International Journal of Community Medicine and Public Health Kaware A et al. Int J Community Med Public Health. 2024 Dec;11(12):4770-4774 http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040
DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20243641
Original Research Article
A prospective cross-sectional study on epidemiological determinants, vaccine hesitancy and adverse events following anti rabies vaccination in
an animal bite
Alka Kaware, Tejaswi Pothipogu, Prachi Ingle*, Jyotsna Deshmukh
Department of Community Medicine, IGGMC, Nagpur, Maharashtra, India Received: 01 September 2024 Revised: 11 November 2024 Accepted: 12 November 2024 *Correspondence: Dr. Prachi Ingle, E-mail: babiingle@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT Background: Rabies is an infectious disease with hundred percent mortality that can be prevented by taking action pre or post exposure to the agent. The individuals’ beliefs, customs and traditions play a major role in any health care practices. In this study we tried to assess the epidemiological determinants, vaccine hesitancy and adverse events following vaccination. Objectives were to study the epidemiological determinants of the individuals with animal bite and to study the vaccine hesitancy and adverse events following vaccination. Methods: A prospective cross-sectional study was conducted among the 300 individuals who came with animal bite to the anti-rabies vaccination centre. The study participants were recruited through convenience sampling. Results: Out of 300 participants 102 (34%) were of age group 15-35 years. Males 188 (62.7%) and females 112 (37.3%). The common animal that reported to bite was dog which was seen in 85.7% of study population. Vaccine hesitancy was observed in 16.7% (50). The 83% (249) participants took the ARV vaccination within 24 hours of the animal bite. The most common adverse events following vaccination reported is skin discoloration at the injection site by 53.3% (160). Conclusions: The vaccine should be made available even in the rural, suburban areas. Newer vaccine with better preservatives should be made to prevent adverse events. Keywords: Animal bite, ARV prophylaxis, Vaccine hesitancy, Adverse events following immunization
INTRODUCTION
Rabies virus belongs to the Rhabdoviridae family, genus Lyssavirus, which includes 15 virus species. All Lyssavirus species have the potential to cause rabies disease in people, but rabies virus is by far the most common cause.1
Through implementation of the Global strategic plan to end human deaths from dog-mediated rabies by 2030,5 affected countries will move a significant step closer to the sustainable development goal (SDG) 3 target of “ending the epidemics of AIDS, tuberculosis, malaria and
neglected tropical diseases (NTD)”. They will also make critical progress towards SDG 3.8 on achieving universal health coverage.2
True burden of rabies in India is not fully known; although as per available information, it causes 18,000 to 20,000 deaths every year. About 30-60% of reported rabies cases and deaths in India occur in children under the age of 15 years as bites that occur in children often go unrecognized and unreported.3 Low awareness of the need to seek health care after a dog bite claims the lives of more than 55,000 people each year, mostly in Asia and
International Journal of Community Medicine and Public Health | December 2024 | Vol 11 | Issue 12 Page 4770
Kaware A et al. Int J Community Med Public Health. 2024 Dec;11(12):4770-4774
Africa. India is endemic for rabies, and accounts for 36% of the world’s rabies deaths.4
According to the WHO, rabies exposure is divided into 3 categories as follows: category I: touching or feeding animals, as well as animal licks on intact skin, category II: nibbling of uncovered skin, minor scratches, or abrasions without bleeding, and category III: single or multiple transdermal bites or scratches, contamination of mucous membrane with the saliva of animals, injury in the head, face, neck, hands (fingertips to wrists), and genital area, type of bite by an animal with probable and confirmed rabies, exposure to bats, bitten or scratched by a bat, and people with weakness severe inherited and acquired immune system.6
Rabies is one of the non tropical disease that predominantly affects already marginalized, poor and vulnerable populations. The key towards implementing effective rabies elimination programs is to engage with local communities, start small, catalyse long-term investment through stimulus packages, ensure the ownership of governments, demonstrate success and cost- effectiveness, and scale up quickly. Rabies elimination is feasible and achievable if this goal is prioritized and adequately supported financially and politically. 8
Post-exposure prophylaxis (PEP) is the emergency response to a rabies exposure. This prevents the virus from entering the central nervous system, which would invariably result in death.
