- (1.) This Court on 5th April, 2016, Anupam Tripathi v. Union of India,(2016) 13 SCC 492 : (2016) 13 SCC 504 had appointed a Committee headed by Justice Siri Jagan, former Judge of the High Court of Kerala. The Committee consists of Justice Siri Jagan, Law Secretary of the State of Kerala and the Director of Health Services, Government of Kerala. The Committee has submitted the interim report which has focused mainly on the menace of street dogs itself and how to control it. The Committee has enumerated situations which are affecting the public at large. We think it appropriate to reproduce the relevant observations of the Committee: "4. In the absence of infra-structural facilities for the Committee such as office, staff, computer, printer, stationery etc., the Committee was unable to proceed further pursuant to the orders of this Court. However, the Committee made deliberations on the sue of drugs for dog bites in Government institutions and came to some inferences on the subject, purely based on the scientific and financial inputs furnished by the Director of Health Services, which are detailed hereunder. 5. India is a nation with substantial fatal rabies cases, mainly due to stray dog bites. Kerala is estimated to have a stray dog population of 2.5 lakhs, which feed lavishly on the wastes and garbage dumps across cities and towns. Frequent stray dog attacks on children in Kerala have created a dangerous situation. There have been incidents of stray dogs chasing, attacking and biting school children, aged persons, pedestrians, morning walkers and two-wheeler riders. Increase in stray dog population in public places like hospitals, railway stations etc. has created panic among the people. More than one lakh people in the State have been bitten by dogs in 2015-16. Rabies is an acute viral disease which causes fatal encephalomyelitis in all the warm blooded animas including man. The virus is found in wild and some domestic animals and is transmitted to other animals and humans through their saliva (bites, scratches and licks). Rabies is invariably fatal. But if animal bites are appropriately and timely managed, the disease is preventable. The National Guidelines for Management of Animal Bites were formulated in 2002 by the expert group meeting at the National Institute of Communicable Diseases, New Delhi, to bring out uniformity in post-exposure prophylaxis. In India, where every dog bite is potentially suspected as rabid animal bite, the treatment should start immediately. Because of long incubation period in most cases of human rabies, it is possible to institute prophylactic post-exposure treatment. This must be started at the earliest, on the day of animal bite itself, to ensure that the individual will be immunised before the virus reaches the nervous system.
(2.) The World Health Organisation recommends classification of animal bites for post exposure prophylaxis as follows, which is followed in our country: Type 1 : Touching or feeding of animals, licks on intact skin. Type of exposure is none and pose exposure prophylaxis is needed if reliable case history is available. Type II : Nibbling of uncovered skin resulting in minor scratches or abrasions, without bleeding. The type of exposure is minor. Recommended prophylaxis is wound management and Anti Rabies Vaccine (On 3rd, 7th and 28th Day). Type III : Single or multiple transdermal bites or scratches, licks on broken skin, contamination of mucous membrane with saliva. This type of exposure is severe. Recommended prophylaxis is by wound management, and treating with Rabies Immunoglobulin and Anti-Rabies Vaccine. Anti-Rabies Vaccine (ARV) : Active immunisation is achieved by administration of safe and potent Cell culture vaccines. It is administered intra-dermal. This vaccine is available in all Public Health Institutions from Primary Health Centres to District Hospitals and Medical Colleges. Rabies Immunoglobulin (RIG) : It provides passive immunity in the form of readymade anti-Rabies antibody to tide over the initial phase of infection. RIG has the property of binding with the rabies virus resulting in the loss of infectivity of the virus. Two Types of RIGs are available: (i) Equine Rabies Immunoglobulin (ERIG) : This is of heterologous origin raised by hyper immunisation of horses. These should be administered after sensitivity test as it may cause adverse allergic reaction in some individuals. Dose is 40 IU per Kg body weight up to a maximum of 3000 IU. ERIG produced in our country contains 300 IU per ml. This is available in all District Hospitals and Medical Colleges. It is administered in lower level hospitals for want of resuscitation facilities in case of severe adverse reactions. However, currently manufactured ERIGs are highly purified and the occurrences of adverse events have been significantly reduced. Still, these should be administered after a sensitivity test and can be safely done only in District Hospitals. (ii) Human Rabies Immunoglobulin (HRIG) : It is safe and free of side effects encountered in serum of heterogenous origin. The dose of HRIG is 20 Units per Kg body weight to a maximum dose of 1500 units. This does require sensitivity testing as there is no adverse reaction. HRIG is available in concentration of 150 IU per ml. At present HRIG is made available in Public Health Institutions because of its high costs."
(3.) As of now, the Kerala Medical Services Corporation is procuring the Anti rabies Vaccine and Equine Rabies Immunoglobulin (ERIG) 300 IU/ml for the post exposure prophylaxis of Rabies.;