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Krishna 26p
Krishna 26p
Krishna 26p
Krishna Neupane
Introduction
• Rabies is an acute viral zoonotic disease that causes fatal
encephalomyelitis in human and many other mammals.
• According to the World Health Organization (WHO); over 10 million
people per year, mostly from Asia are Vaccinated following contact
with the disease.
• Rabies vaccine is a vaccine used to prevent rabies.
• They used to prevent rabies before and for a period of time after
exposure to the virus such as by a dog or cat bite. The immunity that
develops is long lasting after a full course .
• Vaccination dogs is very effective in preventing the spread of rabies of
human.
• Primarily cell culture of embryonated egg based rabies vaccine are
also used worldwide .
Rabies vaccine used in Nepal
In Nepal the vaccine of Brand name Abhayrab is used for vaccination . It is
manufactured by Human Biological Institute ( A division of Indian immunological
limited )
Composition:
Purified lyophilized Rabies Antigen derived from Rabies virus (L. Pasteur 2061/ Vero
strain propagated in Vero cells ) Inactivated .
• Potency : 2.5 I.U per vial
• Stabilizers: Maltose and and human albumin
• Preservative : Thiormesal 0.015% w/v
• Reconstitution: Reconstitute the freeze dried vaccine with 0.5ml diluent (0.9%
Sodium Choride Injection IP ) provided along with pack.
• Storage Temperature: It should be stored within 2 degree to 8 degree Celsius.
Working Mechanism of Rabies Vaccine
Specific Objectives
• To find out demographic pattern of patient vaccinated from ARV.
• To analyze the adverse effect of ARV in different age group.
• To find out medications used in ADR.
METHODOLOGY
Study area :
The study area was done in Sukraraj Tropical centre, Teku.
Study type:
The study type retrospective, cross sectional descriptive type.
Sample technique and sample size:
Simple random sampling of 176 patients were used.
Patient Inclusion criteria:
• People above 5 years.
• People of different gender,
• People of different socioeconomic condition,
• People who are flexible and cooperating
Exclusion criteria:
• Children below 5 years,
• Patients on other medication,
• People who are not flexible and cooperating,
• Patient who is mentally disabled and incomplete clinical information.
Data collection technique and study duration
• A formal request was made from the concerned authority to the hospital
and verbal contest was done to obtain adverse reactions.
• The respondents were assured of confidentiality and privacy of the
information and encouraged to be sincere and truthful to the responses.
• The data was collected through face to face interview with semi-structure
type of questionnaire
• A predesigned questionnaire was asked to patient and a written or verbal
consent will obtain from patient before starting interview as well as
laboratory reports .
DATA ANALYSIS AND ITS INTERPRETATION
• All the collected data from Sukraraj Tropical and Infections diseases
hospital, teku from 22 August to 5th September, were entered in
Microsoft Excel 2010 version and analyzed by using IBM SPSS
Statistics version 25 software. Data were analyzed in terms of
frequency, distribution and percentage.
• Total number of the patients participated in this study were 176 in
which male patients were 53.4% and female patients were 46.6%.
• The patients among 176 interviewed victims 31 were from age group
5-15,36 from age group 16-25, 36 from age group 26-35, 26 from age
group 36-45 , 22 from age group 46-55 and remaining 25 were
patients age ranged above 55.
• Majority of the patients treated with ARV came after the bitten by the
dog and minority of the patients came after the bitten by cat. No
other animal bitten cases are not included in this study.
Prevalence of ADRs due to ARV at STAIDH Teku,
Kathmandu
(for all age groups)
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Adverse reaction in different age groups
• Age group (5-15):
Total number of participant were 31, in which 17 were male and 14
were female patients. Adverse reaction in age group 5-15 must
commonly shows Redness (83.9%), Fever (80.6%) followed by Pain at
site (71.0%). Restlessness, vomiting and others reaction were not
shown in this group.
• Age group (16-25):
Total number of participant were 36, in which 19 were male and 17
were female patients Adverse reaction in age group 16-25 must
commonly shows Redness (52.8%) and Pain at site (52.8%) followed by
Swelling (47.2%).
