WHO new rabies treatment norms has new strategy based on Indian R&D

Nearly four years of research by a government doctor in Himachal Pradesh had contributed to a crucial shift in the World Health Organisation's new treatment guidelines for rabies that kills nearly 20,000 Indians each year.

Two documents released by the global health agency last Friday, carry references to the work undertaken by Omesh Kumar Bharti in DDU Zonal Hospital in Shimla. The findings provide key inputs to the new treatment strategy.

The story behind the change began in 2014, when there was a critical shortage of a medicine known as rabies immune globulin (RIG) in the hill state.

Conventionally, RIG is injected near the rabies wound and in the body as an intramuscular shot on the first day of the animal bite.

RIG is administered besides the standard vaccine.

The globulin helps the body fight the killer disease till anti-rabies vaccine takes over and generate antibody against the virus.

It stops the virus from entering the nerves to prevent disease progression till the time the anti-rabies vaccine starts working.

Because of the scarcity of RIG those days, Bharti decided to inject the available medicines only at the wound.

The medicine in his stock was the cheaper RIG derived from horses (human RIGs are more expensive) that was made at the Central Research Institute, Kasauli.

The RIG left after injecting in the wound of one patient, was to be shared with next rabies exposed patient within the same or next day.

Bharti tried this emergency treatment protocol on 269 patients.

With encouraging results, he subsequently followed up with a number of such patients for the research for which he collaborated with S N Madhusudana from National Institute of Mental Health and Neuro Sciences and Henry Wilde from Chulalongkom University at Bangkok.

"We found injecting the RIG at the wounds is sufficient. There is no need to give an intra-muscular shot away from the wounds. This would bring down the treatment cost as only few drops are required to be injected at the wound," Bharti told DH.

The findings were reported in two papers published in 2016 and 2017.

WHO now says, "RIG infiltration into and around the wound, promptly after exposure," is one of the means for an effective anti-rabies treatment.

"What's more encouraging is the fact that if the RIG is to be applied only at the wound, there wouldn’t be much clinical difference in applying the expensive human RIG and the cheap equine RIG. Given intramuscular, equine RIG can trigger adverse side effects, whose chances are less if it is injected only in and around the wounds," he said.