1
|
John D, Royal A, Bharti O. Burden of illness of dog-mediated rabies in India: A systematic review. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
2
|
Dhillon J, Hoopes J, Epp T. Scoping decades of dog evidence: a scoping review of dog bite-related sequelae. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:364-375. [PMID: 30378009 PMCID: PMC6964408 DOI: 10.17269/s41997-018-0145-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/05/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES There has been considerable literature published focusing on various sequelae to dog bites over the last three decades. Much of the literature has focused on rabies, particularly canine rabies variant, which accounts for the majority of rabies deaths worldwide. This paper describes the complications, the pathogens, and other sequelae resulting from dog bites documented in the literature. METHODS This paper used evidence found through a scoping review which charted the published peer-reviewed and non-peer-reviewed gray literature and online information relating to dog bite incidents. Each complication or sequela was additionally assessed from the viewpoint of Canadian Indigenous, rural, and geographically remote communities, which experience a high number of dog bite incidents annually. SYNTHESIS Peer-reviewed literature (N = 693; case report, original research, and review articles) provided detailed information on specific pathogens, infections, and diseases of interest, especially rabies. However, in addition to these, the sequelae from dog bites may include moderate to severe injuries that further result in anxiety around dogs or post-traumatic stress disorder (PTSD). CONCLUSIONS While a lot of focus in the literature is on rabies as a sequela to dog bites, the impacts of anxiety and PTSD are not as well articulated. Treatment of dog bite injuries may be standardized; however, improved collaborations between diverse health professionals (physicians, veterinarians, counseling services, animal behaviourists, and others) could be of considerable benefit in decreasing the effects of dog bites.
Collapse
Affiliation(s)
- Jasmine Dhillon
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada
- Animal Health Science Directorate, Canadian Food Inspection Agency, 1400 Merivale Rd, Ottawa, ON, K1A 0Y9, Canada
| | | | - Tasha Epp
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada.
| |
Collapse
|
3
|
Guo C, Li Y, Huai Y, Rao CY, Lai S, Mu D, Yin W, Yu H, Nie S. Exposure history, post-exposure prophylaxis use, and clinical characteristics of human rabies cases in China, 2006-2012. Sci Rep 2018; 8:17188. [PMID: 30464190 PMCID: PMC6249250 DOI: 10.1038/s41598-018-35158-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022] Open
Abstract
Rabies is still a public health threat in China. Evaluating the exposure history, clinical characteristics, and post-exposure prophylaxis (PEP) of the cases could help in identifying approaches to reducing the number of these preventable deaths. We analysed data collected from 10,971 case-investigations conducted in China from 2006 to 2012. Most cases (n = 7,947; 92.0%) were caused by animal bites; 5,800 (55.8%) and 2,974 (28.6%) exposures were from domestic and free-roaming dogs, respectively. Only 278 (4.8%) of these domestic dogs had previously received rabies vaccination. Among all cases, 5,927 (59.7%) cases had category III wounds, 1,187 (11.7%) cases initiated the rabies PEP vaccination and 234 (3.9%) cases with category III wounds received rabies immunoglobulin. In our adjusted logistic regression model, male cases (adjusted odds ratio [aOR] = 1.25, 95% confidence interval [CI]: 1.09-1.44) and farmers (aOR = 1.39, 95% CI: 1.10-1.77) and person older than 55 years (aOR = 1.48, 95% CI: 1.01-2.17) were less likely than females and persons in other occupations or younger than 15 years to initiate PEP vaccination. The median incubation period was 66 days (interquartile range (IQR): 33-167 days). To reduce the number of human deaths due to rabies, rabies prevention campaigns targeting males and farmers and older people should be conducted. Increasing routine rabies vaccination among domestic dogs will be essential in the long term.
