Intra-dermal vaccination needs only one-fourth of the conventional dose

From a situation of perennial shortage, anti-rabies vaccine has now become one of the ‘slow-moving' drugs in hospitals' drug stores. There is enough anti-rabies vaccine stock to tide over the next three months in most hospitals, a situation hitherto unheard of, according to Health Department sources.

There is no change in the vaccine requirement though. At the General Hospital, on an average, over 150 persons come daily for anit-rabies vaccination. The difference was brought in by a new vaccine regimen. The Intra-Dermal Rabies Vaccination (IDRV) has brought down the quantity of vaccine required for each vaccination dose by one-fourth, making it possible for the authorities to treat more people, doctors point out. Thiruvananthapuram district has the largest number of IDRV clinics, which are currently functioning at the Community Medicine Department at Medical College Hospital, General Hospital, Nedumangad, Chirayinkeezh and Neyyattinkara taluk hospitals and Vellarada community health centre. The recently upgraded Parassala taluk hospital will become the seventh centre in the district with IDRV facility. The IDRV clinic here will be inaugurated on April 16.

Free for all

“Each district now has at least one IDRV clinic and one health centre with facility for administering the rabies immunoglobulin or the anti-rabies serum. The full course of the vaccination, if administered through the IDRV regimen, is free. So, we want to open more IDRV centres in government hospitals and train more doctors in the regimen,” a senior Health official said.

In government hospitals, where the intra-muscular (IM) regimen is still being followed, only the first dose is free. Because of the high cost of the vaccine, many people do not complete the rabies vaccination course, which could be dangerous. The full course when taken by the IM route would be about five 1-ml vials, with the cost coming to Rs.2,000. But in IDRV, the total dosage required for full protection is only about 0.8 ml, which is less than one vial.

The total cost reduction for IDRV, when compared to IM is 68 per cent, according to a recent study done in the Community Medicine Department of Kozhikode Medical College.

Annual spending

The government is spending around Rs.36 crore annually on purchasing rabies vaccine and this could be brought down substantially if a total shift to IDRV regimen is made.

However, the government does not intend to fully do way with the IM regimen since in certain medical situations only that system will work.

Injected into skin

The IDRV regimen gives a better immune response than the IM regimen as the vaccine is injected into the skin, directly affecting the rabies antigens in the blood.

Finding

According to an immuno surveillance study done at NIMHANS, Bangalore, using serum samples of 115 persons who had been administered anti-rabies vaccine via the IDRV route, its efficacy was found to be very high, conferring an immune status which is 14 times higher than the required level to the bite- victim.

Doctors said that as per a government directive, IDRV may be started in all health centres where at least five persons come daily for anti-rabies vaccination.

The IDRV clinics are supposed to be open on Sundays and other holidays too.