Evaluation of Cost-Effective Strategies for Rabies Post-Exposure Vaccination in Low-Income Countries

Abstract

BackgroundPrompt post-exposure prophylaxis (PEP) is essential in preventing the fatal onset of disease in persons exposed to rabies. Unfortunately, life-saving rabies vaccines and biologicals are often neither accessible nor affordable, particularly to the poorest sectors of society who are most at risk and upon whom the largest burden of rabies falls. Increasing accessibility, reducing costs and preventing delays in delivery of PEP should therefore be prioritized.Methodology/Principal FindingsWe analyzed different PEP vaccination regimens and evaluated their relative costs and benefits to bite victims and healthcare providers. We found PEP vaccination to be an extremely cost-effective intervention (from $200 to less than $60/death averted). Switching from intramuscular (IM) administration of PEP to equally efficacious intradermal (ID) regimens was shown to result in significant savings in the volume of vaccine required to treat the same number of patients, which could mitigate vaccine shortages, and would dramatically reduce the costs of implementing PEP. We present financing mechanisms that would make PEP more affordable and accessible, could help subsidize the cost for those most in need, and could even support new and existing rabies control and prevention programs.Conclusions/SignificanceWe conclude that a universal switch to ID delivery would improve the affordability and accessibility of PEP for bite victims, leading to a likely reduction in human rabies deaths, as well as being economical for healthcare providers.

One Health approach to cost-effective rabies control in India

“…Second, Tamil Nadu has made a commitment to provide PEP for dog bite victims (11), and PEP is a remarkably efficient and life-saving intervention (35,36). Despite the availability of PEP in Tamil Nadu, human rabies deaths continue to occur in the state.…”

Comparison of safety and immunogenicity of 2 WHO prequalified rabies vaccines administered by one week, 4 site intra dermal regimen (4-4-4-0-0) in animal bite cases

“…5,7 The improved compliance and cost effectiveness of this regimen along with advantages and disadvantages of other PEP regimens is very well discussed by Hampson et.al. 19 This was a pioneering study on animal bite cases, where only adults between 18 to 55 years of age were enrolled as study subjects. The safety and immunogenicity of present study was compared with other studies conducted with WHO prequalified vaccines with Essen, updated TRC and one week, 4 site regimen ('Historical control') at Kempegowda Institute of Medical Sciences (KIMS), Bangalore, India and RVNA analyzed at WHO collaborating center for reference and research on Rabies, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.…”

Efficiency of live attenuated and inactivated rabies viruses in prophylactic and post exposure vaccination against the street virus strain

“…vaccination of humans as recommended by WHO. Its high price, however, does not allow its application to animals in developing countries (Kreindel et al, 1998;Hampson et al, 2011). Moreover, WHO did not approve the administration of immunoglobulin to animals (WHO, 2005).…”

“…However, producing large amounts of high titer vaccines would be a large economic burden in developing countries (Knobel et al, 2005;Hampson et al, 2011). Therefore, high efficacy and cheap rabies vaccines are still an urgent need in those areas.…”