Abstract
Asian countries bear the greatest burden of the disease, with a majority (59%) of rabies-related deaths occurring in Asia. In order to promote best practices, we summarized national human vaccination guidelines across this region, to highlight differences and similarities and to discuss the aspects that would benefit from updates. National management guidelines for rabies were retrieved from various sources to extract information on rabies pre- and post-exposure prophylaxis (PrEP, and PEP), booster vaccination, and route of administration. Rabies guidelines recommendations for wound management and PrEP across Asia are broadly aligned to the World Health Organization (WHO) guidelines. For PEP, the 5-dose Essen, and the 4-dose Zagreb are the regimens of choice for intramuscular (IM), and the Thai Red Cross regimen for intradermal (ID), administration. Several national guidelines have yet to endorse ID vaccine administration. Most guidelines recommend rabies immunoglobulin in category III exposures. Booster recommendations are not included in all guidelines, with limited clarity on booster requirement across the spectrum of risk of rabies exposure. In conclusion, national recommendations across Asian countries differ and while some guidelines are closely aligned to the WHO recommendations, resource-saving ID administration and use of rational abbreviated schedules have yet to be endorsed.
Highlights
Despite being entirely preventable, human rabies is estimated to cause 59,000 global deaths annually, of which 59% occur in the Asia region [1,2]
The death toll can be considerably reduced through access to post-exposure prophylaxis (PEP), consisting of wound cleaning, rabies immunoglobulin (RIG) and vaccination
National guidelines are not expected to be necessarily published in scientific journals, this work did rely mostly on information provided by Ministry of Health websites, by national experts, etc
Summary
Human rabies is estimated to cause 59,000 global deaths annually, of which 59% occur in the Asia region [1,2]. Human and canine rabies control are interdependent, and experience has shown that a collaboration between human and animal health sectors is required to enhance cost-effectiveness of rabies control measures, and effectively reduce rabies incidence and associated societal burden [6,7,8]. This approach, under the “One Health” framework, with the goal to eliminate dog-mediated rabies by 2030, is endorsed and jointly advocated by the World Health Organization (WHO), the World Organisation for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO), and the Global Alliance for Rabies Control (GARC) [5]
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