Download: Operational Guidelines for Rabies Prophylaxis – Intra Dermal Rabies Vaccination and Rigs Administration in Kerala

As part of IDRV Kerala 2010, a state level Training of Trainers (ToT) was conducted to provide hands on training on RIGs administration on 25^th and 26^th January 2010 at the Anti rabies Clinic of General Hospital, Thiruvananthapuram. There were 75 participants including Medical officers and Staff nurses from 14 district hospitals, Regional PEID cell coordinators, Medical officers and Health inspectors of Anti Rabies Clinic of 5 Govt. Medical Colleges. The training was led by Dr.G.Sampath, Deputy Civil Surgeon, IPM, Hyderabad & President, APCRI and Dr.D.H.Ashwath Narayana, Asso.Prof, Community Medicine, KIMS, Bangalore. The World Health Organisation (WHO) protocols for administering RIGs were explained to the audience. Patients who came to the Anti rabies clinic were given RIGs and the process of administration was demonstrated to the whole participants through Close Circuit Television (CCTV).

The afternoon session was organized in KGMOA hall where the participants had discussion with the trainers on administration of IDRV. Dr.M.K.Jeevan, Director of Health Services and Dr.V.Geetha, Director of Medical Education graced the valedictory function held at KGMOA hall, Thiruvananthapuram. Dr.V.Geetha handed over the momentos to Dr.G.Sampath, Dr.D.H.Ashwath Narayana, Dr.Preetha,ARC General Hospital and Mr.Sathpathy,Bharat Serums and Biologicals.

On the second day the participants were given opportunity to administer RIGs to Cat III patients at ARC, General Hospital.

Workshop on Developing Guidelines for the Implementation of IDRV in Kerala

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Operational Guidelines for Rabies Prophylaxis and Intra-Dermal Rabies Vaccination in Kerala (pdf)

Rabies is a major public health issue in many parts of the world causing an estimated 55,000 deaths every year.  India suffers a casualty of about 22,000 deaths per year due to rabies and in Kerala Rabies claims about 30-40 lives per year.

Timely and appropriate post exposure prophylaxis can prevent deaths in this one hundred percent fatal disease.  Approximately 3 million people receive post exposure prophylaxis in India.  Nervous Tissue Vaccine (NTV) has been replaced by more safe and effective Cell Culture Vaccines (CCVs) in India since December 2004.  WHO estimates that a full course of Post Exposure Prophylaxis (PEP) requires 31 days of wages for an Asian citizen thereby making it unaffordable to many.  Intradermal post exposure regimen has been approved by WHO as early as in 1992 and has now undergone extensive evaluations in India. It is found to be equally effective and at the same time cost effective (60-70% cost reduction). This regimen has been approved by the Govt. of India in 2006.  NICD, Delhi has formulated and published guidelines for intradermal vaccination for Govt. of India and is already being implemented in states like Uttar Pradesh, Orissa, Andhra Pradesh, Karnataka, West Bengal, Tamilnadu and Himachal Pradesh.

As a part of celebrating World Rabies Day 2008, a workshop on developing guidelines for IDRV (Intra Dermal Rabies Vaccine) in Kerala was held at Thiruvananthapuram on 20^th and 21^st September 2008 at Hotel Taj Residency, Thiruvananthapuram.

Dr. Thomas Mathew, Prof & HOD, Community Medicine, T. D. Medical College, Alappuzha and Nodal Officer, State Disease Control & Monitoring Cell took up the initiative and officiated as the organizing secretary. The workshop was inaugurated by Smt P.K Sreemathy teacher, Honble Minister for Health & Family Welfare. Sri C.Jayan Babu, Worshipful Mayor of Thiruvananthapuram Corporation, Dr Vishwas Mehta IAS, Dr Dinesh Arora IAS, Dr K. Shylaja, DHS, Dr V. Geetha, DME and Dr Alex Franklin, IMA were the other dignitaries who were present for the inauguration. The workshop was enriched by the presence of experts of International and National repute from within and outside the state. Faculties from 8 states, who had already implemented the IDRV regimen in their states, shared their experiences in the workshop.  The workshop was attended by key stakeholders from all over the state. There were representatives from Health Services Department, Medical Education Department and also Service Unions in Health Services. More than 320 delegates attended the workshop on 20^th September during which the faculty shared their experiences regarding IDRV implementation in their states. The workshop on 20^th was followed by a core group meeting on 21^st during which the National Guidelines put forward by NICD in 2007 was discussed in detail and was adopted to suit Kerala scenario. The core group had the presence of nearly 50 experts from within and outside the state.

There were 3 post workshop core group meetings as a result of which the draft guidelines for implementation of IDRV and draft operational guidelines were prepared. It was decided to implement IDRV in a planned phase in the state with the support of Kerala Medical Services Corporation Ltd (KMSCL). As the first step IDRV will be implemented in the Anti Rabies Clinics attached to the 5 Govt. Medical Colleges in the state and also General Hospital, Thiruvananthapuram. It is also planned to impart training to the stakeholders at three levels- National level training from Hyderabad, State level training and District level training.

At present Kerala is following the IM regimen for Anti rabies vaccination and only the bite victims belonging to BPL category are given the costly IM treatment free of cost that too subject to availability. With the adoption of ID regimen we will be able to cater to almost five times the patient load with the present quantity of vaccine. This will surely help in improving the acceptability of the more cost effective IDRV regimen thereby increasing the accessibility of the common man for treatment against this deadly disease. The workshop IDRVKERALA 2008 is believed to be the first step in the direction of a crucial policy change by Govt. of Kerala.