Abstract
Prompt provision of post-exposure-prophylaxis (PEP) including vaccines and rabies immunoglobulin (RIG) to persons bitten by suspect rabid dogs is a key strategy to eliminating human deaths from dog-mediated rabies in Kenya by 2030. We assessed the availability, forecasting and supply chain logistics for rabies PEP in Kenya, compared with the system used for vaccines in the expanded program of immunization (routine vaccines). Semi-structured questionnaires capturing data on forecasting, procurement, distribution, cold chain and storage, monitoring and reporting for routine vaccines and rabies vaccines and RIG were administered to 35 key personnel at the national, county, sub-county and health facility levels in five counties. Results showed large variability in PEP availability (stockouts ranged from 3 to 36 weeks per year) with counties implementing rabies elimination activities having shorter stockouts. PEP is administered intramuscularly using the 5-dose Essen regimen (day 0, 3, 7, 14 and 28). PEP costs to bite patients were reported to range from 10 to 15 US dollars per dose; RIG was seldom available. A less robust supply and logistics infrastructure is used for rabies PEP compared to routine vaccines. Forecasting and monitoring mechanisms for rabies PEP was poor in the study counties. The supply of vaccines from the national to the sub-national level is mainly through two government agencies and a private agency. Since government decentralization, the National Vaccine and Immunization Program has remained as the main supplier of the routine vaccines, playing a lesser role in the supply of rabies biologicals. Adoption of the dose-saving intradermal route for PEP administration, reduction of PEP costs to patients, and placing rabies vaccines within the routine vaccines supply and logistics system would significantly improve PEP availability and accessibility to persons at risk of rabies; a critical step to achieving elimination of human deaths from rabies.
Highlights
The global target for the elimination of dog-mediated human rabies supported by the World Health Organization and partners has been set for 2030 [1]
A total of 35 interview surveys were completed with four respondents drawn from Kenya Medical Supplies Agency (KEMSA), National Vaccine and Immunization program (NVIP) and Mission for Essential Drugs and Supplies (MEDS) at the national level, 23 respondents at the county and sub-county levels and 8 health care workers at the health facilities
The supply of routine and non-routine vaccines in Kenya is by three main institutions: NVIP, KEMSA and MEDS
Summary
The global target for the elimination of dog-mediated human rabies supported by the World Health Organization and partners has been set for 2030 [1]. The feasibility of this goal, including in Africa and Asia where most of the estimated 59,000 annual human rabies deaths occur, is supported by the existence of potent.
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