Book Review :

A Manual for doctors on RABIES :-
By Prof. M. K. Sudarshan, 2nd Edition,2002.

21.5cm x 13.7cm, pp51. Published by the author. Author’s address : Kempegowda Institute of Medical Sciences (KIMS), Department of Community Medicine, College, 3rd floor, K. R. Road, Bangalore- 560004.

The manual is also available on the web at the APCRI site www.apcri.org

Prof. M. K. Sudarshan deserves to be congratulated for bringing out this manual written by him solely. This manual intends to provide the busy medical practitioner the necessary basic information on medical, veterinary and public health aspects of rabies, its prevention and control. It guides the physician in the correct usage of modern Rabies Immunoglobulins (RIGs) and Tissue Culture Vaccines (TCVs) against rabies.

The chapters on Rabies Epidemiology, The Virus, Pathogenesis & Pathology, Clinical Manifestations & Laboratory Diagnosis, Management of a Rabies Patient, and Prevention of Rabies in Man are very nicely written with many figures, illustrations and charts. It will be very easy for a busy doctor to understand the principles behind every step in the management of animal bites as per WHO recommendations, and thereby he or she will be able to manage such cases very confidently.

I will be failing in my duty as a reviewer if I do not mention the points which have to be modified or improved in future editions.

In the chapter on Prevention of Rabies in Man, under the sub-heading Anti-Rabies Immunization, in page 17.“If the animal remains healthy upto 5 days, it may be assumed that it is not rabid, and the treatment discontinued”. As per WHO TRS 931 report, a person should get TCVs and RIGs as applicable according to the category of exposure. The person should get TCV on Day0, Day3 and Day7, and simultaneously the biting animal should be observed for 10(ten) days if it is a known dog or cat only. If the said known dog or cat remained normal and healthy for more than 10(ten) days after the incident then the treatment can be discontinued. A manual for doctors should always stick to the most safe procedures and follow WHO guidelines.

On page 36, in the answer to Question-36, there is a statement “the earlier 3 injections (on days 0,3&7) may provide protective antibody titres for the pre-exposure schedule duration of one year only”. Again this is not as per WHO guidelines. Those patients can be converted to pre-exposure schedule of vaccination, if they received another dose of TCV on Day28.

My overall comments about the manual is that it is very nicely written, and it will be of great help to all doctors who are called for management of animal bites.

Dr. Amlan Goswami