The World Health Organisation (WHO) has issued revised guidelines on rabies prophylaxis by incorporating a low-cost treatment protocol recommended by a Himachal Pradesh government doctor for dog-bite patients.

The Technical Report Series (1012) released on April 20, based on WHO's Expert Consultation, referenced two papers based on practical research by field epidemiologist Omesh Kumar Bharti on the dose and use of rabies immunoglobulins in such patients. The 195-page report on rabies prevention recommends that apart from anti-rabies vaccination, insertion of rabies immunoglobulins in dog-bite wounds only is effective, a protocol established by Bharti.

"While intra-dermal vaccine's doses have been reduced to three from four in the latest guidelines (based on research in Cambodia and Tanzania), the WHO has recommended injection of rabies immunoglobulins now only in dog-bite wounds," said Bharti, posted at the Intra-Dermal Anti-Rabies Clinic and Research Centre of the Deen Dayal Upadhyay Hospital here. He said the treatment cost for a dog-bite patient will resultantly be roughly Rs 350 ($5.50) only from existing Rs 35,000 ($545).

As per the WHO's 2010 guidelines, now replaced by the 2018 guidelines, any dog- or monkey-bite patient was administered vaccine intradermally, along with injection of rabies immunoglobulins in wound(s) and also intramuscularly. As per the earlier protocol, rabies immunoglobulins to be injected were calculated on the basis of body weight of a patient, which was a costly option. The new WHO guidelines no longer recommend intramuscular administration of rabies immunoglobulins.

Bharti's undertook the research initiative in 2014 when he saw a few deaths due to scant availability of rabies immunoglobulins in the market in the hill state. "The low-dose protocol, backed by existing literature, has helped increase availability of rabies immunoglobulins for dog-bite patients in hospitals," he said. He said that he undertook the research with technical support from late S.N. Madhusudana, the then head of WHO Collaborative Rabies Research Centre at the National Institute of Mental Health and Neurosciences, Bengaluru, and Henry Wilde, a noted rabies researcher and WHO consultant in Thailand.