In an effort to ensure safe and efficient administration of rabies vaccine, the Union government has asked all government hospitals in the country to adopt the intra-dermal route for rabies vaccination in humans. The orders have been issued following the recommendations of the World Health Organisation (WHO). The intra-dermal concept is already in vogue in the West and South Asian countries.

There are several benefits if intra-dermal route is adopted. As only 0.1 ml is required for an injection under this route, it saves cost for patients. Besides, this method is painless, effective and scientifically proven. The injections are given on both sides of the arm alternatively and are done Days 0, 3, 7, 28 and 90. The intra-dermal mode has helped Thailand, Philippines and Sri Lanka to reduce cases from 1000 to 20 cases in a year.

Rabies vaccine in India is priced around Rs. 310 and patients spend Rs. 1,500 for the recommended five doses injected intra-muscularly.

The approvals for the intra-dermal mode were sought from the Drugs Controller General of India after the Indian Council of Medical Research (ICMR) provided the analysis of 500 human trial reports conducted by the National Institute of Mental Health and Neuro Sciences (NIMHANS), and Kempegowda Institute of Medical Sciences.

The trial proved to be a milestone as it provided the answer to economies of scale in rabies prevention. Now NIMHANS along with KIMS and Association of Prevention of Rabies in India (APRI) are gearing up for a national training programme for doctors and nurses to gather their experience in intra-dermal route which is different from intra-muscular procedure, Dr. SN Madhusudan, additional professor, department of Neurovirology and head, WHO Collaborating Centre for Reference and Research on Rabies told Pharmabiz.

Presently, only government hospitals in Uttar Pradesh have adopted the intra-dermal method. Other State governments including Karnataka are waiting for rabies injection companies to insert additional information on the injection methodology.

Rabies vaccine available in India are Vaxirab by Zydus Cadila, Rabipure from Novartis, Verorab from Sanofi Pasteur marketed by Ranbaxy, Human Deployed Cell Vaccine by Serum Institute, Human Biologicals' Abhayrab and Bharat Biotech's chromatographically purified vero cell vaccine, Rabirix. The total size of the rabies vaccine market is around Rs. 200 crore.
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In India, there are 17 million bites annually, out of which only 50 per cent has access to medical treatment and the remaining go unreported as they succumb after taking treatment from quacks or application of herbal drugs. There is a serious shortfall of rabies vaccine as only 5 million doses are sold each year.

Globally, there are 50,000 human rabies deaths annually and in India it is 20,000 cases. There are no records of animal deaths with rabies.

According to Dr. Madhusudan, only massive education and awareness across India could increase the usage of rabies vaccine. NIMHANS is also studying the possibility of making rabies injection practical by stopping the 90th day injection. "We are also undertaking the birth control study of dogs to assess the efficacy of process over the last five years on the request of the Bangalore Mahanagara Palike", he added.