• Age group (26-35):
Total number of participant were 36, in which 19 were male and 17
were female patients Adverse reaction in age group 16-25 must
commonly shows Pain at site (52.8%), Muscle pain (52.8%) followed by
Rednss(50%). Fever adverse reaction was not shown in this group.
• Age group (36-45):
Total number of participant were 26, in which 14 were male and 12
were female patients. Adverse reaction in age group 16-25 must
commonly shows Redness (50%), Itching (50.0%) followed by Pain at
site (46.2%). Dizziness, Nausea and fever adverse reaction were not
shown in this group.
• Age group (46-55):
Total number of participant were 22, in which 13 were male and 9 were
female patients. Adverse reaction in age group 16-25 must commonly
shows Redness (68.2%), Muscle pain (63.6%) followed by Pain, Swelling
and itching. Fever and others adverse reaction were not shown in this
group.
• Age group (55+):
Total number of participant were 25, in which 12 were male and
13were female patients. Adverse reaction in age group 16-25 must
commonly shows Redness (60.0%) followed by Pain, Restlessness,
Muscle pain and fever.
Medications to mitigate adverse effects of
ARV
Adverse effect of ARV last for few days and
Drugs used Frequency Percentage of healed itself without further medication. But in
cases some people, we found using of the medication
Lotion 3 2.83 % for the ADR treatment. Only 39 people (
Analgesic drug 11 11.22 % 22.15% ) out of 176 have taken medication for
ADR. Out of the people showing fever as
Anti-histamines 7 10.14 %
ADR, 46.15% of them has taken Antipyretic
Anti-pyretic 18 46.15 % medication. Similarly, 11.22% of people
showing Pain at site has taken analgesic
medication. Only 2.83% of the people whom
redness seen has taken lotion for the treatment.
Discussion
• Dog and other animal bites leading to risk of developing rabies will
continue to occur in most developing countries and there will be ever
increasing demand for safe and potent rabies vaccines. The rabies
virus is transmitted through exposure to saliva from an infected
animal bite, such as dogs, bats, skunks, raccoons, and cats. Rabies is
endemic in dogs in most South-East Asian countries and is most
commonly transmitted to humans via rabid dog bites. It can also be
transmitted from inhalation of aerosolized rabies virus, tissue and
organ transplants, or where broken skin or mucous membranes come
into contact with any infected body fluid, whether humans or
mammals.
• In our study, most frequently occurring side effect of Anti Rabies Vaccine is
Redness at site of injection (66.3%) followed by the Pain at site (61.3%),
Itching (53.8%),Muscle pain ( 45.6%) , Skin rash/ Allergy (43.1%), Weakness
( 32.5%) and so on.
• Similar study carried out by Kimie J kagawa et al in 1992, most adverse
reactions were mild and limited to the injection site , as 63.5% of the
students that experienced adverse reactions reported pain and 48%
redness at site. 40% , reported pruritus and 16% swelling at the injection
site. Some students reported nausea (6.3%), dizziness (3.2%), malaise
(11%) and headache (14.3 %). Fever (19.1%) and muscle aches (16%) were
more frequently reported, and 4 subjects (6.3%) reported
lymphadenopathy. Overall, local adverse reactions occurred in no more
than 12.3% of the vaccinated persons and systemic reactions as fever,
myalgia, dizziness or malaise were reported in < 4% of the students.
CONCLUSION
• The main reservoir of rabies is the dog, which is responsible for almost 99%
of fatal rabies cases in humans.
• Although the rabies vaccines available for animals are safe, immunogenic,
and efficacious when administered as recommended, vaccines that do not
contain proper immunogenic antigens should be identified and discarded.
• Lack of efficacy is also considered an adverse outcome of vaccination.
Although no vaccine can claim 100% efficacy, true lack of efficacy is
uncommon and failure to immunize is more likely to result from
inappropriate administration, pre-existing disease, immunosuppression, or
genetic non-responsiveness than to a problem with the vaccine itself.
Possible reasons behind the adverse effect of ARV observed in
people of different age group:
s behind the adverse effect of ARV observed in people of different age group:
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