KARACHI: In less than a week, two dog-bite victims, one hailing from Karachi and the other from Nawabshah, died of rabies at the Indus Hospital (TIH), officials said on Tuesday.

The first death was of a six-year-old boy, Mustafa, from Garden, Karachi, who was bitten by a dog on May 3 and died on May 21 while the second case was of a 24-year-old man, Nadeem, from Nawabshah who died here on Tuesday.

Hospital sources said case histories gathered from their families showed that both the patients received improper and inadequate treatment at government hospitals.

Mother of boy narrates ordeal

“My boy was bitten by a dog on the face and shoulder on May 3 and taken immediately to the emergency ward of Civil Hospital (Karachi) where I was asked to wash his wounds, which I did for a minute or so,” Rabia, mother of Mustafa, told Dawn.

The doctor saw the boy after half an hour and administered a vaccine four times in different locations, two shots on the cheek and two on the hip, she added.

Second rabies-related death in five days; both patients received improper treatment at govt hospitals

The family was advised to bring the patient for a follow-up and further treatment in the outpatient department on May 6, May 10 and May 17. On the second visit, however, the family was told that there was no need to come again as the treatment had been completed.

Being unsatisfied, the family took the boy to the National Institute of Child Health (NICH).

“The doctor there examined him and briefed us about rabies’ signs and symptoms in detail. He assured us that there is no need to worry given the fact that my son hasn’t shown any signs of illness in a week,” she said.

The family believed that their child was perfectly fine as his wounds gradually healed and he seemed to be recovering. But he wasn’t. Mustafa complained of a headache on the fifth day of Eid. The following days, he had a fever with vomiting.

“On May 20, I was alarmed to see when he showed signs of fear when water was given to him. The doctor at NICH had told us about this symptom of rabies and we took him there immediately,” she said.

At NICH, another ordeal awaited the family as doctors refused to touch the patient after seeing he had full-blown rabies.

“We reported at the NICH at 12.30 midnight and were finally given a bed at 6am after we posted videos of Mustafa’s sufferings on social media,” the mother recalled.

According to the family, doctors’ non-cooperative attitude forced them to shift their child to TIH where the family was counselled about rabies and Mustafa was provided with palliative care.

“Mustafa was my only child. After him, I don’t pray for another baby but for the safety of other children. There are so many stray dogs roaming in our area, which have made residents’ lives terrible but there is no action from the government,” she said.

Critical lapses

Sharing his opinion on Mustafa’s case, Aftab Gohar, heading the rabies’ prevention centre at TIH, said the CHK documents presented by the family had no mention that rabies immunoglobulin (RIG), a life-saving medicine, was administered along with the vaccine.

“Also, there was no mention of which procedure was adopted for the vaccine’s administration as there are two methods; intramuscular and intradermal. Both are effective but have to be given in a proper way.

“The wound wasn’t washed for 10 to 15 minutes with ordinary soap, another critical step in rabies prevention. Last but not the least, two of the injections were given in the buttock area, which reduced their efficacy due to slow absorption,” he pointed out while explaining lapses in the case management.

According to Mr Gohar, administration of RIG is extremely important in serious dog-bite wounds to save life.

A case of misdiagnosis

About the case from Nawabshah, he said 24-year-old Nadeem with a critical wound on the forehead was initially taken to the Civil Hospital in the district and later to other health facilities when he developed rabies’ signs.

“Doctors misdiagnosed his case and treated him for diarrhoea. One of the biggest mistakes in his case was that his wound was stitched. A dog-bite injury is never stitched as it increases the risk for infection. Also in this case, apparently there was no administration of RIG.”

According to experts, rabies is primarily an animal disease and mainly transmitted to man by the bite or scratch of a rabid dog. Within a few days to weeks from a bite/scratch of an infected dog the virus gets into the brain and manifestation of the symptoms start and the disease becomes irreversible and invariably fatal.

Rabies is completely preventable if the WHO recommendations for rabies post-exposure prophylaxis are followed in time and effectively, which includes washing wound/s immediately and thoroughly with soap and flowing water, followed by an effective anti-rabies vaccine series and immunoglobulin.

Published in Dawn, May 26th, 2021