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The Kerala Government Medical Officers’ Association (KGMOA) has issued a strong call for the implementation of a pre-exposure prophylaxis (PrEP) program across the state, citing the alarming rise in rabies-related fatalities. This initiative aims to proactively protect vulnerable populations and significantly reduce the incidence of this devastating disease, which is invariably fatal once symptoms manifest. The KGMOA's appeal underscores the urgent need for a comprehensive and sustainable approach to rabies prevention in Kerala, acknowledging the state's progress in curbing deaths but emphasizing the imperative to adopt more robust strategies. The association highlights the global impact of rabies, noting that it claims approximately 59,000 lives annually, with a particularly heavy burden in India, where nearly 20,000 deaths occur. A significant proportion of these fatalities, around 40%, involve children, highlighting their heightened vulnerability to the disease. In Kerala, while rabies deaths have decreased to around 20-25 per year, the KGMOA argues that this is not a reason for complacency but rather a catalyst for implementing a more effective and preventative healthcare model. The proposed PrEP program involves administering rabies vaccines to individuals at high risk of exposure, providing them with a level of protection before they are ever bitten by a rabid animal. This proactive approach contrasts with the current post-exposure prophylaxis (PEP), which is administered after a bite has occurred. The KGMOA argues that PrEP offers several advantages over PEP, including reduced cost, increased availability, and simplified treatment protocols in the event of a bite. Specifically, individuals who have received PrEP would only require two booster shots following an animal bite, eliminating the need for the expensive and sometimes difficult-to-obtain immunoglobulin serum. This is a crucial point, as the availability and affordability of immunoglobulin can be a major barrier to effective rabies treatment, especially in rural areas.
The KGMOA's proposal prioritizes the implementation of PrEP among children, recognizing their unique vulnerability to rabies. Children are often less likely to report animal bites or properly care for their wounds, increasing their risk of infection. Furthermore, bites to the face or hands are particularly dangerous, as the virus can more quickly reach the brain from these locations. By vaccinating children, the KGMOA aims to protect a particularly vulnerable segment of the population and prevent potentially tragic outcomes. The association advocates for the establishment of a dedicated task force comprising experts in infectious diseases, public health, and veterinary medicine. This task force would be responsible for developing a comprehensive PrEP program tailored to the specific needs of Kerala. The program would be implemented in phases, gradually expanding coverage to encompass the entire state population. In addition to children, the KGMOA identifies other high-risk groups that should be prioritized for PrEP vaccination. These include healthcare workers, veterinary officers, forest officers, sanitation workers, and others who regularly interact with animals or potentially contaminated environments. By protecting these individuals, the PrEP program would not only safeguard their health but also help to prevent the spread of rabies within the community. The KGMOA emphasizes that PrEP should be integrated with other rabies prevention measures, such as stray dog control and public awareness campaigns. Effective stray dog management is essential to reduce the overall risk of rabies transmission, while public awareness campaigns can educate people about the importance of vaccination and proper wound care following an animal bite.
The KGMOA envisions the PrEP program as a potential “Kerala model,” a successful and innovative approach to public health that could be emulated by other states and countries. The association believes that the implementation of PrEP would significantly contribute to achieving the global goal of eliminating all rabies deaths by 2030, and potentially even earlier in Kerala. This ambitious goal requires a concerted effort involving government agencies, healthcare professionals, and the public. The integration of PrEP into the universal immunization program (UIP) is also suggested. This integration would ensure that all children in Kerala have access to rabies vaccination, regardless of their socioeconomic status. Universal access to vaccination is critical to achieving herd immunity and preventing the spread of the disease. The KGMOA's advocacy for PrEP represents a proactive and forward-thinking approach to rabies prevention in Kerala. By shifting the focus from post-exposure treatment to pre-emptive protection, the association aims to significantly reduce the incidence of this devastating disease and ultimately eliminate rabies deaths in the state. The success of this initiative will depend on the collaboration of all stakeholders, including government agencies, healthcare professionals, and the public. Comprehensive rabies control requires an integrated 'One Health' approach, encompassing human and animal health. It is essential to raise awareness among the public regarding responsible pet ownership, to encourage pet vaccination, and to provide immediate treatment for animal bites. This includes thoroughly washing the wound with soap and water, seeking immediate medical care, and completing the full course of rabies post-exposure prophylaxis if indicated.
The economic burden of rabies extends beyond treatment costs. The loss of human life, the impact on livestock, and the need for extensive surveillance and control measures all contribute to the overall economic impact of the disease. Preventing rabies through effective vaccination programs is far more cost-effective than managing the consequences of rabies outbreaks. In addition, effective public awareness campaigns can significantly reduce the risk of rabies transmission by promoting responsible behavior around animals. These campaigns should focus on educating people about the risks of rabies, the importance of vaccination, and the proper way to respond to animal bites. It is also important to address misinformation and misconceptions about rabies, which can hinder prevention efforts. The KGMOA’s call to action highlights the critical need for a proactive and comprehensive approach to rabies prevention in Kerala. The implementation of a pre-exposure prophylaxis (PrEP) program, coupled with effective stray dog management and public awareness campaigns, has the potential to significantly reduce the incidence of this devastating disease and ultimately eliminate rabies deaths in the state. By working together, government agencies, healthcare professionals, and the public can achieve this ambitious goal and create a safer and healthier future for all.
Source: Implement pre-exposure prophylaxis programme in State to prevent rabies death: KGMOA