Abstract
Oral rabies vaccines (ORVs) have been in use to successfully control rabies in wildlife since 1978 across Europe and the USA. This review focuses on the potential and need for the use of ORVs in free-roaming dogs to control dog-transmitted rabies in India. Iterative work to improve ORVs over the past four decades has resulted in vaccines that have high safety profiles whilst generating a consistent protective immune response to the rabies virus. The available evidence for safety and efficacy of modern ORVs in dogs and the broad and outspoken support from prominent global public health institutions for their use provides confidence to national authorities considering their use in rabies-endemic regions. India is estimated to have the largest rabies burden of any country and, whilst considerable progress has been made to increase access to human rabies prophylaxis, examples of high-output mass dog vaccination campaigns to eliminate the virus at the source remain limited. Efficiently accessing a large proportion of the dog population through parenteral methods is a considerable challenge due to the large, evasive stray dog population in many settings. Existing parenteral approaches require large skilled dog-catching teams to reach these dogs, which present financial, operational and logistical limitations to achieve 70% dog vaccination coverage in urban settings in a short duration. ORV presents the potential to accelerate the development of approaches to eliminate rabies across large areas of the South Asia region. Here we review the use of ORVs in wildlife and dogs, with specific consideration of the India setting. We also present the results of a risk analysis for a hypothetical campaign using ORV for the vaccination of dogs in an Indian state.
Highlights
The ancient disease of rabies continues to spread unchecked in the free-roaming dog populations across much of the developing world
The development of global human health initiatives in the 1970s required assurance of consistent standards of vaccine quality, safety and efficacy, it was infeasible to seek licensure in every country of use [88]. This challenge was navigated through the development of the WHO vaccine prequalification programme in 1987, which evolved over several decades to provide international standards of vaccine safety and efficacy for use in national immunization programs [88]
Such mechanisms are yet to be developed for the veterinary vaccine sector, there is broad consensus on the need for international scrutiny of Oral rabies vaccines (ORVs) to make the required evidence readily accessible to national regulatory authorities for decisions of ORV implementation [11]
Summary
The ancient disease of rabies continues to spread unchecked in the free-roaming dog populations across much of the developing world. The issue of high CVR fixed operational costs can be somewhat offset by incorporating DDV as the primary method to efficiently vaccinate dogs readily available for restraint by hand, followed by CVR to access the inaccessible population [19,20]. This does not, Viruses 2022, 14, 155 overcome the major operational limitation of the need to manage a huge skilled workforce focused entirely on sustaining the annual vaccination of dog populations across vast geographic areas. Existing parenteral methods have been used for the systematic annual vaccination of hundreds of thousands of dogs where additional expertise and resources are available but would be infeasible across the larger states of India to control rabies
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