title: Rabies deaths in Pakistan: results of ineffective post-exposure treatment.
abstract: OBJECTIVE
  To estimate the incidence of rabies and the effectiveness of post-exposure treatment (PET) in Pakistan.
  
  
  METHODS
  Rabies cases admitted from July 1993 to December 1994 to a public rabies isolation hospital were analyzed. Two samples (one sample each from a separate peripheral site) of a single batch of sheep brain vaccine (SBV) were also tested for potency by the National Institute of Health (NIH) test in May 1997.
  
  
  RESULTS
  Forty patients were admitted with a history of clinical rabies. The median age was 22 years and 55% were under 15. Thirteen (23%) victims did not receive any vaccine; the remaining 27 (67%) received SBV only, and of these, 16 (40%) received a full course of SBV. No rabies immunoglobulins (RIG) or cell culture vaccines were administered. There were frequent power blackouts and no back-up supply at the public hospital. In-house potency testing of the vaccine batch by the manufacturer was adequate, although it was not tested by the World Health Organization (WHO) recommended NIH test. Samples of SBV of the same batch collected at the peripheral sites showed no potency. Rabies incidence was estimated to range between 7.0 to 9.8 cases per million annually.
  
  
  CONCLUSIONS
  A multi-sectorial approach is needed to decrease rabies incidence in Pakistan. Public and healthcare practitioner education on prompt and appropriate PET, especially the use of cost-effective cell culture intradermal regimens, is needed urgently. The NIH test should be employed for vaccine potency testing. An independent agency is needed for monitoring vaccine quality and strategies are needed for maintaining cold chain. SBV should be replaced by locally manufactured second-generation cell culture rabies vaccine. Purified equine rabies immunoglobulin (ERIG) should be manufactured locally to meet national needs. Furthermore, effective dog control strategies should be implemented to decrease the rabies reservoir.
authors.affiliation: Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan. sparviz19@hotmail.com
authors.forename: Shehzad
authors.initials: S
authors.lastname: Parviz
authors.forename: Rashid
authors.initials: R
authors.lastname: Chotani
authors.forename: Joseph
authors.initials: J
authors.lastname: McCormick
authors.forename: Sue
authors.initials: S
authors.lastname: Fisher-Hoch
authors.forename: Stephen
authors.initials: S
authors.lastname: Luby
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001733:Bites and Stings; D002648:Child; D002675:Child, Preschool; D004283:Dog Diseases / Q000821:virology; D004285:Dogs; D006801:Humans; D007114:Immunization; D015994:Incidence; D010154:Pakistan / Q000453:epidemiology; D011818:Rabies / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control*; D011819:Rabies Vaccines / Q000008:administration & dosage*; D012034:Refrigeration
chemical_list: D011819:Rabies Vaccines