10 Vaccines can be given Intradermally to spare costs as well as doses

Omesh, Thank you. It is very informative. Nagaraj

Dear Dr Bharti, Thank you for your continued interest and obvious support for intradermal (ID) delivery of vaccines. We would agree that this route of delivery for vaccines has the potential to offer many benefits in terms of delivery of reduced doses (and costs), increased vaccine availability, use of needle free delivery devices etc. However, more work is needed and warranted in terms of clinical trials and cost-benefit analysis, to fully understand the extent of the benefits that might realistically be achieved with ID delivery. Although encouraging results have been obtained with ID delivery of 1/5 of the standard dose for several vaccines, most notably rabies and influenza, the number of clinical trials that have been performed is small and it is not yet certain that such a significant reduction in dose will be possible with all vaccines. For example, the recently licensed ID influenza vaccine (from Sanofi-Pasteur) is a 40% reduction in dose from the standard IM formulation. Less dramatic reductions in dose size might be more realistic. We are slightly concerned that you might have misunderstood part of our report on Intradermal Delivery of Vaccines that you cite. In the report the data available on ID delivery of ten different vaccines is reviewed. However, at this stage we cannot say whether all of these ten vaccines can, or should, be delivered intradermally; the database is still small and the results are not always conclusive. More research is needed to determine the degree of dose-sparing that might be achieved with these and other vaccines, and to establish what other changes might be needed to support this (reformulation of vaccines, use of novel delivery devices, use of novel adjuvants, etc). These are all areas of active research in academia and industry and ID delivery of vaccines is an area that PATH and WHO are currently involved. Respectfully, Darin Zehrung PATH

Dear Darin, The efficacy of ID antirabies vaccine is not only proved beyond doubt but million of doses have been given including more than 24,000 doses in my clinic alone. I just wanted to draw the attention of the academia towards doing more efforts to find cheaper alternatives to costly vaccines to make them affordable including making vaccines available through ID route. Thanks and regards, Dr. Omesh BhartiM.B.B.S.,D.H.M.,M.A.E.(Epidemiology) Directorate of Health Safety and Regulation,Himachal Pradesh+91-9418120302 [[email protected]][email protected][/email]; [email protected]

There is no doubt about the efficacy and advantage of ID Rabies vaccine. Omesh has tried to furnish with others in the list. He has taken lot of personal efforts collecting them. The only problem is the usage can be done by those covering large populations since you can not keep the opened vial for longer period. Here we have to link with other methods of preserving the potency the vaccine which would help centres where few doses are given. It is better to refer the cases for vaccine to bigger centres rather than wasting resources at smaller centres wherever it is possible. Nagaraj

Thanks Dr. Nagraj, Actually in Thailand they are keeping the opened antirabies vaccine vials for a week at 4 degree celcius but nobody including WHO is promoting this method of preserving the vaccine, so we not only need new initiatives to bring down the costs of the vaccines but encourage those initiatives that promise so.When Thailand developed the intradermal technique of antirabies vaccination, it took around 13 years by WHO to recommend its use, I wish that this time period should be reduced to a minimum possible, in case new H1N1 vacines comes into picture to be given intradermally, so as to save costs, increase availability and save lives in the face of limited availability of the H1N1 vaccine. Harverson G, Post-exposure intradermal antirabies vaccine: a cheaper alternative for developing countries, Trop Doct. 1984 Apr;14(2):67-70. regards, Dr. Omesh BhartiM.B.B.S.,D.H.M.,M.A.E.(Epidemiology) Directorate of Health Safety and Regulation,Himachal Pradesh+91-9418120302 [[email protected]][email protected][/email]; [email protected]