The Jakarta Post, 30 November 2010
Sixty volunteers took part in the first-ever experiment on intradermal rabies vaccinations (IDRVs) Monday as part of local scientists’ medical experiments to find ways of combating life-threatening rabies effectively — in terms of technical methods and financing.
Twin sisters Mira Pratiwi and Maya Pramita, medical students at Udayana University, were among the 60 volunteers, who comprised nurses, doctors, paramedics and workers at medical laboratories.The two sisters underwent different delivery methods for the rabies vaccination.Mira was given her vaccination with the IDRV method, while her sister Maya had the conventional intramoluscular method.
“Involving these twin sisters is crucial in this medical experiment because we can comprehensively study the impact of the two vaccination delivery methods on people with similar genes. It is the first IDRV injection in Indonesia,” explained AA Raka Sudewi, medical professor at Udayana University and head of researchers.In addition to Mira and Maya, 19 other volunteers also received IDRV vaccinations, 19 got intermolecular vaccinations and the remaining 20 volunteers were given placebos and will also be closely monitored by the team.
IDRV is a deposition of approved modern rabies vaccine (or antigen) in the layers of the dermis. Subsequently, the antigen is carried by antigen presenting cells via the lymphatic drainage to the regional lymph nodes and later to the reticulo-endothelial system, eliciting a prompt and highly protective antibody response.According to WHO, intradermal immunization using cell-culture-based rabies vaccines is an acceptable alternative to standard intramuscular administration.
The intradermal vaccination, first implemented in Thailand in 1984, has been shown to be as safe and immunogenic as the intramuscular vaccination, yet requires less vaccine, for both pre- and post-exposure prophylaxis, leading to lower direct costs. This alternative should thus be considered in settings constrained by cost and supply issues.Bali is among the 24 affected provinces in Indonesia with the highest mortality rate of 109 people since the outbreak of the rabies epidemic in November 2007.
“Using this method, Bali will save 50 percent of the medical costs. To date, Bali has spent Rp 38.5 billion on the procurement of rabies vaccines for humans and animals and still faces shortages in vaccines and funds,” she said.By using the IDRV method, a doctor injects only 0.8 milliliters of vaccine into the layer of the skin, while the intramoluscular method requires at least 2 milliliters of the rabies vaccine.
The experiment, jointly conducted by researchers from Udayana University, Molecular Biology Laboratory and Sanglah General Hospital, is funded by the Li Ka Sing Foundation and University of Oxford’s Global Health Program for a two-year period.