Rabies vaccine stockpile: fixing the supply chain.

Abstract

World Day is 28 September, 2016, (1) and is designed to raise awareness about the prevention and control of this neglected disease. Almost all human rabies are transmitted by domestic dog bites or scratches, usually via saliva. virus replicates in the wound site and gains access to nerves to reach the central nervous system. The incubation period varies from five days to several years. By the time of clinical onset, the virus is widely disseminated throughout the central nervous system and the infection is invariably fatal. Prevention of human rabies and control of canine rabies have been successful in north America, western Europe and a number of Asian and Latin American countries through vaccination of dogs, responsible dog ownership, enforcement of leash laws, and provision of life-saving bite treatment. Pre-exposure immunization is strongly recommended for people in high-risk occupations such as laboratory workers dealing with live rabies virus, vaccinators and people involved in any activity that might bring them professionally or otherwise into direct contact with bats, carnivores and other mammals in rabies-affected areas. 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 Control (GARC) have committed to eliminating rabies deaths in humans by 2030. (2) As Margaret Chan, WHO's Director-General, said: Rabies belongs in the history books. (6) As for many neglected diseases, data are suboptimal. An estimated 59 000 (3,4) people die from rabies every year, despite the existence of effective vaccines. Around 90% of these deaths occur among children living in rural areas in Africa and Asia,5 almost all as a consequence of dog bites. (6) The world has many competing disease-control priorities, and rabies has fallen off the global health agenda. control requires two complementary interventions. Mass dog vaccination programmes are needed to break dog-to-human transmission and people who are exposed to rabies need prompt and effective treatment. Such treatment includes wound care, immunoglobulin and vaccination. WHO, with its partners and stakeholders, are quantifying the resources required to implement these programmes on a scale sufficient to end human rabies deaths. WHO's current rabies vaccine position paper states that four to five courses of the vaccine must be given with rabies immunoglobulin to all people who have sustained bites that perforate the skin. Immunoglobulins provide passive immunity until the vaccine has stimulated the immune system. However, rabies immunoglobulins are expensive. One vial is about 39 United States dollars, and two or more vials are usually needed. (8) Immunoglobulins have to be maintained at 2-8[degrees]C, and are difficult to procure in most countries. Because it is a biological product, rabies immunoglobulin is not covered by WHO's prequalification procedures. Currently four vaccines are pre-qualified by WHO. …