Collapse
Affiliation(s)
- Chun Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Li
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Yang Huai
- International Emerging Infections Program, Division of Global Health Protection, Centers for Disease Control and Prevention, Beijing, China
| | - Carol Y Rao
- International Emerging Infections Program, Division of Global Health Protection, Centers for Disease Control and Prevention, Beijing, China
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shengjie Lai
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Di Mu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenwu Yin
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hongjie Yu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
| | - Shaofa Nie
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| |
Collapse
|
4
|
Angsuwatcharakon P, Khomvilai S, Limsuwun K, Ratananpinit N, Khamchat A, Sanitnai T, Tantawichien T. Immunogenicity and safety of WHO-approved TRC-ID regimen with a chromatographically purified Vero cell rabies vaccine with or without rabies immunoglobulin in children. Expert Rev Vaccines 2018; 17:185-188. [PMID: 29285961 DOI: 10.1080/14760584.2018.1421074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Children are at risk of rabies exposure in many Asian countries. The safety and immunogenicity profile of the WHO-approved two-site intradermal Thai Red Cross regimen (modified TRC-ID regimen; 2-2-2-0-2) with a new chromatographically purified Vero-cell rabies vaccine (CPRV) is lacking. Area covered: We studied the safety and immunogenicity of the TRC-ID regimen with a new CPRV in non-immunized Thai children with possible or proven rabies exposure. Thirty-nine seronegative patients (age range 2-14 years) with rabies exposure (WHO categories II or III) received two 0.1-mL intradermal doses of CPRV at both deltoid regions on days 0, 3, 7, and 28. Twenty-five patients (64.1%) received rabies immunoglobulin due to having rabies exposure, according to WHO category III. All serum samples were tested for rabies neutralizing antibody (Nab) by the rapid fluorescent focus inhibition test (RFFIT) before vaccination, and on days 14 and 90 after vaccination. All patients had an adequate immune response (Nab titers ≥ 0.5 IU/mL) on days 14 and 90. No patients died of rabies infection. No serious adverse reactions were observed. Expert commentary: CPRV is economic, safe, and immunogenic if given as the modified TRC-ID regimen in children.
Collapse
Affiliation(s)
- Piyada Angsuwatcharakon
- a Queen Saovabha Memorial Institute (WHO Collaborating Center for Research on Rabies Pathogenesis and Prevention) , Thai Red Cross Society , Bangkok , Thailand
| | - Sumana Khomvilai
- a Queen Saovabha Memorial Institute (WHO Collaborating Center for Research on Rabies Pathogenesis and Prevention) , Thai Red Cross Society , Bangkok , Thailand
| | - Kornvika Limsuwun
- a Queen Saovabha Memorial Institute (WHO Collaborating Center for Research on Rabies Pathogenesis and Prevention) , Thai Red Cross Society , Bangkok , Thailand
| | - Natchaya Ratananpinit
- a Queen Saovabha Memorial Institute (WHO Collaborating Center for Research on Rabies Pathogenesis and Prevention) , Thai Red Cross Society , Bangkok , Thailand
| | - Apinya Khamchat
- a Queen Saovabha Memorial Institute (WHO Collaborating Center for Research on Rabies Pathogenesis and Prevention) , Thai Red Cross Society , Bangkok , Thailand
| | - Teeranit Sanitnai
- a Queen Saovabha Memorial Institute (WHO Collaborating Center for Research on Rabies Pathogenesis and Prevention) , Thai Red Cross Society , Bangkok , Thailand
| | - Terapong Tantawichien
