One health for dog-mediated rabies elimination in Asia: a collection of local experiences.

Chapter 7 (Page no: 74)

The 'Pooling Strategy' in Himachal Pradesh, India: an innovation for rabies post-exposure prophylaxis during crisis of shortage of life-saving biologicals.

Resource-limited clinics and countries often face ethical dilemmas when treating patients exposed to rabies during rabies vaccine and rabies immunoglobulin (RIG) shortages. This chapter discusses an innovative 'pooling strategy' that was developed during shortage crises of life-saving biologicals in Himachal Pradesh, India. Patients received a fraction of a rabies vaccine vial administered via the intradermal route. RIG was prioritized and only given to high-risk patients with severe exposures. RIG was only infiltrated into wounds to provide immediate virus neutralization, and the dosage was determined by the size and number of wounds (as opposed to systemic administration of RIG intramuscularly using a dosage calculated by patient body weight). Residual drops of vaccine and RIG were consolidated, or 'pooled', to the next vial for the next patient - preventing even a single drop of waste. To date, this protocol has been > 99.9% effective and has saved considerable costs, rabies biologicals and human lives.

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