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Indian Journal of Community Medicine

An Analysis of 51 Hydrophobia at Amritsar (Punjab)

Author(s): D.S. Dhaliwal, Ravneet S. Dhaliwal

Vol. 25, No. 3 (2000-07 - 2000-09)

Department of Community Medicine Sri Guru Ram Das Institute of Medical Sciences & Research, P.O. Vallah, Amritsar

Abstract:

Research question: What is the profile of hydrophobia cases in relation to age, sex, place, incubation period and clinical picture?

Objectives: 1. To study distribution of cases of hydrophobia in relation to their age, sex and place of residence. 2. To study the incubation period in relation to site of bite and type of exposure. 3. To study the distribution of signs and symptoms of disease and the time of their appearance.

Study design: Cross-sectional study.

Participants: Cases of hydrophobia at I.D. Hospital/Antirabic clinic at Amritsar during 1977 and 1978.

Sample size: 51 cases of hydrophobia. Study variables: Age, sex, place, incubation period, signs and symptoms.

Statistical analysis: Percentages.

Results: Out of 51 cases, 82.36% were males. 74.51% cases reported from rural area. Majority of the cases (39.22%) belonged to the age group of 15-45 years. Incubation period in range of 1-3 months was found in majority of the cases (56.86%). Cases of class III exposure (43.13%) had shorter incubation period (<3 months) than cases of class II exposure (29.41%). Besides hydrophobia, symptoms and signs were irritation and pain at the site of bite (74.51%), fever (74.51%) and body aches (19.6%). 98.04% cases were bitten by rabid dogs and 1.96% case were bitten by rabid mongoose.

Keywords: Hydrophobia, Incubation period, Exposure, Rabid dog, Antirabic, Signs and Symptoms.

Introduction:

Rabies in human beings is popularly known as hydrophobia and is the most characteristic symptom of the disease. Hydrophobia is an acute and 100% fatal infection of man, incurred by the bite of rabid animals.

Rabies is prevalent all over the world except Australia, Antaractica, New Zealand, Cyprus, Hawaii and UK1. Rabies is a big public health problem in India. Suri (1973)2 reported incidence of rabies in Verka block as 6.8/1,00,000 population. Accordingly, there may be over 46 thousand persons dying of rabies every year in India. More than 22,000 cases, bitten by rabid/suspected rabid animals, undergo prophylactic antirabic treatment every year in Punjab alone. To understand this problem and to bring into surface few important factors, the analysis of hydrophobia cases was undertaken.

Material and Methods:

The present study included 51 cases of hydrophobia at I.D. Hospital/Antirabic Clinic/ referred to the author at Amritsar during 1977 and 1978. Detailed history of bite, prophylactic antirabic treatment, time between bite and appearance of signs and symptoms, clinical features and duration till death were recorded and analysed.

Results and Discussion:

Table I: Distribution of hydrophobia cases according to age and area of residence.

Age (yrs) Sex Area Total
Male Female Urban Rural
1-5 2 (3.92) 1 (1.96) -   3 (5.88) 3 (5.88)
6-14 12 (23.53) 2 (3.92) 7 (13.72) 7 (13.72) 14 (27.45)
15-45 17 (33.34) 3 (5.88) 2 (3.92) 18 (35.30) 20 (39.22)
45 and above 11 (21.57) 3 (5.88) 4 (7.84) 10 (19.61) 14 (27.45)
Total 42 (82.36) 9 (17.64) 13 (25.49) 38 (74.51) 51 (100.00)

Figures in parentheses indicate percentages.

Total 51 cases of hydrophobia reported during the year 1977 and 1978 (18 cases in 1977 and 33 cases in 1978) died. Among them 82.36% were males and 17.64% were females. 74.51% were from rural area and 25.49% were from urban area. Majority (39.22%) of cases belonged to the age group of 15-45 years followed by 6-14 years (27.45%) and rest 45 years and above. These observations were almost in agreement with that reported by Suri at Amritsar (1973). More risk of bite by rabid animals is there in the active age group of 15-45 years. In rural areas, people work in the fields and are thus always more exposed to the risk of bite. Minimum age of one case was 3 years and maximum age of one case was 83 years and both of them were males.

Incubation Period:

Table II: Distribution of incubation period in relation to site of bite and type of exposure.

