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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Compliance of Post-Exposure Prophylaxis of Anti-rabies Vaccine amongst Animal Bite Cases Attending Secondary Healthcare Hospital in Thiruvallur District, Tamil Nadu, India: A Cross-sectional Study
Correspondence Address :
Dr. Kranthi Karunai Kadal,
Assistant Professor, Department of Pharmacology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai-600116, Tamil Nadu, India.
E-mail: drkranthi10@gmail.com
Introduction: India has the highest burden of animal bite cases globally, with a large proportion of the population affected by dog bites. India is endemic for rabies and accounts for 36% of the world’s rabies deaths. Mortality can be prevented by Post-Exposure Prophylaxis (PEP) with effective vaccines that are available. Vaccines are provided free of charge in Government hospitals.
Aim: To estimate the compliance rate of Anti-Rabies Vaccine (ARV) regimen managed by the intradermal route.
Materials and Methods: This was a cross-sectional record-based study from the ARV Register of Government Hospital, Gummidipoondi, Tamil Nadu, India. The victims of animal bite cases attending the hospital for the ARV regimen for a month were selected from the register to assess adherence to the full course updated Thai Red Cross regimen and identify any constraint factors hindering them from completing the course.
Results: Out of 108 patients, 79 completed the full course ARV regimen, resulting in a compliance rate of 73.1%. Factors such as the distance of the hospital, timings, and forgotten dates were identified as major constraints.
Conclusion: The compliance rate was found to be moderate, with constraint factors like forgotten dates and the distance of the hospital being significant hindrances to compliance. This highlights the importance of strengthening awareness through sensitisation programs and health education in both urban and rural areas to achieve a rabies-free India.
Adherence, Constraints, Dog bite
Rabies is a vaccine-preventable zoonotic disease. The rabies virus belongs to the family Rhabdoviridae and genus Lyssavirus, which is transmitted through bites, licks on broken skin, scratches, and mucous membranes. Apart from a direct bite, the saliva of unimmunised dogs and cats also has the potential to transmit rabies. Human rabies cases have also been documented following corneal transplantation and solid organ transplantation from a misdiagnosed rabies patient (1). Upon entry, the virus spreads neurotropically, multiplying at the site of inoculation (such as muscles) or entering peripheral nerves, traveling via retrograde axoplasmic flow to the central nervous system before reaching the brain. In the brain, the hippocampus, cerebellum, hypothalamus, and scattered neurons in the reticular formation are the main areas involved in the pathogenesis of the disease. The clinical features consist of three phases: the Prodromal phase (numbness and tingling sensation in limbs, malaise, sore throat, increased temperature, priapism, and headache), the Excitation phase (fear of water (hydrophobia), pharyngeal and laryngeal spasms, terror and excitement, cardiac arrhythmias, respiratory arrhythmias, hypertension, intense thirst and dehydration, fear/convulsions on exposure to light, air and sound), and the Paralytic phase (flaccid and limp muscles, convulsions, unconsciousness). The average incubation period ranges between 30-90 days. Due to this longer incubation period, it is possible to institute PEP in patients who report late. Although rabies affects all age groups, children are the most vulnerable, constituting 40% of those exposed to dog bites (2).
The number of dog-mediated rabies deaths is estimated to be 59,000 annually worldwide, with Asia (59.6%) and Africa (36.4%) bearing the highest burden. In India, which accounts for 96% of morbidity and mortality due to animal bites in the country (2), the National Rabies Control Programme (NRCP) has developed a multisectoral collaborative plan known as the “National Action Plan for Dog-Mediated Rabies Elimination (NAPRE).” Various states across India are working towards this plan to eliminate rabies from the country by 2030 (2). The three components in the management of dog bites include the management of animal bite wounds, active immunisation with the ARV, and passive immunisation with Rabies Immunoglobulin (RIG). The World Health Organisation (WHO) estimates that India contributes to 36% of global rabies deaths (3). While there is expected to be a decline in the number of dog bite cases in the near future, it is essential to take adequate measures for the complete elimination of rabies (4). Although vaccines are available free of cost in government hospitals today, there is an increasing demand to motivate animal bite victims to complete the full course of vaccination by healthcare professionals and to address the constraints leading to non compliance by policymakers. Compliance data plays a crucial role in understanding the current real-world scenario and strengthening surveillance for implementing health measures. To reduce the percentage of mortality and ultimately achieve the global goal of zero rabies deaths by 2030, the Ministry of Health and Family Welfare (MoHFW) launched a vision under the NAPRE (5). With the focus of this program, the present study was conducted to assess the compliance of the ARV regimen managed through the intradermal route.