- a Queen Saovabha Memorial Institute (WHO Collaborating Center for Research on Rabies Pathogenesis and Prevention) , Thai Red Cross Society , Bangkok , Thailand.,b Division of Infectious Diseases, Department of Medicine , Chulalongkorn University , Bangkok , Thailand
| |
Collapse
|
5
|
Patel AC, Upmanyu V, Ramasamy S, Gupta PK, Singh R, Singh RP. Molecular and immunogenic characterization of BHK-21 cell line adapted CVS-11 strain of rabies virus and future prospect in vaccination strategy. Virusdisease 2015; 26:288-96. [PMID: 26645040 PMCID: PMC4663707 DOI: 10.1007/s13337-015-0285-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022] Open
Abstract
Development of a cost effective quality vaccine is a key issue in rabies control programme in developing countries. With this perspective, in the present study, challenge virus standard (CVS)-11 strain of rabies virus was adapted to grow in BHK-21 cells, characterized, compared with other viruses including global vaccine strains and field isolates from Indian subcontinent and China at molecular level. This cell adapted virus was evaluated for the production of cost effective veterinary vaccine. The maximum virus titre achieved was 10(7) fluorescent focus unit (FFU)/mL at 10th passage level. There was no nucleotide difference in the nucleoprotein (N) and glycoprotein (G) genes after adaptation in cell line. Phylogenetic analysis showed that adapted virus was grouped with global vaccine strains, closest being with other CVS strains but distinct from the Indian field isolates. Global vaccine strains including cell adapted CVS-11 virus have 83-87 % identity at nucleotide level of G gene with Indian field viruses. Growth kinetics of cell culture adapted virus showed that the optimum virus titer (around 10(7) FFU/mL) could be obtained at around 48 h post infection by co-cultivation method using 0.1 multiplicity of infection inoculums at 37 °C. These findings can be used for up scaling of vaccine production. The protective efficacy of test vaccine produced using 10(6.95) FFU/mL cell culture harvest showed 1.17 IU/mL relative potency by NIH test. Further, adapted virus was found to be suitable for use in rapid fluorescent focus inhibition test.
Collapse
Affiliation(s)
- Arunkumar C. Patel
- />Division of Biological Products, ICAR-Indian Veterinary Research Institute, Izatnagar, 243 122 India
| | - Vikramaditya Upmanyu
- />Division of Biological Standardization, ICAR-Indian Veterinary Research Institute, Izatnagar, 243 122 India
| | - Santhamani Ramasamy
- />Division of Biological Products, ICAR-Indian Veterinary Research Institute, Izatnagar, 243 122 India
| | - Praveen Kumar Gupta
- />Division of Veterinary Biotechnology, ICAR-Indian Veterinary Research Institute, Izatnagar, 243 122 India
| | - Rajendra Singh
- />Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, 243 122 India
| | - Rabindra Prasad Singh
- />Division of Biological Products, ICAR-Indian Veterinary Research Institute, Izatnagar, 243 122 India
| |
Collapse
|
6
|
Zagreb regimen, an abbreviated intramuscular schedule for rabies vaccination. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 22:1-5. [PMID: 25392012 DOI: 10.1128/cvi.00531-14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Zagreb regimen, an abbreviated intramuscular schedule for rabies vaccination, was developed by I. Vodopija and colleagues of the Zagreb Institute of Public Health in Croatia in the 1980s. It was recommended by WHO as one of the intramuscular (IM) schedules for rabies vaccination in 2010. We reviewed the literature on the immunogenicity, safety, economic burden, and compliance of the Zagreb 2-1-1 regimen. Compared to Essen, another IM schedule recommended by WHO, Zagreb has higher compliance, lower medical cost, and better immunogenicity at an early stage.
