Post-Exposure Prophylaxis for Animal Bites: A Low Cost Model for Enhancing Reach and Affordability of Biologicals in High Burden Countries

Abstract

BackgroundRabies is a preventable fatal zoonotic disease of considerably high burden in low and middle income countries of Asia and Africa. Bites from rabid animals are the cause of human rabies. WHO post-exposure prophylaxis (PEP) guidelines recommends taking both vaccine and rabies immunoglobulin for category-III bites. Strict adherence to complete recommended PEP guidelines is the single most important factor in preventing human deaths. Need to calculate the required dose / quantity of rabies immunoglobulin, a key biological, needed for adherence to WHO PEP guidelines leads to prohibitively high cost of PEP and one key reason for bite victims taking in-complete PEP. An alternate published method to inject bite sites only with rabies immunoglobulin to enhance affordability was evaluated for cost-reduction and affordability.Methods25 bite victims requiring rabies immunoglobulin according to category-III of WHO guidelines were part of the study. All the animal bite sites were injected with adequate quantity of rabies immunoglobulin’s to cover only the animal bite sites completely as per published alternate method. This is in contrast to WHO PEP guidelines where calculation of immunoglobulin is done as per body weight and, after injecting all the animal bite sites, the remaining quantity of immunoglobulin is injected intra-muscularly. All victims were vaccines by intra-muscular route only. There was diversity in the profile of the 25 victims in terms of age, sex, number of wounds and body weight. Analysis was done to determine the cost reduction due to reduced quantity of immunoglobulin required in following an alternate approach to the recommended WHO PEP regimen.ResultsCost of rabies immunoglobulin was reduced on an average between (50–70)% if the quantity used was enough to cover the wound sites comprehensively instead of the recommended quantity based on body weight. Follow-up was done for 9 months and none showed clinical signs and symptoms of rabies.ConclusionAn evaluation to check the extent of cost reduction that could make rabies immunoglobulin, a key PEP biological, more affordable was done. The significant cost reduction could be adapted for further studies so as to bring about changes in WHO PEP guidelines which would lead to more affordability for PEP and less deaths due to rabies.Disclosures All authors: No reported disclosures.