PEP consists of: extensive washing with water and soap for at least 15 minutes and local treatment of the wound as soon as possible after a suspected exposure; a course of potent and effective rabies vaccine that meets WHO standards; and the administration of rabies immunoglobulin or monoclonal antibodies into the wound, if indicated.9
METHODS
Study design It was a prospective cross-sectional study. Study setting Study carried out at anti rabies vaccination center of a tertiary care hospital in a Central India. Duration of study Study conducted for 3 months from January 2023 to March 2023. Sampling technique Convenience sampling method was used as sampling technique.
Study area Patients who came with an animal bite to take the anti- rabies vaccine or anti rabies serum immunoglobins to the anti-rabies vaccination center. Sample size In the study we have included the average of the last three months of patient which was 300. The monthly footfall of the number of patients attending ARV OPD found to be ranging from 250 to 300. The interview was done during the history taking as per the convenience of the patient until the sample size was met. The ARV clinic is conducted from Monday to Saturday in a tertiary care center where we have planned to conduct the study.
Inclusion criteria
Patients who were above 5 years of age both gender, patients who were willing to give consent and assent for their children were included in the study. Exclusion criteria
Patients who were taking the vaccine for the second time, patients who were critically ill or not able to give history were excluded. Institutional ethics committee IEC clearance was obtained. Tools of assessment Preformed, pretested questionnaire was used by interview technique. Data collection The data was collected using case record forms that included the socio demographic details, epidemiological details about the environmental exposure to the type of animal, time and place. Clinical assessment The wound site was clinically assessed based on the WHO categorization. Wound management History of post exposure management was asked like whether the wound is washed with soap, disinfectant or application of any traditional medicine, oil, turmeric etc. Vaccine compliance Vaccine compliance and hesitancy were assessed as per the modified Thai regime; where the vaccination was
International Journal of Community Medicine and Public Health | December 2024 | Vol 11 | Issue 12 Page 4771
Kaware A et al. Int J Community Med Public Health. 2024 Dec;11(12):4770-4774
advised on 0, 3, 7, 14 and 28 days. In our hospital we advise Intra dermal administration of ARV 0.1 ml over both Deltoid was given. Adverse events following vaccination The adverse events following immunization were assessed following up with the patient when they came for the subsequent doses of vaccination. Privacy and confidentiality Privacy and confidentiality of the study participants was strictly maintained. Data analysis and statistical inferences The data collected were analyzed using MS excel and IBM SPSS statistical software package version 23.0. The results were computed using the frequencies and percentages. Chi-square test for proportions was used. RESULTS
In the study majority 34% (102) of study participants belong to age group 15-35; followed by 30% (90) were 35-60 years of age, 27% (81) were <15 years of age and 9% (27) were >60 years of age.
Figure 1: Distribution of study participants as per the
age group.
In the study majority of study participants were Male 62.7% (188) and 37.3%(112) were females.
Figure 2: Distribution of study participants as per
gender.
Table 1: The distribution of participants as per their
residence (n=300).
Table 2: The distribution of study participants as per
their socio-economic status (as per modified
Kuppuswamy Sacale-2023).
Figure 3: Distribution of study participants as per the
category of the animal bite.
International Journal of Community Medicine and Public Health | December 2024 | Vol 11 | Issue 12 Page 4772
Kaware A et al. Int J Community Med Public Health. 2024 Dec;11(12):4770-4774
In the study majority of the study participants came for the vaccination reported were category III of the animal bite
Figure 4: Adverse events following anti rabies
vaccination.
DISCUSSION
In the present study the age group affected commonly is 15-35 (34%) years of age, probably due to outdoor activities, jobs, running errands. Which is similar to the study majority of the participants belong to age group 15- 35; 102 (34%).10
Males were 62.7% (188) and females were 37.3% (112) similar to a study conducted by Sahu et al were 72.4% animal bite victims were males and 47.5% were children in age group of 2-18 years.13
Most common bite site was lower limb 55.7% (167) attributing to the animal attacked the person while walking.
