Anti-rabies vaccine in short supply

Due to a dispute between the leading manufacturers of anti-rabies vaccine in the country - Novartis and Aventis Pharma - the supply of anti-rabies vaccine has drastically come down in the last two months.

D A Gundurao, president of Karnataka State Pharmacy Council, revealed that due to scarcity of the vaccines, Rabipur and Verorub, which occupy the major market share in the segment, only 40 per cent of the demand is being met. However, he pointed out that the government had sufficient stock.

“Rabipur, which was manufactured by Novartis and marketed by Aventis, has been the brand leader in anti-rabies vaccine for over 30 years. However, Aventis came out with Verorub, another anti-rabies vaccine. As a result, Novartis cancelled the contract with Novartis," he said. The supply of both the vaccines has now been stopped. The matter is awaiting decision in the Supreme Court.

The Rabies Immunoglobulin (RIG), an anti-rabies serum, to be administered along with the anti-rabies vaccine in severe or Category III cases, is not available in any of the government hospitals in the city, except the Kempegowda Institute of Medical Sciences ( KIMS).

While Bowring and Lady Curzon Hospital did not keep RIG because they did not receive many Category III cases, K C General Hospital did not stock up RIG as they were expensive. Dr Rajanna, Resident Medical Officer of Bowring and Lady Curzon Hospital, said, "We rarely get Category III cases. Last year we referred only two severe cases and one case this year."

Dr Kantharaj, Resident Medical Officer, Victoria Hospital, said, "We have demanded the government to supply us with Rabies Immunoglobulin. However nothing has happened. Whatever the government supplies us, we will give that to people bitten by dogs."
However, Gundurao said that although there was enough stock of RIG with chemists and druggists in the City, the demand was poor. "RIG is available in plenty but few people ask for it," he said.

Incidentally, BBMP hospitals administer anti-rabies vaccine along with RIG free of cost. "We have sufficient amount of anti-rabies vaccines and RIGs. In fact, Government doctors are sending patients to us," said BBMP Chief Health Officer Dr Gayathri L T.
 
Why RIG?
Rabies is 100 per cent fatal. Hence, it is better to administer the anti-rabies vaccine as soon as possible after the dog bite. However, mere vaccination is not enough for people whose wounds come under Category III - single or multiple transdermal bites or scratches, in other words, bites that have penetrated the skin.

Dr D H Ashwath Narayana, secretary general, Association for Prevention and Control of Rabies in India (APCRI), pointed out that it took two weeks for the anti-rabies vaccine to become effective. "To cover this window period of two weeks, RIG is to be administered along with the vaccine. As the RIG is injected directly all wound areas, the effect is immediate," he said, adding that 90 per cent of the dog bite cases in the country fell in Category III.

However, the problem lied in lack of awareness amongst public and doctors. "RIG is not a scare product. However, people don't know about it. Even doctors don't administer it along with the vaccine because it is time-consuming," he said.
Meanwhile, APCRI has been conducting training programmes for doctors.