Rabies deaths in Nepal

On 9 December 1998, 4 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 which are known to apply to the nervous tissue vaccines. Neuroparalytic reactions range from 1:200 to 1:1200 vaccine recipients and 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.