Since 2008, Himachal Pradesh has used a "pooling strategy" to help patients save money by pooling vials of anti-rabies vaccine at a centralized hospital and sharing them using the intradermal technique.
It was Omesh Bharti, epidemiologist at the Himachal Pradesh State Institute of Health & Family Welfare, whose rabies immunisation treatment protocol has been notified as the global standard by WHO.
In 2014, there was an acute shortage of rabies immunoglobulins (RIG) and two patients died after four injections of rabies vaccine were administered without RIG, which was not commercially available.
After an extensive literature review and technical and ethical committee clearances, in June 2014 Himachal started to infiltrate equine RIG (eRIG) into wound/s only without the recommended systemic intramuscular injection.
During the four-year period June 2014 to June 2018, 7506 of 10,830 patients exposed to suspected rabid animals were injected with eRIG in and around the wounds in a single clinic at DDU Hospital Shimla without any adverse outcomes.
The average volume of eRIG used per patient was 0.75 mL and cost US$ 0.75. Of the 80% of patients who were followed up, all were healthy at the end of a year, including 26 patients bitten by laboratory-confirmed rabid dogs. The reaction rate after PEP administration also declined significantly.
After an extensive literature review and technical and ethical committee clearances, in June 2014 Himachal started to infiltrate equine RIG (eRIG) into wound/s only without the recommended systemic intramuscular injection.
During the four-year period June 2014 to June 2018, 7506 of 10,830 patients exposed to suspected rabid animals were injected with eRIG in and around the wounds in a single clinic at DDU Hospital Shimla without any adverse outcomes.
The average volume of eRIG used per patient was 0.75 mL and cost US$ 0.75. Of the 80% of patients who were followed up, all were healthy at the end of a year, including 26 patients bitten by laboratory-confirmed rabid dogs. The reaction rate after PEP administration also declined significantly.
Since February 2018, Himachal has started following the new WHO recommendations on PEP regimens of three intradermal antirabies vaccines instead of four, thereby saving hundreds of vaccine vials that became useful during shortages of rabies vaccine in India. To date, more than 700 vaccine vials have been saved in a single clinic at DDU hospital during the past 6 months alone.
Currently, 90 "pooling centers" have been established for sharing of vaccine and eRIG vials in Himachal State, generating huge savings that have enabled the government to provide PEP free of charge.
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