Immunizing Vulnerable Populations Like Rag Pickers, Garbage Collectors, Municipality Workers and Newspaper Hawkers against Rabies in Shimla Municipality, HP, India

Omesh Kumar Bharti

Corporation Health Officer, Municipal Corporation, Shimla, India.

DOI: 10.4236/wjv.2015.51003                

Abstract

Background: Rabies is a zoonotic disease and many vulnerable sections like rag pickers and municipality workers neglect animal bites due to ignorance of their potential deadly outcomes. Stray dogs abound in garbage pits and this population is exposed to their attacks. It should be a mandate for municipalities to help protect their sanitary workforce, especially rag pickers, from deadly infectious diseases such as Rabies, Hepatitis-B, HIV, Tetanus etc. Objectives: Objective of this study was to study methods to provide pre-exposure Rabies vaccination for such highly exposed populations by engaging them and understanding their perception of this disease through a constant dialogue with them. Methods: We started by engaging with the rag pickers to know how best to entice them to get themselves immunized. We then attempted to search literature for the most practical methods likely to succeed in reducing risk of rabies deaths in this population. Results: WHO approved 3 injections of 0.1 ml tissue culture vaccine on days 0, 7 and 21 were tried but were shown to result in many dropouts among rag pickers for repeat injections. We then followed a method where 0.1 ml of rabies vaccine was injected at 4 different anatomical sited in one setting. This proved acceptable and relatively inexpensive. A small number of subjects were studied by determination of neutralizing antibody by RFFIT, which proved immunogenic having anamnestic response on boosters given single IM or at 4 sites ID subsequently, implying that short schedule rabies pre-exposure vaccination can be done in high risk groups and may save lives if applied to the poorest that are highly exposed.

Keywords

Pre-Exposure Rabies Vaccination, Intradermal Antirabies Vaccination (IDRV), Rag Pickers

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Rauf, M.U.A., Saleem, M.D., Anwer, M.O., et al. (2013) HIV, Hepatitis B and Hepatitis C in Garbage Scavengers of Karachi. Journal of Pakistan Medical Association, 63, 798-802. http://www.jpma.org.pk/PdfDownload/4256.pdf
[2]	Khawplod, P., Wilde, H., Benjavongkulchai, M., et al. (2007) Immunogenicity Study of Abbreviated Rabies Preexposure Vaccination Schedules, International Society of Travel Medicine, 1195-1982. Journal of Travel Medicine, 14, 173-176. http://onlinelibrary.wiley.com/doi/10.1111/j.1708-8305.2007.00120.x/pdf http://dx.doi.org/10.1111/j.1708-8305.2007.00120.x
[3]	Khawplod, P., Wilde, H., Sriaroon, C., Chomchey, P., Kamolthum, T., Sitprija, V., et al. (2008) One or Three Intradermal Injections within One Week for Rabies Pre-Exposure Immunization. Developments in Biologicals, 131, 393- 401. http://www.ncbi.nlm.nih.gov/pubmed/18634501
[4]	Warrell, M.J. (2012) Current Rabies Vaccines and Prophylaxis Schedules: Preventing Rabies before and after Exposure. Travel Medicine and Infectious Disease, 10, 1-15. http://www.travelmedicinejournal.com/article/S1477-8939(11)00130-X/abstract http://dx.doi.org/10.1016/j.tmaid.2011.12.005
[5]	Bharti, O.K., Damme, W., Decoster, K., Isaakidis, P., Appelmans, A., Ramachandran, V. and Phull, A. (2012) Breaking the Barriers to Access a Low Cost Intra-Dermal Rabies Vaccine through Innovative “Pooling Strategy”. World Journal of Vaccines, 2, 121-124. http://dx.doi.org/10.4236/wjv.2012.23016
[6]	Garba A., Umoh, J.U., et al. (2015) Rabies Virus Neutralizing Antibodies in Unvaccinated Rabies Occupational Risk Groups in Niger State, Nigeria. International Journal of Tropical Disease & Health, 6, 35-43. http://dx.doi.org/10.9734/IJTDH/2015/14461
[7]	Ekanem, E.E., Eyong, K.I., et al. (2013) Stray Dog Trade Fuelled by Dog Meat Consumption as a Risk Factor for Rabies Infection in Calabar, Southern Nigeria. African Health Sciences, 13, 1170-1173. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056491/ http://dx.doi.org/10.4314/ahs.v13i4.44
[8]	Mshelbwala, P.P., et al. (2013) Detection of Rabies Antigen in the Saliva and Brains of Apparently Healthy Dogs Slaughtered for Human Consumption and Its Public Health Implications in Abia State, Nigeria. ISRN Veterinary Science, 2013, Article ID: 468043. http://www.hindawi.com/journals/isrn/2013/468043/
[9]	Wertheim, H.F.L., Nguyen, T.Q., Nguyen, K.A.T., de Jong, M.D., Taylor, W.R.J., et al. (2009) Furious Rabies after an Atypical Exposure. PLoS Medicine, 6, e1000044. http://dx.doi.org/10.1371/journal.pmed.1000044
[10]	Atuman, Y.J., Adawa, Y.A., Solomon, A., Mshelbwala, P.P. and Ogunkoya, A.B. (2014) Potential Risks for Rabies Spill-Over from Apparently Healthy Dogs to Wildlife in Bauchi State, Nigeria. Journal of Veterinary Advances, 4, 493-498. http://dx.doi.org/10.5455/jva.20140418115203
[11]	Mshelbwala, P.P., Ogunkoya, A.B. and Maikai, B.V. (2013) Detection of Rabies Antigen in the Saliva and Brains of Apparently Healthy Dogs Slaughtered for Human Consumption and Its Public Health Implications in Abia State, Nigeria. ISRN Veterinary Science, 2013, Article ID 468043, 5 p. http://dx.doi.org/10.1155/2013/468043.
[12]	Dhillon, S., Sampath, K., Moore, C., Dosanjh, A. and Thiel, D. (2013) High-Dose Intra-Dermal Hepatitis B Vaccine in a Liver Transplant Patient Who Failed Prior Intramuscular Vaccination: A Brief Case Report. World Journal of Vaccines, 3, 16-18. http://dx.doi.org/10.4236/wjv.2013.31003
[13]	Chutivongse, S., Wild, H., et al. (1991) One-Year Study of the 2-1-1 Intramuscular Postexposure Rabies Vaccine Regimen in 100 Severely Exposed Thai Patients Using Rabies Immune Globulin and Vero Cell Rabies Vaccine. Vaccine, 9, 573-576. http://www.ncbi.nlm.nih.gov/pubmed/1771970 http://dx.doi.org/10.1016/0264-410X(91)90244-Z
[14]	Turner, G.S., Aoki, F.Y., et al. (1976) Human Diploid Cell Strain Rabies Vaccine. Rapid Prophylactic Immunization of Volunteers with Small Doses. The Lancet, 307, 1379-1381. http://www.ncbi.nlm.nih.gov/pubmed/59017 http://dx.doi.org/10.1016/S0140-6736(76)93028-2