SHIMLA: The revised guidelines of World Health Organisation ( WHO ) on rabies prophylaxis have incorporated a ‘low-cost treatment protocol’ proposed by a government doctor from Himachal Pradesh for dog-bite patients.Released on Friday, WHO’s technical report series (1012) has referenced two papers on practical research by field epidemiologist Dr Omesh Kumar Bharti on “dose and cost sparing” use of rabies immunoglobulins (RIG) in dog-bite patients. The 195-page technical report series for rabies prevention across the globe recommends that apart from anti-rabies vaccination, the infiltration of RIG in wound only is effective, a protocol established by Dr Bharti at Deen Dayal Upadhayaya Hospital.As per earlier WHO guidelines in 2010, now replaced by 2018 guidelines, any dog/monkey-bite patient was administered vaccine intradermally and along with this, the RIG was injected in wound and remaining in muscle, intramuscularly (IM). The RIG was calculated on body weight (of patient)) basis, which was a costly option.The WHO guidelines 2018, however, no longer recommend intra-muscular administration of RIG at a distance from the wound. “While they have cut intra-dermal vaccine doses from four to three in latest guidelines (based on research done in Cambodia and Tanzania), the WHO has recommended injecting RIG only in wounds in dog-bite patients now,” said Dr Bharti.He said the cost of treatment for dog-bite patients would now be drastically cut from Rs 35,000 to about Rs 350 per patient.Dr Bharti took to this life-saving research initiative in 2014, when he saw some deaths due to scant availability of RIG in the market in the hill state. “The low-dose protocol, which was backed by existing literature, increased the availability of RIG for dog-bite patients in the hospital. With support from hospital authorities and the state health high-ups, we have now been giving vaccine and RIG free of cost to all patients,” he said.

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