Success Story of a Low Cost Intra-Dermal Rabies Vaccination (IDRV) Clinic-Lessons Learnt over Five Years of 12,000 Patient Vaccinations “Without Failure” at DDU Hospital Shimla, Himachal Pradesh, India <br/>—“Saving a Drop of Rabies Vaccine and Immunoglobulins” 12 Innovations to Make Himachal Pradesh Rabies Free State by 2020

Abstract

Background: Rabies is a dreaded disease and an estimated 55,000 people die of rabies every year. Himachal Pradesh is in the North bordering China and is predominantly rural and hilly. Villages are near forests, where wild reservoirs of rabies exist. Since health facilities are not accessible easily, we need to innovate on existing schedules of rabies vaccination keeping in view the compliance of the patients and affordability so as to give them the best possible option of treatment. In the year 2006 and 2007, we, at DDU Hospital Shimla, experienced a severe shortage of rabies vaccine and patients were running from pillar to post to fetch rabies vaccine. At the same time, we

Rabies vaccine and immunoglobulin supply and logistics: Challenges and opportunities for rabies elimination in Kenya

“…Adoption of the ID route requires advocacy to overcome challenges of inertia to use of new methods and off-label use of ID administration before the vaccine manufacturers have updated vial labels. Introduction of animal bite centers could pool bite patients in a region, and integrated bite case management could aid in judicious and appropriate administration of PEP, by confirming rabid dogs and identifying healthy dogs where PEP is not required [ 23 – 25 ]. The second opportunity comes with introduction of universal health coverage (UHC).…”

One Health for Dog-mediated Rabies Elimination in Asia

“…One specific region suffering from frequent supply shortages of rabies biologicals was Himachal Pradesh, a northern state in India situated in the Western Himalayas. This mountainous state is predominantly rural, and the extreme landscape complicates the ability of some citizens to seek medical care (Bharti et al, 2015). Patients in Himachal Pradesh would be required to search multiple hospitals and clinics, running 'from pillar to post' to find a facility that stocked rabies biologicals.…”

“…Patients in Himachal Pradesh would be required to search multiple hospitals and clinics, running 'from pillar to post' to find a facility that stocked rabies biologicals. The state also suffered from poor compliance with the PEP regimen among lower-income patients who could not afford these life-saving biologicals nor return to the clinic on subsequent days to complete the rabies vaccine series (Bharti et al, 2015). In addition, a lack of government funding to cover the cost of PEP for low-income patients further hindered the state's ability to stock clinics with rabies PEP biologicals, making it unavailable to even those that could afford it.…”

“…With only a finite supply that could not meet demand, the Deen Dayal Upadhyaya (DDU) Hospital in Shimla (the capital of Himachal Pradesh) recognized the need for unconventional clinical interventions to ensure all persons exposed to rabies could receive adequate postexposure treatment, without compromising patient safety or rabies PEP efficacy. After extensive literature reviews and advocacy sessions, in August 2008, the first low-cost ID rabies vaccination clinic, named Anti-Rabies Clinic and Research Centre (ARCRC), opened at DDU Hospital Shimla, amid a rabies vaccine shortage (Bharti et al, 2015). Since 2008, ARCRC has saved countless human lives and substantial costs by opening over 90 ID rabies vaccine clinics (called 'pooling centres') in the state.…”

Spontaneous Rabies in a Stray Bitch after Parturition Induced Immunosuppression <br/>—Investigating an Impending Outbreak of Rabies with One Health Approach

“…The new rabies virus strain found in Israel, V7, can both serve as reservoir in Dogs and dogs can transmit rabies as well [15]. We tested the brains samples of six animals in Shimla municipality and to our surprise all stray dogs, a pup and some wild animals were found to be positive for rabies virus [16] though none of them appeared to have died due to rabies. This underlines the endemicity of rabies virus in domestic as well wildlife in and around Shimla Municipality.…”