Rabies, 1996

Abstract

A majority of the 50,000 annual human rabies deaths worldwide occur in canine endemic regions with a large stray dog population. Control of the disease is hampered by cultural and economic realities. The high cost of imported modern tissue culture vaccines is the main reason why dangerous neural tissue derived products are still being used throughout the developing world. Several studies have shown that reduced-dose intradermal postexposure vaccine regimens are safe, effective, and economical. Their use has been approved by the Rabies Committee of the World Health Organization. Recent well-studied rabies vaccine treatment failures have demonstrated that rabies immune globulins are essential biological products that save lives. There is now a critical worldwide shortage of human and purified equine rabies immune globulins. Oral vaccination of stray dogs in developing countries appears promising but has not yet been studied on a large scale. Recent studies have provided better understanding of pitfalls in postexposure management and the handling of special problems that are not uncommon in countries where canine rabies is endemic. This essay endeavors to present the current rabies problem from the vantage point of an infectious diseases consultant practicing in a rabies endemic region of Asia.