Collapse
|
7
|
Tantawichien T, Sibunruang S, Tantawichien T, Angsanakul J, Benjavongkulchai M, Limsuwan K, Udomchaisakul P, Khomvilai S, Sitprija V. Safety and immunogenicity of chromatographically purified Vero cell rabies vaccine for intradermal pre- and post-exposure rabies prophylaxis. Expert Rev Vaccines 2014; 13:1593-601. [DOI: 10.1586/14760584.2014.971764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
8
|
Babboni SD, da Costa HF, Martorelli LDFA, Kataoka APDAG, Victoria C, Padovani CR, Modolo JR. Kinetics of rabies antibodies as a strategy for canine active immunization. J Venom Anim Toxins Incl Trop Dis 2014; 20:37. [PMID: 26413082 PMCID: PMC4582946 DOI: 10.1186/1678-9199-20-37] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/14/2014] [Indexed: 11/05/2022] Open
Abstract
Background Rabies, a zoonosis found throughout the globe, is caused by a virus of the Lyssavirus genus. The disease is transmitted to humans through the inoculation of the virus present in the saliva of infected mammals. Since its prognosis is usually fatal for humans, nationwide public campaigns to vaccinate dogs and cats against rabies aim to break the epidemiological link between the virus and its reservoirs in Brazil. Findings During 12 months we evaluated the active immunity of dogs first vaccinated (booster shot at 30 days after first vaccination) against rabies using the Fuenzalida-Palácios modified vaccine in the urban area of Botucatu city, São Pauto state, Brazil. Of the analyzed dogs, 54.7% maintained protective titers (≥0.5 IU/mL) for 360 days after the first vaccination whereas 51.5% during all the study period. Conclusions The present results suggest a new vaccination schedule for dogs that have never been vaccinated. In addition to the first dose of vaccine, two others are recommended: the second at 30 days after the first and the third dose at 180 days after the first for the maintenance of protective titers during 12 months.
Collapse
Affiliation(s)
- Selene Daniela Babboni
- Department of Veterinary Hygiene and Public Health, School of Veterinary Medicine and Animal Husbandry, São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, São Paulo State, Brazil
| | - Hení Falcão da Costa
- Department of Animal Health and Production, Veterinary Medicine School, São Paulo State University (UNESP - Univ Estadual Paulista), Araçatuba, São Paulo State, Brazil
| | - Luzia de Fátima Alves Martorelli
- Laboratory of Zoonoses and Vector-Borne Diseases, Center for the Control of Zoonosis of São Paulo City, São Paulo, São Paulo state, Brazil
| | | | - Cassiano Victoria
- Department of Veterinary Hygiene and Public Health, School of Veterinary Medicine and Animal Husbandry, São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, São Paulo State, Brazil
| | - Carlos Roberto Padovani
- Department of Biostatistics, Botucatu Biosciences Institute, São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, São Paulo State, Brazil
| | - José Rafael Modolo
- Department of Veterinary Hygiene and Public Health, School of Veterinary Medicine and Animal Husbandry, São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, São Paulo State, Brazil
| |
Collapse
|
9
|
Madhusudana SN, Mani RS. Intradermal vaccination for rabies prophylaxis: conceptualization, evolution, present status and future. Expert Rev Vaccines 2014; 13:641-55. [DOI: 10.1586/14760584.2014.901893] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Shampur Narayan Madhusudana
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research on Rabies, National Institute of Mental Health and Neurosciences (NIMHANS),
Bangalore, Karnataka 560029, India
| | - Reeta Subramaniam Mani
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research on Rabies, National Institute of Mental Health and Neurosciences (NIMHANS),
Bangalore, Karnataka 560029, India
| |
Collapse
|
10
|
Wera E, Velthuis AGJ, Geong M, Hogeveen H. Costs of rabies control: an economic calculation method applied to Flores Island. PLoS One 2013; 8:e83654. [PMID: 24386244 PMCID: PMC3873960 DOI: 10.1371/journal.pone.0083654] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 11/06/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rabies is a zoonotic disease that, in most human cases, is fatal once clinical signs appear. The disease transmits to humans through an animal bite. Dogs are the main vector of rabies in humans on Flores Island, Indonesia, resulting in about 19 human deaths each year. Currently, rabies control measures on Flores Island include mass vaccination and culling of dogs, laboratory diagnostics of suspected rabid dogs, putting imported dogs in quarantine, and pre- and post-exposure treatment (PET) of humans. The objective of this study was to estimate the costs of the applied rabies control measures on Flores Island. METHODOLOGY/PRINCIPAL FINDINGS A deterministic economic model was developed to calculate the costs of the rabies control measures and their individual cost components from 2000 to 2011. The inputs for the economic model were obtained from (i) relevant literature, (ii) available data on Flores Island, and (iii) experts such as responsible policy makers and veterinarians involved in rabies control measures in the past. As a result, the total costs of rabies control measures were estimated to be US$1.12 million (range: US$0.60-1.47 million) per year. The costs of culling roaming dogs were the highest portion, about 39 percent of the total costs, followed by PET (35 percent), mass vaccination (24 percent), pre-exposure treatment (1.4 percent), and others (1.3 percent) (dog-bite investigation, diagnostic of suspected rabid dogs, trace-back investigation of human contact with rabid dogs, and quarantine of imported dogs). CONCLUSIONS/SIGNIFICANCE This study demonstrates that rabies has a large economic impact on the government and dog owners. Control of rabies by culling dogs is relatively costly for the dog owners in comparison with other measures. Providing PET for humans is an effective way to prevent rabies, but is costly for government and does not provide a permanent solution to rabies in the future.