Dog bite was more frequent and common 85.7% (257) among the study population similar to a study conducted by Ichhpujani et al were dog bites caused maximum morbidity (92%). Second most common biting animal was monkey (3.2%), followed by cat (1.8%), fox (0.4%).13 According to the study conducted by Lilare et al 52.6% of subjects were in anti-rabies category III followed by 46.6% and 0.8% in category II and I respectively the results were different from the study conducted by Ichhpujani et al where most bites (64.3%) were unprovoked bites by stray (64.7%) animals. 63% had category III exposure as per the WHO classification.13,14
Compliance to the vaccine was found to be 83% and 17% of study conducted by Lilare et al population has shown
vaccine hesitancy which was similar to the study reveals that majority 56.4% of subjects had started the anti- rabies vaccination between 1-5 days whereas 39.9% had no delay.14 The 53.3% (160) has reported that the discoloration of skin as adverse event which is indifferent to the study conducted by Haradanhalli et al where they have observed 14.2% had minor adverse drug events, namely pain, numbness, itching, redness, rash, body ache, malaise, nausea, and fever, which subsided without any complication. Whereas we found in this study 2% (6) of study population having these minor symptoms.12
CONCLUSION
The vaccine should be made available even in the rural, suburban areas. Newer vaccine with better preservatives should be made to prevent adverse events. Stray dogs should be vaccinated and the policy makers are advised to focus on one health approach, by creating kennels for the stray dogs. Increase the veterinary clinics and screening among the stray dogs and wild animals.
Funding: No funding sources Conflict of interest: None declared Ethical approval: The study was approved by the Institutional Ethics Committee
REFERENCES
1. Rabies. CDC. 2022. Available at: https://www.cdc.gov/rabies/. Accessed in 12 January 2024. 2. World Health Organization: WHO. Rabies. World Health Organization: WHO. 2023. Available at: https://www.who.int/news-room/fact- sheets/detail/rabies. Accessed in 12 January 2024. 3. Minghui R, Stone M, Semedo MH, Nel L. New global strategic plan to eliminate dog-mediated rabies by 2030. The Lancet Global Health. 2018;6(8):e828- 9. 4. World Health Organization: WHO. Rabies-India. World Health Organization: WHO. 2019. Available at: https://www.who.int/india/health-topics/rabies. Accessed on 12 January 2024. 5. Sellan V, Chenchu KR, Vikram A, Ezhilvanan M. Dropout rate of anti-rabies vaccination among rural and urban communities in Tamil Nadu: A comparative cross-sectional study. Asian J Med Sci. 2023;14(1):65-9. 6. Organization WH. WHO Expert Consultation on Rabies: Third Report. World Health Organization. 2018. 7. Gan H, Hou X, Wang Y, Xu G, Huang Z, Zhang T, et al. Global burden of rabies in 204 countries and territories, from 1990 to 2019: results from the Global Burden of Disease Study 2019. Int J Infect Dis. 2023;126:136-44. 8. World Health Organization: WHO. Rabies - India. World Health Organization: WHO. 2019. Available
International Journal of Community Medicine and Public Health | December 2024 | Vol 11 | Issue 12 Page 4773
Kaware A et al. Int J Community Med Public Health. 2024 Dec;11(12):4770-4774
at: https://www.who.int/india/health-topics/rabies. Accessed on 8 February 2024. 9. World Health Organization: WHO. Rabies. World Health Organization: WHO. 2023. Available at: https://www.who.int/news-room/fact- sheets/detail/rabies. Accessed on 8 February 2024. 10. Sahu KK, Manar MK, Singh SK, Singh H. Epidemiological characteristics of patients attending for rabies post-exposure prophylaxis at the infectious diseases hospital of Lucknow, India. J Global Infect Dis. 2015;7(1):30-2. 11. Shankaraiah RH, Rajashekar RA, Veena V, Hanumanthaiah AN. Compliance to anti-rabies vaccination in post-exposure prophylaxis. Indian J Publ Heal. 2015;59(1):58-60. 12. Haradanhalli RS, Anwith HS, Pradeep BS, Isloor S, Bilagumba G. Health-seeking behavior and compliance to post exposure prophylaxis among
animal bite victims in India. Indian J Publ Heal. 2019;63(5):20-5. 13. Ichhpujani RL, Mala C, Veena M, Singh J, Bhardwaj M, Bhattacharya D, et al. Epidemiology of animal bites and rabies cases in India. A multicentric study. J Communicable Dis. 2008;40(1):27-36. 14. Lilare RR, Rathod N, Narlawar UW. Compliance of post exposure rabies vaccination among patients attending anti-rabies OPD in the government medical college, Nagpur. Int J Community Med Public Health. 2018;5:3045 8.
Cite this article as: Kaware A, Pothipogu T, Ingle P, Deshmukh J. A prospective cross-sectional study on epidemiological determinants, vaccine hesitancy and adverse events following anti rabies vaccination in an animal bite. Int J Community Med Public Health 2024;11:4770-4.
International Journal of Community Medicine and Public Health | December 2024 | Vol 11 | Issue 12 Page 4774