As the demand for Intravenous immunoglobulin (IVIG) needed for treating post COVID-19 Multisystem Inflammatory Syndrome in Children (MIS-C) has been high during the pandemic, experts now suggest that it would be advisable for the government to stock up for the third wave.
IVIG is a therapy treatment for patients with antibody deficiencies. It is prepared from a pool of immunoglobulins (antibodies) from the plasma of thousands of healthy donors and helps the patient fight infections. While it was in use even during the pre-COVID-19 days, the demand has gone up during the pandemic, especially in the second wave when doctors saw many children with MIS-C.
Epidemiologist and public health specialist Sunil Kumar D.R., who heads the Department of Community Medicine at Akash Institute of Medical Sciences, said IVIG treatment proved extremely crucial during the second wave when a lot of children developed MIS-C. “Children develop MIS-C two to six weeks post COVID-19. Symptoms include fever, vomiting, diarrhoea, abdominal pain and rashes,” he said.
“As children with MIS-C are extremely sick, any shortage can prove to be fatal and hence, while the second wave is subsiding it is advisable that the government stock IVIG for the third wave,” said Dr. Kumar, who is also part of the BBMP’s death audit committee.
Drop in donations
Sagar Bhattad, Consultant, Paediatric Immunology and Rheumatology at Aster CMI Hospital, said as immunoglobulin is a biological product derived from the plasma of healthy donors it is a challenge to produce it in a short span of time.
“Plasma donations have come down during the pandemic and due to this production has also gone down. However, the demand is high. The government should collaborate with manufacturers now and also explore importing stocks. While rational use should be promoted, steps should be taken to prevent hoarding,” he said.
“Although steroids are another option, we prefer a combination of steroids and IVIG if the disease severity is high. Trials are underway in the West, to compare IVIG versus steroids,” he said.
Judicious use
Chandrika S Bhat, Consultant, Paediatric Rheumatology Services, Rainbow Children’s Hospital said as the production of immunoglobulins is a long process, it would be advisable for doctors to use IVIG judiciously.
Supraja Chandrashekhar, Consultant Paediatrician and Paediatric Intensivist at Columbia Asia Hospitals ( a unit of Manipal Hospitals), Yeshwanthpur, said the demand for IVIG has shot up in the last one year. “We have seen and treated over 35 cases at our hospital,” she said.
“IVIG is expensive and a 10 gram vial costs over ₹ 15,000. The dosage depends on the weight of the child (2 gms per kg is the recommended dose). As a lot of adolescents weighing over 50 kgs also develop MIS-C, capping dose of 100 gms is recommended,” she added.
Tenders floated
State Health Commissioner K.V. Trilok Chandra said the government has started the process to procure 10,000 doses of IVIG at a cost of over ₹10 crore.
“We have already floated tenders and are hoping the procurement process will be completed by next month. The stocks will be supplied in batches and will be used in all government hospitals where MIS-C cases are reported,” the Commissioner told The Hindu on Friday.