This was a cross-sectional study conducted at the Government Hospital in Gummidipoondi taluk of Thiruvallur district, Tamil Nadu, India. Data for a period of one month, specifically from April 30, 2023, to May 31, 2023, was considered for the study. The study plan was initiated in June 2023, and datacollection took place in September 2023. The study was conducted after obtaining approval from the Institutional Ethics Committee (IEC) (CSP-MED/23/SEP/93/224).
The number of patients visiting the hospital for ARV ranges from 6 to 10 per day, indicating that it is an endemic area for dog bites. The Government Hospital in Gummidipoondi provides free intradermal rabies vaccine for animal bite cases treated at the hospital. After receiving approval, details were collected from the hospital’s ARV register.
Inclusion criteria:
1. All animal bite cases attending the hospital for ARV aged between 2 years and 80 years.
2. Patients of both genders seeking treatment at the hospital for ARV.
3. Category-II bite (minor scratches or abrasions without bleeding, nibbling of uncovered skin) and III bite (contaminated mucous membrane with saliva, such as licks, single or multiple transdermal bites or scratches, licks on broken skin) (5).
Exclusion criteria:
1. Category-I bite.
2. Patients who have received pre-exposure prophylaxis.
3. Cases of re-exposure (5).
The vaccine is administered for bites from dogs, cats, rats, monkeys, and pigs. According to the Updated Thai Red Cross Schedule, 0.1 mL of the vaccine is given in 2 shots on days 0, 3, 7, and 28, administered intradermally on both deltoids (5).
Sample size: Based on previous studies, with a prevalence (P) of 42.8% adherence to ARV and a 10% non response rate, the sample size was calculated for this study using the formula
N=4pq/d2
where n=desired sample size, P (prevalence) of 42.8, q (100-p)=57.2, and a precision of 10. The sample size calculated for this study was 108 (6).
After initial wound management such as washing the wound in the hospital with running water and soap for 15 minutes, irrespective of prior cleaning, the purified lyophilised rabies antigen derived from the Rabies virus (Abhayrab) vaccine was used for intradermal injection. Following the first dose, patients were advised to return for the next three doses, with manually written dosage dates provided on paper to ensure adherence. Category-II patients received the intradermal vaccine as per the schedule. For Category-III patients, in addition to local treatment, immediate protection was provided through RIG as passive immunisation, which is highly recommended for Category-III bites (7). Category-III patients received the rabies vaccine along with immunoglobulin (Premi-RAB: Enzyme-refined Equine Immunoglobulin 1500 IU/5 mL). The dose of immunoglobulin is 40 IU/kg body weight of the patient, administered within 24 hours, preferably by deep intramuscular injection up to the seventh day after the first dose of ARV. Both categories also received tetanus prophylaxis, with one dose of 0.5 mL of Td (Tetanus-Diphtheria) administered intramuscularly in the upper outer gluteal region. Children who had received less than three doses of the vaccine, had been more than 10 years since the last dose, or had a vaccine status of more than five years with a severe wound, received the Td vaccine. Data for the study were collected from the case proforma. Compliance with ARV was evaluated using the follow-up register. A patient is considered compliant if they complete the full ARV schedule. In cases of non adherence, the reasons for non-adherence were identified through interviews with the patient/guardian conducted by telephone, with the details recorded in the register (Table/Fig 1).
Statistical Analysis
The data was collected and coded in Microsoft Excel version 2010, and it was analysed using Statistical Package for Social Sciences (SPSS) software version 20.0. The socio-demographic variables and the compliance results were presented in the form of tables, figures, and percentages. The Chi-square test was used to determine the significance of association, with the p-value set at <0.05.
Among the 108 victims, the majority were males 64 (59.3%), and the age group less than or equal to 45 accounted for 75 (69.4%) individuals with a mean age of 31.2±17.6 years. The urban area covered the most cases at 59 (54.6%), with dogs being the predominant animal at 95 (88%). Other animal bites included in the study were from rats, pigs, cats, and monkeys. Most victims experienced a single bite 89 (82.4%), categorised as Category-II in 103 (95.4%) cases, and the majority were educated with 64 (59.3%) having received some level of education (Table/Fig 2). The compliance rate in this study was found to be 79 (73.1%) (Table/Fig 3). Regarding compliance with ARV based on demographic profile, adherence was higher in the age group less than 45 at 55 (73.3%), male gender at 49 (76.6%), and slightly more rural individuals completed the course at 37 (75.5%). Compliance rates for other animal bites were also higher, likely due to the lower number of bites from these animals at 10 (76.9%). Compliance rates for multiple bites showed a higher percentage compared to single bites at 17 (89.5%). Adherence for Category-III bites was 5 (100%). School-goers had a higher compliance rate at 26 (83.9%). The relationship between demographic profile and ARV completion is presented in (Table/Fig 4). However, the p-value was not statistically significant for all demographic profiles.
