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OBJECTIVE: To assess the appropriateness of the use of anti-rabies vaccine and immunogfubulin therapy. DESIGN: A hospital based observational descriptive study conducted prospectively. SETTING: Patients receiving post exposure anti-rabies therapy at the Teaching Hospital, Ragama during the month of December 2000 were studied. METHODS: 500 persons seeking RPEP with a history of animal contact were selected by the non-probability sampling method and individually interviewed using a structured questionnaire. The information on the survival or death of the offending animal was obtained during the 14 day observation period. RESULTS: 500 exposed persons included 418 (83.6%), 61 (12.2%),16 (3.2%), 3 (0.6%) and 2 (0.4% ) due to dog, cat, rat, monkey and squirrel contacts respectively. 383 of 500 (77%) had been exposed due to observable animals and in 322 of 383 (84% ), the animal survived beyond the 14 day observation period. In contrast, only in 44 of 383 (11% ), the animal died. In 17of 383 ( 4%) persons exposed to observable animals, the information on death or survival of the animal was not available. The results show that complete RPEP in 61 of 500 (12.2%) cases could have been avoided based on the nature of exposure. In addition, the 4"1 and 5th vaccine doses of 322 of 500 (64.4%) cases too, could have been withheld as the animals responsible for the exposure cases survived beyond the 14 day observation. CONCLUSION: This study clearly shows that use of RPEP is often unnecessary and the expenditure on anti-rabies vaccines and immunoglubilins could have been minimised considerably by greater compliance with the use of proper RPEP guidelines. Education of doctors on logical implementation of RPEP guidelines and the co-operation by the public could optimise the use of this expensive resource in Sri Lanka. |
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