KARACHI: Ten days ago, a seven-year-old from Shikarpur ended up at the Indus Hospital in a state of gasping. He was immediately put on a ventilator. The cause, his father learnt, was a dog bite on the child’s arm.

The father told a doctor at the hospital that last month his son had been bitten by a rabid dog. “He was playing outside with other children … teasing the neighbour’s dog when the animal suddenly attacked my boy,” he said.

“We took him to big hospitals in Shikarpur, Larkana and Hyderabad for the anti-rabies vaccine but people there kept telling me that it was unavailable. They kept promising me that they would try to procure it but never did. In the end I had no other option but to bring my child to Karachi,” he said.

Doctors fear the hospitals that have the vaccines at the moment will soon run out of it

Six hours later, the child passed away.

Fatal bite

Mohammad Aftab Gohar, the manager of the rabies programme at the Indus Hospital, explained that unfortunately most public sector hospitals in the country were facing a chronic shortage of rabies vaccine. In the last 10 years, he said, Karachi has had more than 27,000 animal bite victims.

“We don’t have a national level stock.

Most hospitals purchase vaccines on their own from local vendors and they don’t have any vaccine these days,” he told Dawn. Sources say that the country is short by 800,000 doses.

“For the last few months an extreme shortage of the rabies vaccine has been observed across the country, including Sindh, and as a consequence patients have to travel long distances to get to hospitals such as the Indus Hospital and Jinnah Postgraduate Medical Centre for vaccinations,” added Mr Gohar.

The vaccine, he explained, can be imported from Europe but it is more expensive there and the supply has progressively reduced.

“India produces a good quality vaccine which is economical for us but due to a limited supply from there we are facing an extreme shortage,” he added.

In the last couple of years, incidents of dog bites have increased in India. According to a report by the Global Alliance on Rabies Control, India accounts for about 35 per cent of the human rabies deaths, more than any other country.

The vaccine is also produced in Thailand but the total doses produced is enough only to meet the country’s needs.

“The vaccine is not available in the country. It is tapering off. At Indus [Hospital] we do have a supply but some day it will run out as our numbers have gone up,” claimed Dr Nasreen Salauddin, the head of infectious diseases at the Indus Hospital.

“At Jinnah hospital they have their own supply as Seemi Jamali is as tough about this as I am. Whoever has it uses it ... but there are days we get phone calls from Balochistan for the vaccine and many times people just show up at the clinic ... but it will dry out,” she said, adding that the last time they procured the vaccine was three to six months ago.

If this isn’t sorted out soon more people will die. “You can still survive if you’re getting an outdated vaccine for measles, mumps or rubella but if you fail with the rabies vaccines — you’re killing the patient,” she said, adding that it was important to remember that most dogs are not rabid.

What is rabies?

Rabies, Mr Gohar explained, is a virus which is transmitted to humans through a bite or scratch of an infected animal and invariably becomes fatal once symptoms are developed.

However, the death can be prevented if for example a dog-bite victim is provided with post-exposure prophylaxis (PEP) timely and effectively, as recommended by the World Health Organisation (WHO).

“Once rabies develops in a patient, they will die in five to seven days,” he said, adding that once symptoms such as fever, hydrophobia or aerophobia begin to show there is no going back. All you can do is to make the patient comfortable.

Published in Dawn, May 27th, 2019