The compliance rate for the 2nd dose was 104 (96.3%), for the 3rd dose was 93 (86.1%), and for the 4th dose was 86 (79.6%) (Table/Fig 5). Regarding dose delays, a total of 12 patients experienced delays. One patient was delayed by one day for the 2nd dose. For the 3rd dose, out of five patients, two were delayed by two days and three were delayed by one day. On the 28th day, all six patients were delayed by one day (Table/Fig 6). There was a decrease in the completion rate for subsequent doses, especially for the 7th and 28th day vaccine schedule, as indicated by the data. Out of the 29 patients who did not complete the schedule, information on the limiting factors for non adherence was collected from the follow-up register. The main obstacles were related to travel costs, hospital timings (outpatient hours), distance from the residential place, loss of wages, and some patients also missed the due dates that were manually provided by the staff nurses for complete vaccination (Table/Fig 7).
The compliance rate of this study was found to be 73.1%. In India, under the Ministry of Health and Family Welfare (MoHFW) of India, the National Centre for Disease Control is working towards the global initiative to eliminate rabies by 2030. The program recommends a completing the vaccination course regardless of the animal’s status. Currently, there are no antiviral medications or immunomodulators available for the complete cure of rabies. Therefore, a complete course of ARV is mandatory for preventing this fatal disease.
Recent advancements, such as research on the use of monoclonal antibodies like Docaravimab and Miromavimab in combination with Essen or the updated Thai Red Cross Vaccine regimen, as conducted by Manna A et al., to assess their safety in Category-III patients, have proven to be safe and effective in rabies prophylaxis (8). The development of small molecule inhibitors and immunostimulatory substances is emerging in the modern era. In-vitro models, such as si-RNA-based studies, also demonstrate promising results (9). Effective management is essential, especially in light of these recent developments.
In a study conducted by Kulkarni P et al., with a sample size of 100 patients, the compliance rate was 14.6% (10). Similarly, in a study by Titoria R and Gupta G, also with a sample size of 100, the compliance rate was 43% (6). This current study, with a compliance rate of 73.1%, showed a significantly higher level of compliance compared to the previous studies. On the other hand, in a study conducted by Wadde SK et al., involving 7892 patients, the compliance rate was 58.19% (11). Additionally, in a study by Gudegowda KS et al., with 2815 patients, the compliance rate was 79.6%, with constraint factors including forgetting dates and distance from the hospital (12). Similarly, in a study by Panda M and Kapoor R, constraint factors included residence far from the rabies clinic, forgetfulness, fear of loss of wages, and ill advice from relatives and friends, which are almost identical to the constraints identified in this study, emphasising the need for targeted action (13). The analysis of this study indicates that India is making progress towards its target.
Prevention, promotion, and partnership are the three key principles of the NAPRE (2). Prevention aims to improve accessibility and affordability through the implementation of cost-effective public health measures for all individuals. Promotion plays a crucial role in the elimination process, involving advocacy, and educational awareness to enhance understanding of rabies, as highlighted in this study. Partnership involves coordinated support for anti-rabies efforts, engaging the community, urban and rural civil society, government, private sectors, and international partners (Table/Fig 8).
Limitation(s)
Since rabies is endemic throughout India, this study could have been conducted at multiple centres to enhance the understanding of compliance. The vaccination status of non compliant patients, including whether they received the vaccine from other medical centers or became defaulters, was not known.
The compliance rate in this study was found to be 73.1%, with major constraints for non compliance being forgotten dates, distance, travel, and timing. The results of this study emphasise the need to encourage animal bite patients not only to receive the vaccine but also to adhere to the full vaccination course and address the constraint factors. Political will, community participation, operational research, sustained funds for logistics, and intersectoral coordination are the five pillars of the NAPRE. With research as a major focus, this study was conducted with the aim of supporting and collaborating towards a rabies-free India by 2030. The study concludes that the compliance obtained enables further steps in a multisectoral approach to achieve a 100% compliance rate and eliminate the disease.
The authors express sincere gratitude for the opportunity and support provided by the Chief Medical Officer, Government Hospital, Gummidipoondi, Thiruvalllur, Tamil Nadu to undertake this study.
DOI: 10.7860/JCDR/2024/69941.19348
Date of Submission: Feb 05, 2024
Date of Peer Review: Feb 26, 2024
Date of Acceptance: Mar 26, 2024
Date of Publishing: May 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 06, 2024
• Manual Googling: Feb 22, 2024
• iThenticate Software: Mar 23, 2024 (9%)
ETYMOLOGY: Author Origin
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