris, in Malappuram due to rabies triggered a debate on the efficacy of ARV in Kerala. The Health Minister said that in cases where people died despite vaccination, the wounds were severe.
Ziya sustained bite wounds over the head, chest, left shoulder, left middle finger, and left lower limb. Health officials who investigated the case said that there were deep, lacerated wounds on her scalp. She was administered with the anti-rabies serum (ARS) and intradermal rabies vaccine (IDRV), however she contracted infection and died. ARS is injected at the site of injury, and it works faster than the vaccine. ARS contains antibodies which neutralise the virus quickly. ARS is administered to give immunity from the virus until the vaccine takes effect, which usually takes 1-2 weeks.
According to the Health Minister, out of six people who died, one patient took a single dose of the vaccine. Following the deaths, the batches of vaccine which were administered to the victims were sent for quality tests. The result showed that all the batches met the standards. Wounds on the face, neck and head, which caused the virus to directly enter the nerves, resulted in the deaths of people who were vaccinated, according to the report of the Health department.
The department report notes that the vaccine is stored in refrigerators at a specified temperature (2-8 degrees Celsius). The vaccine is taken out only for administering the dosage to the patients, and once used, it is put back in the refrigerator.
In 2022, the state government constituted an expert committee for rabies deaths after a debate was triggered on the use of the vaccine following a series of fatalities. The committee analysed deaths which happened despite being vaccinated, and one of the major findings was that the wounds of these deaths were in the highly innervated areas of the head, face, neck and interdigital areas of the arms. The shorter incubation period pointed towards the direct inoculation of the rabies virus into the wounds, the committee noted in the report.