Collapse
Affiliation(s)
- Ewaldus Wera
- Animal Health Study Program, Kupang State Agriculture Polytechnic, West Timor, Indonesia
- Business Economics Group, Wageningen University, Wageningen, The Netherlands
| | | | - Maria Geong
- Husbandry Department of East Nusa Tenggara Province, Indonesia
| | - Henk Hogeveen
- Business Economics Group, Wageningen University, Wageningen, The Netherlands
| |
Collapse
|
11
|
Zehrung D, Jarrahian C, Wales A. Intradermal delivery for vaccine dose sparing: Overview of current issues. Vaccine 2013. [DOI: 10.1016/j.vaccine.2012.11.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
12
|
Tenzin, Wangdi K, Ward MP. Human and animal rabies prevention and control cost in Bhutan, 2001-2008: the cost-benefit of dog rabies elimination. Vaccine 2012; 31:260-70. [PMID: 22634297 DOI: 10.1016/j.vaccine.2012.05.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 05/10/2012] [Accepted: 05/11/2012] [Indexed: 11/15/2022]
Abstract
The objective of this study was to estimate the cost of various interventions and to quantify the economic impacts of rabies in Bhutan. Cost-benefit of dog rabies elimination versus human post exposure treatment cost was also assessed. The average direct medical cost of human post-exposure treatment (using rabies vaccine only) was estimated to be Nu. 1615 (US$ 35.65) per 5-dose Essen regimen per patient. The cost would increase to Nu. 2497 (US$ 55.13) and Nu. 19,633 (US$ 433.41) per patient when one dose of either equine rabies immunoglobulin (ERIG) or human rabies immunoglobulin (HRIG) is administered, respectively. The societal cost (direct medical and indirect patient expenses) per patient was estimated to be Nu. 2019 (US$ 45), Nu. 2901 (US$ 64) and Nu. 20,037 (US$ 442) using vaccine only, vaccine with ERIG and vaccine with HRIG, respectively. The average cost per dog vaccination and sterilization were estimated to be Nu. 75 (US$ 1.66) and Nu. 288 (US$ 6.36), respectively. The total direct cost of rabies and various interventions between 2001 and 2008 was estimated to be Nu. 46.95 million (US$ 1.03 million). The direct cost for intensified human PET was estimated to be Nu. 5.85 million (US$ 0.11 million) per year with a cumulated estimated costs of Nu. 35.10 million (US$ 0.70 million) while the cost of mass dog vaccination with at least 70% coverage is estimated to be approximately Nu. 10.31 million (US$ 0.21 million) at the end of 6 years. The combined cost of mass dog vaccination and human PET was estimated to be greater than the cost of human PET alone during the first 2 years of the campaign, and then would be lower than human PET cost alone after the 5th year of the campaign. The total cumulated cost of the combined strategy was estimated to be Nu. 34.14 million (US$ 0.73 million) and would be lower than the cumulated cost of human PET alone (Nu. 35.10 million, US$ 0.77 million) at the end of 6 years. Rabies represents a substantial economic impact to the Bhutanese society. Well-planned and implemented mass dog vaccination would result in elimination of rabies reservoirs in the domestic dog population and would eliminate human rabies cases. It would also reduce the recurrent expenditure on human post-exposure treatment.
