গতকাল ২৮ সেপ্টেম্বর ছিল বিশ্ব জলাতংক দিবস। সে উপলক্ষে একটি অতি গুরুত্বপূর্ন বিষয় নিয়ে আলোকপাত করা হচ্ছে।
বিড়ালের অতি সামান্য কামড়/আচড়ে ভ্যাক্সিন দিব কিনা?
প্রায়শই এই ব্যাপারটি নিয়ে অনেককে স্ট্যাটাস দিতে দেখি। অনেকেই ডিসিশন নিতে পারেন না যে কি করবেন। আবার চিকিৎসক হিসেবে আমাদেরকেও আত্নীয়-স্বজনদের মাঝে পরামর্শ দিতে হয়। ভ্যাক্সিন কি আসলেই নিতে হবে নাকি হবে না, না নিলে আবার মনের মধ্যে খুতখুতি থেকে যায়, পরে যদি কিছু হয়।
একটি পরিসংখ্যান দিয়ে শুরু করি। বাংলাদেশে প্রধানত বে-ওয়ারিশ কুকুরের মাধ্যমে ৯১% এবং গৃহপালিত বিড়ালের মাধ্যমে মাত্র ৫% জলাতংক রোগ ছড়ায়। কিন্তু তবুও কুকুরের চেয়ে বিড়ালের কামড়/আচড় বেশি বিপদজনক হতে পারে। এর কারন হল, কুকুরের কামড়ে হয় blunt wound যা widely exposed but superficial হয় সাধারণত (তবে deep woundও হয়, তখন সেটা WHO category-III তে পড়বে)। আর বিড়ালের কামড় বা আচড় হল sharp cutting wound, confined to a tiny space but deeply penetrated like injection syringe (বিড়ালের দাঁত ও নখর সূচের ন্যয় চোখা ও ধাঁরালো)। So কুকুরের কামড়ের স্থানে ক্ষারযুক্ত সাবান/ডিটারজেন্ট দিয়ে ঘষে ধুয়ে ফেললে saliva containing rabis virus এর glycoprotein আবরন নষ্ট/ধ্বংস হয়ে যায়। chance of viral infection is near to zero. কিন্তু বিড়ালের কামড়/আচড় দ্বারা ক্ষতস্থান বা wound-এ saliva প্রবেশ করে নাই এটা কেউ surely বলতে পারবে না।
তাহলে বিড়ালের কামড়/আচড় নিয়ে এত চিন্তা কেন করব?
বিড়ালের দাঁত/নখ দিয়ে কামড়/আচড়ে sharp but deeply penetrated wound হওয়ার কারনেঃ
১.আক্রান্ত স্থানে সাবান দিয়ে পরিষ্কার করলেও wound-র গভীর থেকে saliva remove হওয়ার সম্ভাবনা কম। নখের সাথেও saliva লেগে থাকতে পারে, আচড়ে যদি সামান্য রক্ত যদি বের হয় তাহলেই vessel injury & then inflammation, সামান্য ফুলে যাবে, ব্যাথার তীব্রতাও খুব অল্প হবে।
২.যদি saliva তে র্যাবিসের জীবানু থাকে (বিড়াল র্যাবিসে আক্রান্ত হলে) তাহলে সহজেই তা wound-র saliva থেকে blood stream or mucosa তে গিয়ে transmit হবে। কারণ penetration যত deep, blood vessel তত nearer to wound।
এখন কথা হল, বিড়ালটি র্যাবিস আক্রান্ত ছিল কিনা তা কিভাবে বুঝব?
এক্ষেত্রে ৮-১০দিন পর্যন্ত বিড়ালকে অবজারভেশনে রাখতে হবে। যদি বিড়াল মারা যায়, তাহলে ভ্যাক্সিন না দিয়ে থাকলে অবশ্যই যত দ্রুত সম্ভব ভ্যাক্সিন শুরু দিতে হবে আক্রান্ত ব্যক্তিকে। আর যদি মারা না যায় তাহলে বুঝা যাবে বিড়ালটি র্যাবিস আক্রান্ত ছিল না। চিন্তার অবসান হবে।
কিন্তু সমস্যা হল, বিড়ালের গলায় ঘন্টা বাঁধবে কে?
