PESHAWAR: The health department has instructed all the hospitals in the province to provide free of cost anti-rabies vaccine to the victims of dog bite to safeguard the lives of people.

The directives have been issued to all the district and tehsil hospitals as well as medical teaching institutions to ensure that the dog-bitten people get complete dosage of the vaccine and in case of non-availability of stock, the health facilities should arrange the medicine from the market through local purchase.

A letter, issued from the office of Director-General Health Services Khyber Pakhtunkhwa to all the directors of the medical teaching institutions, district health officers and medical superintendents, also contains the latest guidelines of World Health Organisation regarding management of dog bite cases to ensure that the victims don’t suffer.

According to it, dog bite and scratches pose serious threat to people and it is a major public health concern because of risk of the rabies’ transmission and associated physical and psychosocial trauma.

It says that timely medical assistance should be provided to all the victims of dog bite coming to health outlets to save them from the consequences.

Dept says 27,000 dog bite cases recorded in current year so far

The letter has directed the officials to ensure availability of anti-rabies vaccine (ARV) in their respective health facilities for management of dog bite cases and arrange rabies immunoglobulin (RIG) for exposed cases as per guidelines.

RIG is antibodies against rabies virus. It is passive immunity and given in case of cat wounds and when the bite is on highly innervated part of the body like face and hands.

ARV is antigen and active immunity. When injected, it causes the body to produce antibodies against the antigens.

The administration of ARV is recommended for late arrivals. It works even if the dog bite is 12 months old while RIG is administered to the victim within seven days.

Citing the reporting of the district health information system (DHIS), the letter said that more than 50,000 cases of dog bite, including 40,000 from secondary care health facilities and 10,000 from primary care health outlets, had been recorded in 2021. The number of dog-bitten persons was 27,000 till May 31 this year.

The instructions circulated to the hospitals said that the management of dog bite cases was possible provided the victims got timely treatment as per guidelines and the required medication free of cost.

To facilitate people, free availability of anti-rabies vaccine in public health facilities, across the province, should be ensured as lack of medication amounted to endangering the lives of the affected people, said the letter.

The letter also included updated protocols of WHO for management of wound caused by dog bite, directing the respective DHOs and MS to refer the victims in a timely manner to hospitals to ensure best medication.

It also categorised wounds of dog bite and described the risk of rabies virus exposure in accordance with the type of contact with the animal suspected of having rabies.

Officials said that the directives were issued owing to rise in dog bite cases in the province and complaints about non-availability of vaccines in some of the hospitals. The stray dogs often attacked unwary people, most of whom were unable to purchase the injections from the market, they added.

They said that a vial of anti-rabies vaccine was sold for over Rs5,000 in the market that was not affordable for most of the people. The hospitals purchased the drug from National Institute of Health (NIH), Islamabad, which couldn’t manufacture too much quantity as it had to supply it to the entire country, they added.

“Therefore, the hospitals have a legal option to purchase the injections from the market and provide the same to the patients. Rabies is a viral zoonotic disease and it can prove fatal if left untreated,” said officials.

Published in Dawn, June 30th, 2022

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