New Indian protocol sharply cuts cost of treating animal bites

Costly treatment of dog and monkey bites can be sharply brought down by an eight-fold reduction in the quantity of immunoglobulin used and paring the vaccine dose five-fold, according to a new protocol devised by four Indian researchers that has been carried in a leading international journal.

"The treatment of bites by rabid animal involves a lot of expenditure the world over, ranging from Rs.2,700 ($40) to Rs.31,500 ($475) that includes vaccination and life-saving rabies immunoglobulin. We have brought it down to a few hundred rupees (Rs.650 or $10 through innovative techniques," lead researcher Omesh Kumar Bharti, who is based here, told IANS.

"It took seven years to conceptualise and execute the research methodology," added Bharti, a field epidemiologist with the Himachal Pradesh government.

The study, titled 'Local infiltration of rabies immunoglobulins without systemic intramuscular administration: An alternative cost effective approach for passive immunization against rabies', has been published in the online edition of the journal "Human Vaccines and Immunotherapeutics" on August 28 by PubMed, a worldwide archive of life science journals.

In sum, while 363 vials of rabies would have been required to treat 269 category III patients - who were part of the survey - as per WHO recommendation based on body weight, the new method required only 42 vials of five ml. (A category-III wound involves the oozing of blood after a bite.)

The study was conducted at the Deen Dayal Upadhyay Hospital here. The other members of the research team were S.N. Madhusudana, head of the WHO Collaborating Centre for Reference and Research on Rabies at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru, Pyare Lal Gaunta, the former medical superintendent of Deen Dayal Upadhyay Hospital here, and A.Y. Belludi, also from NIMHANS.

"While poor patients were earlier unable to afford the costly life-saving immunoglobulin, the non-availability of the medicine in the market had left even the rich patients helpless and prone to risk of dreaded death due to rabies," Bharti said.

The authors shared that as per WHO protocol. the immunoglobulin should be injected as much as possible in the wound and whatever is left should be administered intra-muscularly.

"We took the cue from the WHO protocol and limited the use of immunoglobulin to only within the wound because of shortage of immunoglobulin," Bharti explained.

The minimum dose of immunoglobulin given to a patient during the study was 0.25ml and the maximum was 8 ml.

Immunoglobulin is a live product that immediately neutralises virus till vaccination induces active immunity against the rabies virus.

On an average 1.26 ml of immunoglobulin is required per patient that costs only Rs.150 ($2.27) and proved life-saving and cost-effective.

"All the patients during the study were followed for nine months and they were healthy and normal at the end of observation period. With local infiltration, that required small quantities of immunoglobulin, it could be made available to all patients in times of short supply in the market," the study says.

The new technique was introduced after a thorough study of available scientific evidences worldwide and verification of blood samples from NIMHANS.

Bharti felt that this preliminary study would become the base for further studies that may ultimately help the WHO revise its guidelines on animal bite prophylaxis.

Bharti had earlier worked on the implementation of a low-cost intra-dermal anti-rabies vaccination technique. His experience on the innovative pooling technique was appreciated at a WHO conference in Geneva in 2010.

(Vishal Gulati can be contacted at vishal.g@ians.in)