Feasibility of sustainable provision of intradermal post exposure prophylaxis against rabies at primary care level –evidence from rural Haryana

BMC Health Services Research

Chandrakant S Pandav¹  Shashi Kant¹  Sanjay K Rai¹  Rizwan SA¹  Sanjeev Kumar²  Harshal Salve¹ 

[1] Centre for Community Medicine, Old OT Block, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India;Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhopal, India

关键词: India;    Rural;    Primary care;    Rabies;    Intra-dermal PEP;   

Others  :  1130669
DOI  :  10.1186/1472-6963-14-278

 received in 2013-10-14, accepted in 2014-06-16,  发布年份 2014

【 摘 要 】

Background

Rabies is the most severe and neglected public health problem in India. Management of animal bite with post exposure prophylaxis is the only existent strategy to prevent rabies related deaths. Cost-effective and sustainable programme for provision of post exposure prophylaxis (PEP) is needed in India.

Methods

In this study, we have documented the experience of implementation of intra-dermal anti rabies vaccination in Animal Bite Management (ABM) clinic at Primary Health Centre (PHC). This study facility belonged to Comprehensive Rural Health Services Project, Ballabgarh in Faridabad district of Haryana. Hospital service record of ABM clinic was analyzed and various feasibility issues such as costing of services, vaccine wastage and other operational issues in providing PEP services at PHC level were documented.

Results

A total of 619 patients were treated in the ABM clinic. Service utilization of ABM clinic was increased by 38% in the second year of implementation. Mean age of the patients was 23.9 years (SD: 18.8) and majority (70.4%) were males. Majority (86%) of the patients received the first dose of anti-rabies vaccine within the recommended 48 hours. A total 446 vaccine vials (1 ml) were consumed of which 20.8% was contributed in vaccine wastage. User-fee (350 Indian Rupees) collected from the patients. User-fee was re-used to purchase vaccines, intradermal (ID) syringes and other consumables required to ensure regular availability of ARV services at the PHC.

Conclusions

This study demonstrated the cost-effective and sustainable model of provision of PEP against rabies at primary care level. ID PEP provision at primary care level not only address the unmet need of animal bite management in the community also reduces the out of pocket expenditure of the patients.

【 授权许可】

   
2014 Salve et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Tomasiewicz K, Fota-Markowska H, Krzowska-Firych J, Krawczuk G: Post-exposure anti-rabies prophylaxis in Lublin province (eastern poland) in 2004-2005. Ann Agric Environ Med 2006, 13:337-340.
• [2]Sudarshan MK, Mahendra BJ, Madhusudana SN, Ashwoath Narayana DH, Rahman A, Rao NS, X-Meslin F, Lobo D, Ravikumar K, Gangaboraiah : An epidemiological study of animal bites in India: results of a WHO sponsored national multi-centric rabies survey. J Commun Dis 2006, 38(1):32-39.
• [3]Franka R, Wu XF, Jackson FR, Velasco-Villa A, Palmer DP, Henderson H, Hayat W, Green DB, Blanton JD, Greenberg L, Rupprecht CE: Rabies virus pathogenesis in relationship to intervention with inactivated and attenuated rabies vaccines. Vaccine 2009, 27:7149-7155.
• [4]World Health Organization: Recommendations for rabies post-exposure prophylaxis. 2010. Available (updated version -2013) at http://www.who.int/rabies/PEP_Prophylaxis_guideline_15_11_2013.pdf webcite [Accessed on October 14, 2013]
• [5]Knobel DL, Cleaveland S, Coleman PG, Fevre EM, Meltzer MI, Miranda ME, Shaw A, Zinsstag J, Meslin FX: Re-evaluating the burden of rabies in Africa and Asia. Bull World Health Organ 2005, 83:360-368.
• [6]Muller T, Dietzschold B, Ertl H, Fooks AR, Freuling C, Fehlner-Gardiner C, Kliemt J, Meslin FX, Franka R, Rupprecht CE, Tordo N, Wanderler AI, Kieny MP: Development of a mouse monoclonal antibody cocktail for post-exposure rabies prophylaxis in humans. PLoS Negl Trop Dis 2009, 3:e542.
• [7]Ly S, Buchy P, Heng NY, Ong S, Chhor N, Bourhy H, Vong S: Rabies Situation in Cambodia. PLoS Negl Trop Dis 2009, 3:e511. doi:510.1371/journal.pntd.0000511
• [8]The Asian Rabies Expert Bureau Preventing the incurable: Asian rabies experts advocate rabies control. Vaccine 2006, 24:3045-3049.
• [9]Hampson K, Dobson A, Kaare M, Dushoff J, Magoto M, Sindoya E, Cleaveland S: Rabies exposures, post-exposure prophylaxis and deaths in a region of endemic canine rabies. PLoS Negl Trop Dis 2008, 2:e339.
• [10]Post exposure treatment and correct technique of intra-dermal immunization against rabies Geneva: World health organization; 1997. Available at http://whqlibdoc.who.int/hq/1996/WHO_EMC_ZOO_96.6.pdf webcite [Accessed on September 21, 2013]
• [11]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(3):e982. doi:10.1371/journal.pntd.0000982
• [12]National Guidelines for Rabies Prophylaxis and Intra-dermal Administration of Cell Culture Rabies Vaccines NICD 2007. Available at http://www.ncdc.gov.in/Rabies_Guidelines.pdf webcite [Accessed on September 21, 2013]
• [13]National Rural Health Mission: Implementation Guidelines New Delhi: Ministry of Health and Family Welfare, Government of India. 2005. Available at http://nrhm.gov.in/ webcite [Accessed on 21 September 21, 2013]
• [14]Kant S, Misra P, Gupta S, Goswami K, Krishnan A, Nongkynrih B, Rai SK, Srivastava R, Pandav CS: Cohort Profile: The Ballabgarh Health and Demographic Surveillance System (CRHSP-AIIMS). Int J Epidemiol 2013. doi:10.1093/ije/dyt055 [Epub ahead of print]
• [15]Kulkarni PS, Raut SK, Jadhav SS, Kapre SV, Deuskar N: Immunogenicity of two modern tissue culture rabies vaccines in pre-exposure prophylaxis. Hum Vaccine 2007, 3(5):183-186.
• [16]Chhabra M, Icchpujani RL, Bhardwaj M, Tiwari KN, Panda RC, Lal S: Safety and immunogenicity of intradermal Thi Red Cross (2-2-2-0-1-1) post exposure vaccination regimen in the Indian population using Purified Chick Embryo Cell Rabies vaccine. Indian J Med Microbiol 2005, 23(1):24-28.
• [17]Madhusudana SN, Sanjay TV, Mahendra BJ, Sudarshan MK, Narayana DH, Giri A, Muhamuda K, Ravi V, Vakil HB, Malerczyk C: Comparison of safety and immunogenicity of purified chick embryo cell rabies vaccine (PCECV) and purified vero cell rabies vaccine (PVRV) using the Thai Red Cross intradermal regimen at a dose of 0.1 ML. Hum Vaccine 2006, 2:200-204.
• [18]Sekhri N, Savedoff W: Private health insurance: implications for developing countries. Bull World Health Organ 2005, 83:127-134.
• [19]Rasania SK, Bhalla S, Khandekar J, Pathi S, Matta S, Singh S: Post exposure management of animal bite cases attending a primary health centers of Delhi. J Commun Dis 2004, 36(3):195-198.
• [20]Shankar P, Arun Kumar A, Rajesh K: Panos Kanavos user-fee in health care: evidence of effect on service utilization & equity from north India. Indian J Med Res 2012, 136:868-876.