Rabies in Nepal
Brief Report
Rabies in Nepal
Source: Pandey P, Rotivel Y. ProMed-mail, Dec. 21, 1998.
On dec. 9, 1998, four persons died from rabies in Dang district, western Nepal. All had been bitten by rabid dogs a few months earlier and had undergone a 10-day course of Sheep Brain BPL antirabies vaccine as supplied by the government. However, the victims did not receive Rabies Immune Globulin (either human or equine). (Altogether in 1998 to date, 1000 people have received treatment for dog bites in the Dang area of Nepal.)
Doubt has been cast on the possibility of vaccine failure in these cases; however, there are reminders from various specialists that this may not be the only possible cause of death. Lack of immune globulin, wrong route of administration, bite of neck, face, or head as well as loss of potency of vaccine are alternative causes. Also, some of the deaths could be due to vaccine-related complications that are known to apply to the nervous tissue vaccines. Neuroparalytic reactions range from 1:200 to 1:1200 vaccine recipients; 25% of these are reported as being vaccine recipients, and 25% of these are reported as being fatal. (Source: Prativa Pandey, Medical Director, CIWEC Clinic, Kathmandu and Yolande Rotivel, Chief of the Rabies Treatment Centre, Institut Pasteur, Paris via ProMed-mail 21/12/98). NB: The human diploid cell vaccine (HDCV), routinely used in western countries, is highly effective and has a very low incidence of serious side effects.
Attention CME Subscribers
Due to an American Health Consultants error, a mistake has been made with the CME numbering. The numbering should have started over in the January/February 1999 issue. In that issue, questions 14-17 should be questions 1-4. A Scantron form for CME subscribers is enclosed in this issue, which will cover the July/August—November/December 1998 test. We regret any confusion this may have caused.
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The content of the Travel Medicine Advisor country-specific handout sheets is in no way intended to replace the medical advice of a trained travel medicine practitioner. Various medical conditions, medications, previous immunization status, itinerary, duration of stay, and proposed activities must be considered before specific recommendations can be made. These handouts are designed to provide supplementary written information and general guidelines regarding health risks, and the potential need for immunizations, medications, and precautions for international travelers. Information contained in these handouts is updated regularly but may not reflect very recent changes in requirements and recommendations for international travel.
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