WHO’s latest rabies recommendations and guidance save lives and reduce the cost of treatment

Abstract

Rabies vaccination is a crucial part of rabies post-exposure prophylaxis (PEP), but it tends to consist of long and costly regimens of intramuscular (IM) injections. Most human rabies deaths are caused by delayed access, unaffordability or ineffective delivery of PEP. Reducing these barriers is crucial to ensure that this incurable yet preventable disease does not cost lives. In 2022, WHO published new guidance towards the introduction or expansion of rabies vaccination into national immunization programmes to systematically drive down human rabies deaths effectively and cost-efficiently. Such guidance grounds on the latest scientific recommendation provided by WHO’s Strategic Advisory Group of Experts in 2018. WHO recommends a shortened 1-week rabies vaccination schedule, with visits on days 0, 3 and 7. On each visit, a 2-site intradermal (ID) injection (using only 0.1 ml of vaccine in each site) is administered. ID administration allows for vials to be shared among several patients within a 6-8 hours timeline. Compared to IM administration, ID is cost- and dose-sparing, even in low-throughput clinics. Additionally, this regimen requires only 3 visits to the healthcare facility, improving patient compliance. However, the uptake of this shortened ID regimen remains limited. It should now be a matter of urgency for Health Ministries in rabies-endemic settings to adopt the WHO-recommended shortened ID vaccination schedule and ensure appropriate medical training to improve PEP delivery. This will enable countries to improve PEP delivery and allow underserved populations to access affordable, life-saving rabies vaccines.

Dog ecology and rabies control including canine vaccination coverage: Impacts from a survey in Madagascar

“…This shows that many people are aware of the threat, but further education is needed so that vulnerable individuals understand the potential consequences of failing to receive PEP which can lead to delays or failure to seek treatment [ 31 ]. This may improve immediate wound management at the individual level, however the WHO has just recently urged for Health Ministries to improve healthcare service delivery and enabling underserved population to access rabies vaccines [ 2 ]. As medical and healthcare resources are generally limited and the weak health system is a major challenge in Madagascar, improvement of existing infrastructures and expansion of the healthcare system including integrated health services, particularly in remote settings, can be a significant gamechanger for disease prevention in the future.…”

“…Rabies is present on all continents except Antarctica, and it is considered endemic in every country in Africa [ 1 , 2 ]. Rabies virus (RABV ; species Lyssavirus rabies) is causing one of the oldest zoonotic diseases known to mankind, leading to fatal encephalomyelitis in animals and humans.…”

“…Rabies virus (RABV ; species Lyssavirus rabies) is causing one of the oldest zoonotic diseases known to mankind, leading to fatal encephalomyelitis in animals and humans. Despite safe and effective vaccines available for use in humans and animals, dog-mediated rabies continues to represent a serious global health threat causing 99 percent of human rabies deaths [ 2 , 3 ]. About 80% of people at risk reside in poor rural areas of Africa and Asia.…”

“…Domestic dogs are Madagascar’s most prevalent RABV reservoir, therefore it makes sense to target dog-mediated rabies as the most promising and cost-effective way to lessen disease burden and preventing human rabies deaths [ 2 ]. This relies on a stable, canine population that is healthy and immunized, as well as case management and monitoring of dog bites linked to public awareness and animal disease surveillance [ 2 ].…”

“…Domestic dogs are Madagascar’s most prevalent RABV reservoir, therefore it makes sense to target dog-mediated rabies as the most promising and cost-effective way to lessen disease burden and preventing human rabies deaths [ 2 ]. This relies on a stable, canine population that is healthy and immunized, as well as case management and monitoring of dog bites linked to public awareness and animal disease surveillance [ 2 ]. However, with no sustainable national rabies disease prevention and control strategy currently implemented, the Malagasy government heavily relies on indiscriminate dog culling and strychnine poisoning [ 12 ].…”