Vax shortage, closure of PHCs at noon leave city at risk of rabies

Time of India

4 days ago

Chennai: The city, reeling under a surging stray dog population, is facing a rabies crisis. Yet, institutions intended to be the frontline against this deadly disease — primary health centres (PHCs) in the city and suburbs — are consistently inadequate.
A TOI investigation uncovered shortages of anti-rabies vaccine (ARV) and unjustified closure at noon citing fears of "wastage". Worse, none of the PHCs had rabies immunoglobulin, which provides immediate antibodies to neutralise the virus at the wound site, particularly in severe bites.
Staff nurses at two of the nine PHCs surveyed – Virugambakkam and Maduravoyal – said they had no stock of ARV vaccine.
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"We can give a TT injection," a nurse at Virugambakkam PHC said.
What she did not say was that Tetanus Toxoid is not a substitute for ARV and that the patient must take the vaccine at the next available centre as early as possible. Other PHCs at Perambur, Royapettah, T Nagar, Valasaravakkam, and Avadi turned away patients who reached the centres after noon.
Almost all staff at these centres said the vaccination is done only between 9am and noon. The multi-dose vaccine vials should be discarded within up to six hours of opening, they said.
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Kundrathur was the only PHC where the vaccine was available throughout the day.
Experts said PHCs that do not have the vaccine in stock must either offer them at people's doorstep through the Makkalai Thedi Maruthuvam scheme or take them to the nearest hospital where the vaccine is available.
Anti-rabies vaccines are incredibly effective, but factors such as delays can make them redundant, said infectious diseases expert Dr Subramaniam Swaminathan.
"When the staff offer Tetanus Toxoid or a less effective vaccine instead of directing the patients to the nearest facility, patients may assume it is not serious," he said.
Studies by the directorate of public health also showed most people think dog bites cannot give them rabies, and some assume that bleeding injuries are safe as virus will wash off with the blood.
"Many people skip vaccinations if they see the wound heal or if they don't see visible wounds, both of which are wrong.
If there is a two-day delay, starting the vaccine with immunoglobulin may be effective," Dr Subramaniam added. However, none of the PHCs stock immunoglobulin.
Senior officials in the health department, including director of public health Dr T S Selvavinayagam, said they have repeatedly asked people to get themselves vaccinated against rabies for all animal bites at the nearest PHCs.
"All people infected by rabies in the state have either skipped vaccination or have not completed the course," he said.
Earlier, health minister Ma Subramanian had told reporters that PHCs and CHCs (Community Health Centers) have also been instructed to maintain a round-the-clock supply of ARVs, with a minimum stock of 20 vials.