Collapse
Affiliation(s)
- Tenzin
- University of Sydney, Camden, NSW 2570, Australia
| | | | | |
Collapse
|
13
|
Warrell M. Current rabies vaccines and prophylaxis schedules: Preventing rabies before and after exposure. Travel Med Infect Dis 2012; 10:1-15. [DOI: 10.1016/j.tmaid.2011.12.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 12/21/2011] [Indexed: 02/07/2023]
|
14
|
Hampson K, Cleaveland S, Briggs D. Evaluation of cost-effective strategies for rabies post-exposure vaccination in low-income countries. PLoS Negl Trop Dis 2011; 5:e982. [PMID: 21408121 PMCID: PMC3050908 DOI: 10.1371/journal.pntd.0000982] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 02/09/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Prompt post-exposure prophylaxis (PEP) is essential in preventing the fatal onset of disease in persons exposed to rabies. Unfortunately, life-saving rabies vaccines and biologicals are often neither accessible nor affordable, particularly to the poorest sectors of society who are most at risk and upon whom the largest burden of rabies falls. Increasing accessibility, reducing costs and preventing delays in delivery of PEP should therefore be prioritized. METHODOLOGY/PRINCIPAL FINDINGS We analyzed different PEP vaccination regimens and evaluated their relative costs and benefits to bite victims and healthcare providers. We found PEP vaccination to be an extremely cost-effective intervention (from $200 to less than $60/death averted). Switching from intramuscular (IM) administration of PEP to equally efficacious intradermal (ID) regimens was shown to result in significant savings in the volume of vaccine required to treat the same number of patients, which could mitigate vaccine shortages, and would dramatically reduce the costs of implementing PEP. We present financing mechanisms that would make PEP more affordable and accessible, could help subsidize the cost for those most in need, and could even support new and existing rabies control and prevention programs. CONCLUSIONS/SIGNIFICANCE We conclude that a universal switch to ID delivery would improve the affordability and accessibility of PEP for bite victims, leading to a likely reduction in human rabies deaths, as well as being economical for healthcare providers.
Collapse
Affiliation(s)
- Katie Hampson
- Boyd Orr Centre for Population and Ecosystem Health, Institute for Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom.
| | | | | |
Collapse
|
15
|
Hickling JK, Jones KR, Friede M, Zehrung D, Chen D, Kristensen D. Intradermal delivery of vaccines: potential benefits and current challenges. Bull World Health Organ 2011; 89:221-6. [PMID: 21379418 PMCID: PMC3044245 DOI: 10.2471/blt.10.079426] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 11/01/2010] [Accepted: 11/02/2010] [Indexed: 01/18/2023] Open
Abstract
Delivery of vaccine antigens to the dermis and/or epidermis of human skin (i.e. intradermal delivery) might be more efficient than injection into the muscle or subcutaneous tissue, thereby reducing the volumes of antigen. This is known as dose-sparing and has been demonstrated in clinical trials with some, but not all, vaccines. Dose-sparing could be beneficial to immunization programmes by potentially reducing the costs of purchase, distribution and storage of vaccines; increasing vaccine availability and effectiveness. The data obtained with intradermal delivery of some vaccines are encouraging and warrant further study and development; however significant gaps in knowledge and operational challenges such as reformulation, optimizing vaccine presentation and development of novel devices to aid intradermal vaccine delivery need to be addressed. Modelling of the costs and potential savings resulting from intradermal delivery should be done to provide realistic expectations of the potential benefits and to support cases for investment. Implementation and uptake of intradermal vaccine delivery requires further research and development, which depends upon collaboration between multiple stakeholders in the field of vaccination.
