AH Hashmi, S Parviz, SB Moosvi, A. Rehman, SP Luby

Department of Community Health Sciences, Aga Khan University

Untreated human rabies has essentially 100% mortality. Vaccination of exposed persons with high potency human diploid cell vaccine and control of rabies in domestic animals have reduced human rabies to almost negligible levels in developed countries. In Pakistan, the National Institute of Health manufactures sheep brain vaccine and selected health care facilities are designated to vaccinate all persons with high risk wounds. A dog control program also exists, but the effectiveness of these efforts has not been studied before. We conducted a study to estimate the incidence of rabies in Karachi and thereby evaluate the efficacy of the rabies vaccine program.

We reviewed the charts of all rabies cases admitted to Civil Hospital Karachi from 1st July 1993 through 31st December 1994. Similarly all the cases admitted to Aga Khan University Hospital from 1st January 1988 through 31st December 1994 were included in the study. These two hospitals were chosen because they are the only ones in Karachi where rabies cases get admitted. We interviewed emergency room physicians at Civil Hospital to estimate the percentage of rabies cases that were admitted to the hospital.

During the 18 months, 40 cases of rabies were admitted to the Civil Hospital Karachi. Of these, 27 cases (68%) had received anti-rabies vaccine after a dog-bite with only 13 (32%) unvaccinated. Of the 27 who received the vaccine, 16 (40%) received the full recommended dose. All cases were preceded by a of dog-bite. All 40 cases died (100%). Based on the number of Karachi residents admitted to Civil hospital and AKUH, and upon the estimate of the emergency room physicians at Civil Hospital that only 30% of diagnosed rabies cases are admitted to the hospital (the rest go home to die when their prognosis is explained), and an estimated Karachi population of 10,000,000, we estimate an incidence of 9 rabies deaths per 1 million persons per year in Karachi.

A lot of people are dying of rabies in Karachi. Some of these deaths are due to receiving no or incomplete prophylaxis. Forty percent are due to vaccine failure which may have resulted from a low potency of the vaccine, lack of maintaining cold chain, problems with administration, failure to administer passive immunization when indicated, or improper wound care. Improving the vaccine and it’s delivery would be expected to save lives.

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