Sunday, 12 May 2002  
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Book Review: 

The Guidelines for the prevention and control of Rabies in Sri Lanka


The Guidelines for the prevention and control of Rabies in Sri Lanka. Report of the Expert Committee, published by the College of General Practitioners of Sri Lanka.

Having twice in my boyhood come into contact with rabid dogs and having as a consequence to submit myself to the trauma of prolonged courses of anti-rabies injections, I was naturally much interested in the Report of the Expert Committee on the Prevention and Control of Rabies setting out guidelines, a copy of which recently came into my hand. The Expert Committee, which has Prof. Tissa Vitarana as Chairman and Dr. Dennis J. Aloysius as Secretary/Convenor, is composed of some of the most eminent persons in the medical field.

For a start, I was greatly heartened to learn that the incidence of rabies, which from my own experience seemed to be fairly widespread in my youth (no doubt due to the vast majority of dogs not having been immunized against rabies), is on the decline, with only 109 cases recorded in 2000 as against 377 in 1977. However, as the Report observes, since Sri Lanka is an island, it should be possible for our health and veterinary agencies to completely eliminate rabies and therefore its recommendation to establish a Task Force with adequate human and financial resources and the necessary authority to achieve this objective within a given time frame seems and essential first step. Equally worthy of consideration is the proposal to decentralize the rabies control programme, including the setting up of rabies diagnostic laboratories, in each province.

Further, as the report points out, attention should also be given to a more regular and reliable system of collecting statistical data pertaining to rabies and the training of health personnel in treating those infected by rabies.

However, to my mind the most useful part of the Report is where it suggests guidelines in regard to the treatment of those exposed to rabies infection. At present, treatment centers on tissue culture vaccines (TC ARV) and specific Rabies Immunoglobulin (RIG). While they provide a relatively safe and effective prophylactic regime, they are extremely expensive. In 2001 the cost of importing the above amounted to Rs. 171 million. Since in a number of instances the administration of such expensive medication is not really necessary, the Expert Committee, by specifying when medical authorities should actually resort to such measures and more importantly when not to, and then prescribing the course of treatment, believes that the use of such expensive vaccines can be significantly reduced, with consequent benefits to the national exchequer. This section of the Expert Committee's report and the Guidelines it has proposed should be carefully studied with a view to implementation.

All in all, the public, the medical and health authorities of Sri Lanka, as well as the medical profession itself, owes a great debt of gratitude to the Expert Committee for their painstaking work in this vital field.

Crescat Development Ltd.

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