Vol. 11 No. 11 - June, 2009

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Medical students in India for rabies trial

Medical students in India for rabies trial
India is home to more than 25 million stray dogs, a significant factor in new rabies cases. While working in the King Edward Memorial Hospital in Mumbai, the students saw as many as 75 people a day with fresh bites from potentially rabid dogs or for followup visits after treatment for previous bites.

Every morning patients lined up early, waiting for the dog bite clinic to open at the King Edward Memorial Hospital in Mumbai, India. As many as 75 people a day, every day, presented with fresh bites from potentially rabid dogs or for follow-up visits after treatment for previous bites.

Into this mix traveled four University of Massachusetts Medical School students this spring on a new international elective that combined a clinical clerkship and a research module, with the students participating in the planning for a Phase 1 clinical trial of a monoclonal antibody (MAb) targeted at rabies.

“Every day we saw a steady stream of people, many with very significant injuries, deep punctures and gaping wounds,” said Victoria Martin, SOM ’10, who along with Heather Wiggin, SOM ’10, Elizabeth Patton, SOM ’09, and Mary Flynn, SOM ’09, spent four weeks in Mumbai. “The physicians working there have tremendous clinical diagnostic skills. They have to rely heavily on their clinical skills, so their knowledge base is huge.”

The new elective was sponsored by the UMMS Massachusetts Biologic Laboratories (MBL) and is part of an ongoing exchange program established by Avinash Patwardhan, MD, a former assistant professor of medicine at UMMS and head of pulmonary medicine at the Fallon Clinic; and Nilima Patwardhan, MD, professor of surgery at UMMS. The Patwardhans helped to forge an alliance between UMMS and the Seth Gordhandas Sunderdas Medical College at King Edward Memorial, where the husband and wife team studied and trained.

“Avi and Nilima have done wonderful work building the relationship between the two medical schools and raising money to support our students who go to Mumbai for clinical electives,” said Michael A. Godkin, PhD, professor of family medicine & community health and medicine, who coordinates the international programs at UMMS. “Traveling abroad is a valuable cultural experience and a great opportunity to see how clinical medicine is practiced in places without the level of resources we have here.”

Rabies is not considered a significant health issue in the United States, yet more than 40,000 people are exposed to the disease each year here and require treatment. Worldwide, however, rabies remains a growing and deadly problem. The World Health Organization estimates that at least 10 million people are exposed to rabid animals each year, resulting in some 55,000 deaths.

The rabies virus causes acute encephalitis that is fatal once symptoms appear; however, the infection is preventable if patients are promptly treated with vaccine and human rabies immune globulin (hRIG). Unfortunately, hRIG is a scarce and expensive blood product and is often not available in developing countries. “In most cases, the patients we saw only got vaccine,” Martin said. “There wasn’t any immune globulin available.”

Vaccine alone can save lives, but it is not the optimal treatment. So the MBL partnered with the U.S. Centers for Disease Control and Prevention to develop a human MAb that could neutralize the rabies virus and substitute for hRIG. MBL then joined forces with the Serum Institute of India to produce the MAbs in India and begin human clinical trials.

“We expect the Phase 1 trial to begin this summer,” said Deborah C. Molrine, MD, MPH, associate professor of pediatrics and deputy director of clinical and regulatory affairs at MBL. “The students in this program not only saw the clinical side of rabies, they also learned about the components of conducting a clinical trial. They will continue to participate as the trial progresses, working with us here at MBL.”

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