Collapse
|
16
|
Intradermal rabies vaccination: the evolution and future of pre- and post-exposure prophylaxis. Curr Top Microbiol Immunol 2011; 351:139-57. [PMID: 21267707 DOI: 10.1007/82_2010_121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Inactivated rabies vaccines have been used to pioneer the immunological and economical advantages of intradermal (ID) administration over 35 years. Vaccine shortages or its prohibitive cost stimulated studies of various doses, frequency and sites of injection. An economical regimen for pre-exposure prophylaxis requires one-tenth of an intramuscular dose, but the early popularity of the method has been stifled by pharmaceutical regulations. There has also been reluctance to use multiple-site post-exposure ID regimens, except in a very few Asian counties. A new four-site ID regimen could overcome many of the problems encountered to date. The time is ripe to make dramatic progress towards efficient use of the current excellent vaccines globally, wherever there is a shortage of vaccine or funds.
Collapse
|
17
|
Lang J, Feroldi E, Vien NC. Pre-exposure purified vero cell rabies vaccine and concomitant routine childhood vaccinations: 5-year post-vaccination follow-up study of an infant cohort in Vietnam. J Trop Pediatr 2009; 55:26-31. [PMID: 18048461 DOI: 10.1093/tropej/fmm100] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Children have a high risk of exposure to rabies in countries where the disease is endemic. This prospective, 5-year study followed two groups of children who had received diphtheria, tetanus, whole-cell pertussis and inactivated poliomyelitis vaccine (DTP-IPV) at 2, 3, 4 months and 1 year (Group B) or concomitant with three doses of purified Vero cell rabies vaccine (PVRV), given at 2, 4 months and 1 year (Group A). Antibody determinations were made annually for 5 years. Data were available from a total of 72 subjects; 30 in Group A and 32 in Group B. In Group A, the percentage of patients immunized against rabies (anti-rabies > or = 0.5 IU/ml) decreased from 100% after the third vaccination to 63%, 5 years later. After 5 years, 93.8% in Group A and 96.7% in Group B had seroprotective diphtheria antibody titers > or = 0.01 IU/ml, and all subjects had anti-polio (type 1, 2 and 3) seroprotective titers > or = 5 1:dil. We conclude that co-administration of PVRV with DTP-IPV elicited protective antibody concentrations to all antigens that persist for at least 5 years, with continued protection against rabies in over 60% of subjects. These results are consistent with integration of pre-exposure rabies vaccination into the Expanded Program on Immunization (EPI) in countries where rabies is endemic.
Collapse
Affiliation(s)
- Jean Lang
- Sanofi Pasteur, Marcy L'etoile, France.
| | | | | |
Collapse
|
18
|
McElhaney J, Dutz J. Better Influenza Vaccines for Older People: What Will It Take? J Infect Dis 2008; 198:632-4. [DOI: 10.1086/590435] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
19
|
Warrell MJ, Riddell A, Yu LM, Phipps J, Diggle L, Bourhy H, Deeks JJ, Fooks AR, Audry L, Brookes SM, Meslin FX, Moxon R, Pollard AJ, Warrell DA. A simplified 4-site economical intradermal post-exposure rabies vaccine regimen: a randomised controlled comparison with standard methods. PLoS Negl Trop Dis 2008; 2:e224. [PMID: 18431444 PMCID: PMC2292256 DOI: 10.1371/journal.pntd.0000224] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 03/14/2008] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The need for economical rabies post-exposure prophylaxis (PEP) is increasing in developing countries. Implementation of the two currently approved economical intradermal (ID) vaccine regimens is restricted due to confusion over different vaccines, regimens and dosages, lack of confidence in intradermal technique, and pharmaceutical regulations. We therefore compared a simplified 4-site economical PEP regimen with standard methods. METHODS Two hundred and fifty-four volunteers were randomly allocated to a single blind controlled trial. Each received purified vero cell rabies vaccine by one of four PEP regimens: the currently accepted 2-site ID; the 8-site regimen using 0.05 ml per ID site; a new 4-site ID regimen (on day 0, approximately 0.1 ml at 4 ID sites, using the whole 0.5 ml ampoule of vaccine; on day 7, 0.1 ml ID at 2 sites and at one site on days 28 and 90); or the standard 5-dose intramuscular regimen. All ID regimens required the same total amount of vaccine, 60% less than the intramuscular method. Neutralising antibody responses were measured five times over a year in 229 people, for whom complete data were available. FINDINGS All ID regimens showed similar immunogenicity. The intramuscular regimen gave the lowest geometric mean antibody titres. Using the rapid fluorescent focus inhibition test, some sera had unexpectedly high antibody levels that were not attributable to previous vaccination. The results were confirmed using the fluorescent antibody virus neutralisation method. CONCLUSIONS This 4-site PEP regimen proved as immunogenic as current regimens, and has the advantages of requiring fewer clinic visits, being more practicable, and having a wider margin of safety, especially in inexperienced hands, than the 2-site regimen. It is more convenient than the 8-site method, and can be used economically with vaccines formulated in 1.0 or 0.5 ml ampoules. The 4-site regimen now meets all requirements of immunogenicity for PEP and can be introduced without further studies. TRIAL REGISTRATION Controlled-Trials.com ISRCTN 30087513.
