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Indian Journal of Community Medicine

Epidemiological Profile of Hydrophobia Cases - S.M.S. Hospital, Jaipur

Author(s): A. Kashyap

Vol. 29, No. 4 (2004-10 - 2004-12)

Introduction

Rabies has plagued mankind since ancient times. As far back as 3000 BC, oriental physicians had described a disease resembling rabies. The fear by no means is because the disease transmitted by animals in humans is perhaps the most painful and horrible of all communicable diseases. No treatment has succeeded in curing hydrophobia till date. The estimated number of deaths year is 25,000 and even more2, 3 while >3 million people receive post exposure prophylaxis every year4.

Extremely variable incubation period and large number of factors affecting it are important in estimation of risk and deciding mode of prophylaxis.

The present study is an attempt to have the epidemiological profile of Hydrophobia cases admitted in Isolation ward of S.M.S. Hospital, Jaipur through available records and to find out the vaccination status of patients dying of rabies and their choice of vaccine.

Material and Methods

Records of clinically diagnosed cases of hydrophobia admitted in isolation ward of S.M.S. Hospital, Jaipur from April 1996 to March 1999 were analysed all the cases with classical signs and symptoms of hydrophobia, acrophobia, photophobia, wide spread stimulation of CNS with sensory and motor changes along with strong positive history of animal bites were considered as clinically confirmed or classical hydrophobia and others who were initially diagnosed as viral encephalitis, tetanus or meningitis were labeled as atypical cases of rabies.

The data analysed using statistical tools like proportions, average (mean), SD, SE and Chi square test.

Observation and Discussion

It was observed that during the study period a total number 144 cases of hydrophobia were admitted in isolation ward S.M.S. Hospital, Jaipur, out of which 118 i.e. 81.94% were male. Male : Female ratio being 4.5 : 1 (P< 001).

Maximum no. of hydrophobia patients belong to age group below 16 years (67.76%), followed by 18.7% in 16 to 45 years. After 55 years again there is increase in number of cases. This age difference is also statistically highly significant (P<.001), may be attributed to more exposure to animal bites in this age group.

Though average incubation period (IP) is found to be highly variable (S.D. 40) the mean incubation period was 68 days. The shortest mean incubation period is observed in age group of 8 years (IP=7days) and maximum in age group of 40 years (IP=3 years). It decreases again in later ages of life (P<.001). This shows that age is one of the most important variable and I.P. tends to become shorter in extreme ends of life and longer in middle age group probably because of immunity status and shorter length to travel in child Warrel and Warrel5 also observed a highly variable I.P. from 4 days to many years, average being 3-8 weeks.

Grade and site of bite was mentioned only in 9 out of 144 cases indicating incomplete case reporting. All these 9 cases were of III grade bite and below 16 years of age. The fate of biting animal is show in table I.

Table I: Fate of Biting Animal

Total No. Died Killed Unknown Alive* History of Animal bite not given
14 32 36 69 3 4*
  22.0% 25.0% 48.3% 2.1% 2.8%
*All with typical presentation.
*In one case, dog was traced and found alive an dhealthy after one month by author.

The relationship of vaccination status of indivdual with clinical presentation in shown in table II.

Table II : Relationship of Vaccination Status of Individual With Clinical Presentation

  Vaccinated
  Unvaccinated NTV TCV
  Partial Complete Partial Complete
Classical 132 3 --- --- ---
n=135 (100%) (97.7%) (2.31%)      
Atypical 0 6 1 2  
n=9   (66.67%) (11.1%) (22.2%)  
Total 144 (100%) 132 9 1 2  
  (91.7%) (65%) (0.7%) (1.4%)  
Note: Failure Rate of NTV in comparison to TCV is 5:1

History of animal bite was not available in 2.8% cases (4 cases out of 144), indicating a probability of hydrophobia after a small unnoticeable exposure to animals. In 2.1% cases dog was found alive after the death of the patients, it shows possibility of healthy carrier state. Molyneuex M.E. have shown antirabic antibody in 4 to 18% unvaccinated anmals and there are reports of dogs living for several months with rabies virus being repeatedly isolated from saliva. There has been one report from India of a healthy dog that bit a child who developed fatal Rabies after 6 weeks; the dog lived for 4 years4

-Mean duration of stay in hospital was 1.5 days in classical cases while it ws 4.9 days in atypical cases. 2 of these cases were transferred to neuro medicine ward in suspicion of post vaccinial-encephalopothy where they were expired and diagnosed as hydrophobia. 7 of these cases were initially diagnosed as viral encephalitis, one as tetanus and one as meningitis. H/o dealth was verified by family members.

While 77.8% of classical cases left against medical advice only 33.3% atypical cases persued this course of actions indicating hopelessness of medical faculty because when they were not sure of diagnosis as rabies they tried in 66.6% cases till patient died. Otherwise, in classical cases patient got the message and left.

References:

  1. Bhatia, R. Ichhpujani, R.L. (1994), Immunization against Infectious Diseases. 141:60.
  2. Debbie J.G. (1988), WH Forum 9 (4) 536.
  3. Sehgal and R. Bhatia (1985) Rabies : Current Status and Proposed Control Programme in India NICD, Delhi-54.
  4. Molyneux Me (1985) Medical Digest 11 (4) London U.K.
  5. Warrel D.A. and M.J. Warrel Medicine International 53:2194, May 1988.

Department of P.S.M.,
S.P. Medical College, Bikaner (Rajasthan)

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