Awareness about rabies post exposure prophylaxis in Pakistan among patients and health care workers: results from an Asian Rabies Expert Bureau study.

OBJECTIVE To identify the gaps in information on rabies and post exposure prophylaxis (PEP) in relation to categorization of wound severity, wound washing and appropriate use of vaccine and rabies immunoglobulin after exposure, and define actions that should be taken at dog bite management centres for prevention of rabies occurring after animal bites. STUDY DESIGN Cross-sectional survey. PLACE AND DURATION OF STUDY A multicentre study across Pakistan conducted from 1st July 2007 to 31st January 2008. METHODOLOGY A pre-tested questionnaire was distributed to the respective medical officers in 6 dog bite management centres across Pakistan from 1st July 2007 to 31st January 2008. Information was obtained about demographics of dog bite victims, the timing and type of PEP administered and their responses to the injury. RESULTS Out of 519 completed questionnaires the mean age of dog bite victims was 24 years. Over one-third were less than 18 years of age; male/female ratio was 4.9:1; 43% lived in rural Pakistan; 67.8% were classified as lower socioeconomic class; 98% animal bites were from dogs, of which 92.5% were first time bites. 45.5% wounds were classified as Category I (no risk), 42.7%, Category II (moderate risk) and 11.9% Category III (severe risk). Tissue culture vaccine (TCV) was used 54% by intramuscular route and 45% by intradermal route. Only 118 (22.9%) patients received rabies immunoglobulin (RIG). Critical analysis of the results reveals serious gaps in understanding of wound severity classification and correct application of PEP with vaccine and RIG. CONCLUSION There is a dire need for improved awareness and understanding of dog bite management among health care givers in order to prevent rabies deaths.