যে বিড়ালটি কামড়/আচড় দিল সেটিকে কে ই বা খুজে বেড়াবে, আর কিভাবেই বা অবজারভেশনে রাখা যাবে যদি না পাওয়া যায়।
কাজেই, অতি দ্রুত ভ্যাক্সিন শুরু করে দেয়াটাই উত্তম (as post-exposure prophylaxis)। কারন শেষ কথা একটাই, আল্লাহ না করুক, ভ্যাক্সিন না দেয়ার ফলে, ব্যাখ্যাতীত কোন কারণে যদি র্যাবিসে একবার আক্রান্ত হয়ে যায় তাহলে এর সুরাহা আর নেই এবং এর ফলাফল হল ‘মৃত্যু’ যার Probability/P-value=1.
বি.দ্রঃ আসলে এই লেখাতে কোন ডোজ/শিডিউল/ডিউরেশান/কজোলজি/মেকানিজম এগুলো একাডেমিক ভাবে উল্লেখ নেই। লেখাটির মাধ্যমে একজন চিকিৎসক হিসেবে যে অভিমত এবং সবার মাঝে সচেতনতা বৃদ্ধির লক্ষ্যেই লিখা। এর বাইরে অনেকেই অনেক বেশি জ্ঞান রাখেন এ বিষয়ে, এর বিপরীতেও অনেক যুক্তি আসতে পারে এটা মেনে নিয়েই লিখা।
বোনাস তথ্যঃ র্যাবিস একটি zoonotic disease তার মানে এটা animal to human ট্রান্সমিশন হবে। But human-to-human transmission through bites is theoretically possible but has never been confirmed yet.
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লিখেছেনঃ
ডা. তৌহিদ ইসলাম
রংপুর মেডিকেল কলেজ।
Case fatality rate is 100%, so vaccine is must.
Post er Link: https://www.facebook.com/groups/platform.bd/permalink/966748890131237/
এখানে Writer এর নামঃ
Dr. Tauhid Hasan
RpMC (2007-08)
Amar bashar posha biral amar abbur paye achor diye kete felsa 3 mash ageo dicilo tokhon vaccine niyechilo kinto kotha holo akhon ki abar vaccine nity hobe?ar Jodi vaccine na ney tahole ki kono shomoshsha hobe?
sir amer leg er upor Diya biral দৌড়েগেছে
কিন্তু আমার পা দিয়ে রক্ত বের হয় নাই
uporibhaga Foska porasa choto foska
Ami ki vacksin dabo sir 01717668139 it’s my con.. Num…
Sir, আমার ভাইকে ৩ সপ্তাহ আগে বিড়াল আঁচড় দিয়েছে, ভেকসিন নেয়া হয় নি। বিড়ালটি মারা যায়নি (৮-১০ দিন observation করার কথা বলা হয়েছে post এ)। এখন করনীয় কী? জানালে উপকৃত হতাম।
Sir, আমার ভাইকে ৩ সপ্তাহ আগে বিড়াল আঁচড় দিয়েছে, ভেকসিন নেয়া হয় নি। বিড়ালটি মারা যায়নি (৮-১০ দিন observation করার কথা বলা হয়েছে post এ)। এখন করনীয় কী?
বিড়াল চাটলে কি ভ্যাক্সিন নিতে হবে?
আমার ৫ বছর বয়েসে কুকুরে কামড় দিলে তখন ভেক্সিন দিয়েছিলাম, এখন আমার বয়স ১৮ এখন আবার বিড়ালে হাচড় দিয়েছে, তো এবারও ভেক্সিন দিচ্ছি, তবে এটা কি ঠিক হচ্ছে?
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