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DR. K. N. RAO MEMORIAL ORATION
Year : 2012  |  Volume : 56  |  Issue : 3  |  Page : 187-188  

From guidelines to ground reality: Maximizing the benefits of IDRV in the fourth year of its implementation


Professor, Department of Community Medicine, Government Medical College, Thiruvananthapuram & Nodal Officer, IDRV Kerala, India

Date of Web Publication3-Dec-2012

Correspondence Address:
Thomas Mathew
Professer, Department of Community Medicine, Government Medical College, Thiruvananthapuram & Nodal Officer, IDRV Kerala
India
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DOI: 10.4103/0019-557X.104207

PMID: 23229209

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   Abstract 

The updated Thai Red Cross Intradermal (TRC-ID) regimen is the most effective strategy for India as it uses only 40% volume of vaccines in comparison with intramuscular (IM) when 0.5 ml vial is used and 20% when 1-ml vial is used; hence, the cost-effectiveness of intradermal (ID) regimen further increases when 1 ml vial is used. To improve the compliance of ID, postexposure prophylaxis (PEP) given free of cost is the ideal solution. For availability and avoiding administrative delays, universal ID delivery of PEP is the answer. ID is safe, effective, and well tolerated. Technique of ID can be learned easily. Universal ID with 1 ml is the ethical solution, which is easy to administer and monitor, economical, effective, and imparts early immunity (Five E's).


How to cite this article:
Mathew T. From guidelines to ground reality: Maximizing the benefits of IDRV in the fourth year of its implementation. Indian J Public Health 2012;56:187-8

How to cite this URL:
Mathew T. From guidelines to ground reality: Maximizing the benefits of IDRV in the fourth year of its implementation. Indian J Public Health [serial online] 2012 [cited 2014 Apr 23];56:187-8. Available from: http://www.ijph.in/text.asp?2012/56/3/187/104207


   Background Top


Rabies is a deadly viral infection that is mainly spread by infected animals. Even in the 21 st century, rabies remains incurable. Legislation and implementation regarding dog population control through sterilization are not practiced adequately. In this situation, human pre-exposure and postexposure prophylaxis together with vaccination of domestic animals and wildlife animals are currently the most efficient interventions [Table 1]. In Kerala, like in any other parts of the country, the high cost of cell culture vaccines administered intramuscularly was the major limiting factor in the fight against the disease. Alhough the use of ID route for tissue culture antirabies vaccine was approved by Government of India in 2006, its implementation is yet to gain momentum.
Table 1: Pattern of animal bites cases attending Anti Rabies Clinics in Kerala from March 2009 to January 2012

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   Implementation Process Top


Intradermal rabies vaccination (IDRV) has become a reality in Kerala due to the synergistic support from the Department of Health, Government of Kerala, by providing administrative support and academic inputs from dedicated members of Association for Prevention and Control of Rabies in India (APCRI), which showed the commitment of the Association toward the achievements of its organizational goals. The success of this program in Kerala can be attributed to the broad base ownership built for IDRV in Government Medical Colleges and also in the district health services. [1] Kerala experience shows that to translate policy to practice, it requires the backup of technical, administrative, political, and scientific advocacy [Figure 1]a and b. In India, IDRV has been implemented in 15 states so far, Jammu and Kashmir, Delhi, Rajasthan, Gujarat, Jharkhand, Uttar Pradesh, Madhya Pradesh, Tripura, West Bengal, Odisha, Andhra Pradesh, Maharashtra, Karnataka, Tamil Nadu, and Kerala.
Figure1: (a and b) IDRV Centers in Kerala March 2009 to December 2011

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   Unique Features of IDRV Implementation in Kerala Top


  • Implementation through the Government system facilitated by

    • Strong political will
    • Administrative and logistic support from Directorate of Health Services (DHS), National Rural Health Mission (NRHM), and Kerala Medical Services Corporation Ltd. (KMSCL)
    • Artistic innovations by Hindustan Latex Family Planning Promotion Trust (HLFPPT)
    • Academic inputs from Community Medicine Departments of five Government Medical Colleges in Kerala.
  • Systematic implementation
    • National workshop for developing guidelines [2] (20 th -21 st September 2008)
    • Training of Trainers Workshop (ToT) at Institute of Preventive Medicine (IPM), Hyderabad (15 th -18 th December 2008)
    • Hands on training since February 2009
    • Inauguration of 1 st model IDRV clinic on 27 th February 2009 at General Hospital, Trivandrum (TVM)
    • Visit by Dr. F.X. Meslin, Team Leader, World Health Organization (WHO), Geneva (18 th -21 th November 2009).
  • Government orders for implementation
    • Implementation of IDRV in Kerala→GO (MS) No. 557/2008/H&FW dated 31 st October 2008
    • IDRV free of cost for all (APL/BPL) as per the GO (Rt) No. 3357/2009/H&FWD dated 18 th November 2009.
To improve the compliance of ID, PEP given free of cost is the ideal solution. For availability and avoiding administrative delays, universal ID delivery of PEP is the answer. [3] Realizing the significance of implementing IDRV in the state, the Government has decided to provide IDRV free of cost to all, irrespective of their APL, and BPL status. As on 31 st December 2011, there are 288 centers providing this service in this state, and the government is planning to scale it up to all hospitals in the state, which caters to more than five bite victims per day. From March 2009 to January 2012, more than one and a half lakh patients have received IDRV in Kerala.

 
   References Top

1.Philip S. Model anti rabies clinic - A resource centre for rabies control. APCRICON 2010, July, 3 rd . p. 29-31.  Back to cited text no. 1
    
2.Department of Health and Family Welfare Govt. of Kerala. Operational guidelines for rabies prophylaxis - Intra dermal rabies vaccination and RIGs administration in Kerala. 5 th edition. 2010.  Back to cited text no. 2
    
3.Hampson K, Cleaveland S, Briggs D. Evaluation of cost-effective strategies for rabies post-exposure vaccination in low-income countries. PLoS Negl Trop Dis 2011;5:e982.  Back to cited text no. 3
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    Figures

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