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  • Author: Doddabele Hanumanthappa Ashwath Narayana x
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Ravish Hardanahalli Shankaraiah, Gangaboraiah Bilagumba, Doddabele Hanumanthappa Ashwath Narayana, Rachana Annadani and Veena Vijayashankar


Background: Animal bites in humans are an important public health problem. Timely and correct postexposure prophylaxis for victims is necessary to prevent deaths.

Objectives: We studied the knowledge, attitude, and actual practice of rabies prophylaxis among physicians at animal bite clinics and the relationship between their knowledge and actual practice.

Methods: A cross sectional study was conducted among 109 physicians working in eight Indian cities. The data collected were analyzed using SPSS version16.0. The descriptive statistics computed. Spearman’s rank correlation was computed to measure the relationship between knowledge, attitude and practice.

Results: The knowledge, attitude and practice of these anti rabies clinic physicians were inadequate with respect to different parameters. The appropriate life-saving use of immunoglobulins was one of these. The present study also showed that there was a significant difference between knowledge, attitude, and practice.

Conclusions: Knowledge, attitude, and practice needs to be improved through properly designed awareness programmes for all physicians dealing with rabies exposures. Emphasis should be on following current WHO guidelines for post exposure prophylaxis of rabies.

Open access

Mysore Kalappa Sudarshan, Haradanhalli Shankaraiah Ravish and Doddabele Hanumanthappa Ashwath Narayana


Background: In rabies endemic areas, re-exposures to rabies are quite common and the incidence could be up to 15%. The recent guidelines of World Health Organization do not specify the duration of protection provided by previous pre- or post exposure prophylaxis. This often puts the treating physician in a dilemma in such cases of re-exposure.

Objective: Study the time interval between primary and booster vaccination in individuals who have taken previously a full course of either pre- or post exposure prophylaxis and are now re-exposed to rabies.

Methods: The data obtained through a literature search using Pubmed and advanced Google search along with data from in house clinical trials were used for analysis. Sixty-six vaccine cohorts spanning more than 27 years from 1983 to 2010 from six countries were studied. The duration of protection offered by previous vaccination was assessed by using a surrogate marker of adequate (> 0.5 IU per mL) rabies virus neutralizing antibody levels in the individuals vaccinated either by pre-exposure or post exposure regimens received by intramuscular or intradermal routes.

Results: The proportions of 2,795 subjects who had received prior post-exposure immunization and produced rabies virus neutralizing antibody levels of less than 0.5 IU per mL were 0.07% and 0.14% at the end of the first and third month post primary vaccination. All 577 subjects with previous pre-exposure vaccination had antibody responses above 0.5 IU per mL at the end of the first and third month post primary vaccination.

Conclusion: We concluded that it may be safe for up to three months after previous pre- or post exposure vaccination to not administer boosters to healthy subjects who have been re-exposed to rabies.