Collapse
Affiliation(s)
- Mary J Warrell
- The Oxford Vaccine Group, Centre for Clinical Vaccinology & Tropical Medicine University of Oxford, Churchill Hospital, Oxford, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Toovey S. Preventing rabies with the Verorab® vaccine: 1985–2005. Travel Med Infect Dis 2007; 5:327-48. [DOI: 10.1016/j.tmaid.2007.07.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 07/12/2007] [Indexed: 11/16/2022]
|
21
|
Trabelsi K, Rourou S, Loukil H, Majoul S, Kallel H. Optimization of virus yield as a strategy to improve rabies vaccine production by Vero cells in a bioreactor. J Biotechnol 2005; 121:261-71. [PMID: 16153733 DOI: 10.1016/j.jbiotec.2005.07.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2005] [Revised: 05/09/2005] [Accepted: 07/11/2005] [Indexed: 10/25/2022]
Abstract
To improve rabies vaccine production by Vero cells, we have developed a strategy based on high cell density culture and optimization of virus yield. We have first optimized cell growth in spinner flask using a Taguchi's L8 experimental design. We analyzed the effects of the following factors: initial glucose and glutamine concentrations, Cytodex 1 concentration and the regulation of glucose level at 1 g l(-1). We have also investigated the effect of the following factor interactions: Cytodex 1 concentration/glutamine concentration, Cytodex 1 concentration/glucose concentration and glucose concentration/glutamine concentration. Statistical analysis of the collected data pointed to the initial glucose concentration, the regulation of glucose level at 1 g l(-1) and the interactions between Cytodex 1 concentration/initial glucose concentration and Cytodex 1 concentration/initial glutamine concentration as the parameters that affected cell growth. Using the optimal conditions determined earlier, we have studied Vero cell growth in a 7-l bioreactor and in batch culture, and obtained a cell density level equal to 3.6 +/- 0.2 x 10(6) cells ml-1. Cell infection with rabies virus (LP 2061/Vero strain) at a multiplicity of infection (MOI) of 0.3 using M199 medium supplemented with 0.2% bovine serum albumin (BSA), yielded a maximal virus titer equal to 8 +/- 1.6 x 10(7) Fluorescent Focus Units (FFU) ml-1. We have also studied Vero cell growth in a 7-l bioreactor using recirculation as a perfusion culture mode during cell proliferation step and perfusion for virus multiplication phase. In comparison to batch culture, we reached a higher cell density level that was equal to 10.1 +/- 0.5 x 10(6) cells ml-1. Cell infection under the conditions previously indicated, yielded 14l of virus harvest that had a virus titer equal to 2.6 +/- 0.5 x 10(7) FFU ml-1. The activity of the inactivated virus harvest showed a protective activity that meets WHO requirements.
Collapse
Affiliation(s)
- Khaled Trabelsi
- Viral Vaccines Research and Development Unit, Institut Pasteur de Tunis 13, Place Pasteur, BP 74, 1002 Belvédère, Tunis, Tunisia
| | | | | | | | | |
Collapse
|