PDF(Pubmed)
Abstract：
BACKGROUND: Rabies is a neglected tropical disease endemic in 150 countries, including India where it is present in all states and union territories except Andaman and Nicobar Islands Lakshadweep. Kerala reports high incidence of animal bites. This article discusses the preventable death of a 17-year-old tribal girl due to rabies in Kerala and the equity concerns it raises.
METHODS: The case study was conducted using qualitative methods such as rapid key informant interviews, interactions in tribal assembly meetings, unstructured participant observations, and document verification. Thematic analysis was used, and the results are presented as an ethnographic summary with the use of quotes to substantiate the observations.
RESULTS: The girl had gone to a town with her sister for a few days when she developed difficulty in eating, behavioral abnormalities, and injuries on her body. She subsequently died, and a post-mortem revealed Negri bodies in her brain, confirming rabies as the cause of death. The girl had been bitten by a puppy from the forest eight months prior, but she did not receive post-exposure prophylaxis. Multiple dogs are kept in each household in the settlement, and the community takes good care of them since they protect them from wild animals. However, awareness about the need for post-exposure prophylaxis is low, and access to it is difficult for this population. The social problems in the settlement affect their quality of life and their interactions with the outside world.
CONCLUSIONS: To prevent such deaths, it is essential to increase awareness and ensure equitable access to life-saving vaccines and immunoglobulin in hard-to-reach tribal areas. The cost-effectiveness of pre-exposure prophylaxis for children in high-risk areas such as this tribal settlement should be evaluated and compared with the WHO-recommended strategies of mass canine vaccination and One Health.
METHODS: The case study was conducted using qualitative methods such as rapid key informant interviews, interactions in tribal assembly meetings, unstructured participant observations, and document verification. Thematic analysis was used, and the results are presented as an ethnographic summary with the use of quotes to substantiate the observations.
RESULTS: The girl had gone to a town with her sister for a few days when she developed difficulty in eating, behavioral abnormalities, and injuries on her body. She subsequently died, and a post-mortem revealed Negri bodies in her brain, confirming rabies as the cause of death. The girl had been bitten by a puppy from the forest eight months prior, but she did not receive post-exposure prophylaxis. Multiple dogs are kept in each household in the settlement, and the community takes good care of them since they protect them from wild animals. However, awareness about the need for post-exposure prophylaxis is low, and access to it is difficult for this population. The social problems in the settlement affect their quality of life and their interactions with the outside world.
CONCLUSIONS: To prevent such deaths, it is essential to increase awareness and ensure equitable access to life-saving vaccines and immunoglobulin in hard-to-reach tribal areas. The cost-effectiveness of pre-exposure prophylaxis for children in high-risk areas such as this tribal settlement should be evaluated and compared with the WHO-recommended strategies of mass canine vaccination and One Health.
摘要：
背景：狂犬病是150个国家被忽视的热带病地方病，包括印度，它存在于除安达曼和尼科巴群岛Lakshadweep以外的所有州和联邦领土。喀拉拉邦报告动物咬伤的发生率很高。本文讨论了喀拉拉邦一名17岁部落女孩因狂犬病而可预防的死亡及其引起的公平问题。
方法：案例研究是使用定性方法进行的，例如快速关键线人访谈，部落集会会议中的互动，非结构化参与者观察，文件验证。使用主题分析，结果以人种学摘要的形式呈现，并使用引号来证实观察结果。
结果：这个女孩和她的妹妹去了一个小镇几天，当时她出现了进食困难，行为异常,还有她身上的伤.后来她死了,验尸发现Negri的尸体在她的大脑中,确认狂犬病是死因.这个女孩八个月前被森林里的小狗咬了，但她没有接受暴露后预防.定居点的每个家庭都养了多条狗，社区很好地照顾他们，因为他们保护他们免受野生动物的侵害。然而,对暴露后预防需求的认识很低，对于这个人群来说，很难获得它。定居点中的社会问题影响着他们的生活质量以及与外界的互动。
结论：为了防止此类死亡，必须提高认识，并确保在难以到达的部落地区公平获得救生疫苗和免疫球蛋白。应对该部落定居点等高风险地区的儿童进行暴露前预防的成本效益进行评估，并与世卫组织推荐的大规模犬类疫苗接种和“一个健康”战略进行比较。
方法：案例研究是使用定性方法进行的，例如快速关键线人访谈，部落集会会议中的互动，非结构化参与者观察，文件验证。使用主题分析，结果以人种学摘要的形式呈现，并使用引号来证实观察结果。
结果：这个女孩和她的妹妹去了一个小镇几天，当时她出现了进食困难，行为异常,还有她身上的伤.后来她死了,验尸发现Negri的尸体在她的大脑中,确认狂犬病是死因.这个女孩八个月前被森林里的小狗咬了，但她没有接受暴露后预防.定居点的每个家庭都养了多条狗，社区很好地照顾他们，因为他们保护他们免受野生动物的侵害。然而,对暴露后预防需求的认识很低，对于这个人群来说，很难获得它。定居点中的社会问题影响着他们的生活质量以及与外界的互动。
结论：为了防止此类死亡，必须提高认识，并确保在难以到达的部落地区公平获得救生疫苗和免疫球蛋白。应对该部落定居点等高风险地区的儿童进行暴露前预防的成本效益进行评估，并与世卫组织推荐的大规模犬类疫苗接种和“一个健康”战略进行比较。