Site of bite -7 days 2-3 weeks -1 month 1-3 months 3-6 months 6-12 months More than year Total
Face -   2 (3.92) 1 (1.96) 1 (1.96)     -   -   4 (7.84)
Fingers & hands -   -   2 (3.92) 12 (23.53) 1 (1.96) 1 (1.96) -   16 (31.37)
Lower extremities 1 (1.96) -   2 (3.92) 12 (23.53) 6 (11.76) 3 (5.88) 1 (1.96) 25 (49.02)
Other parts -   -   -   4 (7.84) 2 (3.92) -   -   6 (11.76)
Total 1 (1.96) 2 (3.92) 5 (9.80) 29 (56.86) 9 (17.65) 4 (7.84) 1 (1.96) 51 (100.00)
Class II -   -   2 (3.92) 13 (25.49) 5 (9.80) 3 (5.88) 1 (1.96) 24 (47.06)
Class III 1 (1.96) 2 (3.92) 3 (5.88) 16 (31.37) 4 (7.84) 1 (1.96) -   27 (52.94)

Figures in parentheses indicate percentages.

In majority of cases (56.86%), the incubation period was 1-3 months. In one case, minimum incubation period was 6 days. The longest incubation period in one case was 8 years. All the cases had either class II (47.06%) or class III (52.94%) types of bites. Lower extremities had been bitten more as these were exposed and accessible parts of body. Hands and fingers had second place in exposure to bite, due to use of these parts of the body to defend against the animal bite.

Class III exposure cases (43.13%) had shorter incubation period (<3 months) as compared to class II exposure cases (29.41%). Thus it could be commented that more severe the exposure, less would be the incubation period. No case of class II exposure had incubation period less than 3 weeks.

Symptoms and signs:

Table III: Distribution of signs and symptoms of disease and the time of their appearance before death.

Day of appearance
of signs and symptoms
Signs and symptoms
Irritation Fever Hydrophobia Body aches
1 day 3 (5.88) 1 (1.96) 23 (45.10) -  
2 days 10 (19.61) 11 (21.57) 19 (37.25) 2 (3.92)
3 days 13 (25.49) 14 (27.45) 3 (5.88) 1 (1.96)
4 days 8 (15.69) 7 (13.72) 3 (5.88) 1 (1.96)
5-6 days 4 (7.84) 4 (7.84) 3 (5.88) 4 (7.84)
7 days and above -   1 (1.96) -   2 (3.92)
Total 38 (74.51) 38 (74.51) 51 (100.00) 10 (19.60)

Figures in parentheses indicate percentages.

Hydrophobia was present in all the cases. It was present for one day (45.10%) or 2 days (37.25%) before death in majority of cases. Longest duration of symptoms was pain in testes bitten on right foot for a duration of 15 days. One case (bitten on upper lip) had irritation of right eye for 7 days. Numbness of lower extremities and constipation for 6 days was present in one case, while difficulty in micturition for 2-4 days was present in 3 cases. All the 51 cases (100%) died within 8 days of the appearance of signs and symptoms.

Source of Bite:

Majority of cases (96.08%) were bitten by furious type of rabid dogs and only one case (1.96%) by dumb type rabid dog. One case (1.96%) was bitten by mongoose. Majority of rabid dogs (74.51%) were killed and 15.69% died of rabies while the fate of 9.8% dogs was not known either to hydrophobia cases or to their attendants. The history of survival of any dog was not known. Veeraraghavan3reported that seven dogs were alive when patients developed rabies and Chowdhury4 reported that six pet dogs were alive at the time when the patients (the victims of bite) were seeking admission for rabies in hospital (one month after bite in 3 cases, 3 months after bite in 2 cases, 6 months after bite in one case).

Prophylactic Treatment:

Eight cases (15.69%) developed rabies inspite of complete or partial antirabic prophylactic treatment with antirabic vaccine. Out of these, 37.50% had class III exposure. Eleven to fourteen doses of antirabic vaccine (BPL) were administered in 4 cases and one case had one booster dose also. One case, had been given complete antirabic vaccine injections as well as 9cc of antirabic serum. He developed hydrophobia after 3 months of the 2nd booster and died on 3rd day of illness. This is in tune with the report by Veeraraghavan et al and Chowdhury et al.

References:

  1. Park JE: Text book of preventive and social medicine. 7th edition, Nai Dunia Printing Press, Keshar Bagh Road, Indore (India). 1979;446-454.
  2. Suri SP: An epidemiological study of hydrophobia as reported at V.J. Hospital and Infectious Diseases Hospital, Amritsar. M.D. Thesis (Social and Preventive Medicine), Guru Nanak Dev University, Amritsar (Punjab). 1973.
  3. Veeraraghavan N: Annual report of Director Pasteur Institute Coonoor, Diccesan Press, Madras (India), 1966, 1967, 1968 and 1970.
  4. Chowdhury JK, Modak KK: Report on rabies in West Bengal. JIMA 1983; 81(5): 69-74.
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