A Shorter Post-exposure Prophylaxis Regimen for Rabies, Pakistan

Overview

Journal Bull World Health Organ

Specialty Public Health

Date 2021 Jul 12

PMID 34248223

Citations 1

Authors

Naseem Salahuddin

Nadia Ansari

Muhammad Aftab Gohar

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the cost and effectiveness of the two-site, 1-week, intradermal rabies post-exposure prophylaxis regimen recommended by the World Health Organization (WHO) in 2018.

Methods: We compared the number of rabies vaccine and rabies immunoglobulin ampoules consumed at The Indus Hospital in Karachi, Pakistan and their cost before and after implementing WHO's 2018 recommendations. In 2017, patients with suspected rabies-infected bites were treated using the two-site, 4-week, Thai Red Cross regimen, which involved administering four rabies vaccine doses intradermally over 4 weeks and infiltrating immunoglobulin into serious wounds, with the remainder injected into a distant muscle. In 2018, patients received three vaccine doses intradermally over 1 week, with a calculated amount of immunoglobulin infiltrated into wounds only. Remaining immunoglobulin was saved for other patients. The survival of patients bitten by apparently rabid dogs was used as a surrogate for effectiveness.

Findings: Despite treating 8.5% more patients in 2018 (5370 patients) than 2017 (4948 patients), 140 fewer ampoules of rabies vaccine and 436 fewer ampoules of rabies immunoglobulin were used, at a cost saving of 4202 United States dollars. Of 56 patients bitten by apparently rabid dogs, 50 were alive at 6-month follow-up. The remaining six patients could not be contacted but did not present to any hospital with rabies.

Conclusion: The new regimen was more economical than the two-site, 4-week regimen and was equally effective. This regimen is recommended for preventing rabies in countries where the disease is endemic and rabies vaccine and immunoglobulin are in short supply.

Citing Articles

Rabies post-exposure prophylaxis delivery to ensure treatment efficacy and increase compliance.

Nadal D, Bote K, Masthi R, Narayana A, Ross Y, Wallace R IJID One Health. 2023; 1:100006.

PMID: 38152594 PMC: 10752235. DOI: 10.1016/j.ijidoh.2023.100006.

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