It was following the relentless efforts of Omesh Kumar Bharti, an epidemiologist, that the World Health Organization changed the guidelines for application of rabies immunoglobulins (RIG) on wounds in 2018.
His studies challenged the norms for intramuscular injection in rabies treatment that had made the vaccine and RIG inaccessible to the common man. Dr. Bharti was awarded Padmashree this year.
It was after a few rabies deaths in 2014 that the Himachal Pradesh government asked Dr. Bharti to look into the matter. His crusade for making intradermal application of the vaccine accessible to all under a country-wide vaccine-pooling technique had made the authorities take note of him.
ADVERTISEMENT
The WHO has now recommended that the RIG be given as per the weight of the person to impede rabies in violent or deep bites. “While rabies vaccine was given, no doctor used to give immunoglobulins, because of the high cost. In 2014, almost no immunoglobulin was available in the country,” he added.
Rabies virus enters the brain and so, intravenous injections are supposed to be effective in controlling the virus. “I came across a paper that said the drug will be effective if given on the wound. I followed it up after getting a few vials from the Central Research Institute, Kasuli, omitting the WHO recommendation of additional RIG to be given as intramuscular injection. No death was reported.”
This procedure required 10 times less RIG and brought down the cost considerably. Dr. Bharti said the hurdle to get the study published was a big task. However, when it was published, the WHO intervened to make his paper accessible to all.
ADVERTISEMENT
He was asked to provide more data.
Help came from S.N. Madhusoodan from NIMHANS for laboratory and technical support and a friend in the JP University of Biotechnology gave him ethical clearance for the study that was carried out with equine RIG as human RIG was not available.
From June 2014 to June 2018, 7,506 of 10,830 patients exposed to suspected rabid animals were injected with eRIG in and around the wounds in a clinic at Deen Dayal Upadhyay Hospital, Shimla, without any adverse outcomes. 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.
“I was put to most rigorous tests as it was unacceptable to challenge the prevailing norms. It was to overcome the inherent institutional and hierarchical bias that I got a PG in applied epidemiology”.