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Sreenivasan N, Li A, Shiferaw M, Tran CH, Wallace R, Blanton J, Knopf L, Abela-Ridder B, Hyde T. Overview of rabies post-exposure prophylaxis access, procurement and distribution in selected countries in Asia and Africa, 2017-2018. Vaccine 2019; 37 Suppl 1:A6-A13. [PMID: 31471150 PMCID: PMC10351478 DOI: 10.1016/j.vaccine.2019.04.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 03/21/2019] [Accepted: 04/09/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Rabies is a neglected zoonotic disease with a global burden of approximately 59,000 human deaths a year. Once clinical symptoms appear, rabies is almost invariably fatal; however, with timely and appropriate post-exposure prophylaxis (PEP) consisting of wound washing, vaccine, and in some cases rabies immunoglobulin (RIG), the disease is almost entirely preventable. Access to PEP is limited in many countries, and when available, is often very expensive. METHODS We distributed a standardized assessment tool electronically to a convenience sample of 25 low- and middle-income countries in Asia and Africa to collect information on rabies PEP procurement, forecasting, distribution, monitoring and reporting. Information was collected from national rabies focal points, focal points at the World Health Organization (WHO) country offices, and others involved in procurement, logistics and distribution of PEP. Because RIG was limited in availability or unavailable in many countries, the assessment focused on vaccine. Data were collected between January 2017 and May 2018. RESULTS We received responses from key informants in 23 countries: 11 countries in Asia and 12 countries in Africa. In 9 of 23 (39%) countries, rabies vaccine was provided for free in the public sector and was consistently available. In 10 (43%) countries, all or some patients were required to pay for the vaccine in the public sector, with the cost of a single dose ranging from US$ 6.60 to US$ 20/dose. The primary reason for the high cost of the vaccine for patients was a lack of funding at the central level to subsidize vaccine costs. In the remaining 4 (17%) countries, vaccine was provided for free but was often unavailable so patients were required to purchase it instead. The majority of countries used the intramuscular route for vaccine administration and only 5 countries exclusively used the dose-sparing intradermal (ID) route. Half (11/22; 50%) of all countries assessed had a standardized distribution system for PEP, separate from the systems used for routine childhood vaccines, and almost half used separate storage facilities at both central and health facility levels. Approximately half (9/22; 41%) of all countries assessed reported having regular weekly, monthly or quarterly reporting on rabies vaccination. CONCLUSIONS While all countries in our assessment had rabies vaccines available in the public sector to some extent, barriers to access include the high cost of the vaccine to the government as well as to patients. Countries should be encouraged to use ID administration as this would provide access to rabies vaccine for many more people with the same number of vaccine vials. In addition, standardized monitoring and reporting of vaccine utilization should be encouraged, in order to improve data on PEP needs.
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Affiliation(s)
- N Sreenivasan
- Centers for Disease Control and Prevention, Atlanta, USA.
| | - A Li
- PHI/CDC Global Health Fellowship and ASPPH/CDC Allen Rosenfield Global Health Fellowship, Atlanta, USA
| | - M Shiferaw
- Centers for Disease Control and Prevention, Atlanta, USA
| | - C H Tran
- Centers for Disease Control and Prevention, Atlanta, USA
| | - R Wallace
- Centers for Disease Control and Prevention, Atlanta, USA
| | - J Blanton
- Centers for Disease Control and Prevention, Atlanta, USA
| | - L Knopf
- World Health Organization, Geneva, Switzerland
| | | | - T Hyde
- Centers for Disease Control and Prevention, Atlanta, USA
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Vora NM, Orciari LA, Niezgoda M, Selvaggi G, Stosor V, Lyon GM, Wallace RM, Gabel J, Stanek DR, Jenkins P, Shiferaw M, Yager P, Jackson F, Hanlon CA, Damon I, Blanton JD, Recuenco S, Franka R. Clinical management and humoral immune responses to rabies post-exposure prophylaxis among three patients who received solid organs from a donor with rabies. Transpl Infect Dis 2015; 17:389-95. [PMID: 25851103 DOI: 10.1111/tid.12393] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/08/2015] [Accepted: 03/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The rabies virus causes a fatal encephalitis and can be transmitted through organ transplantation. In 2013, a man developed rabies 18 months after receiving a kidney from a donor with rabies, who was not known to have been infected when the organs were procured. Three additional persons who received organs from the same donor (liver, kidney, heart), all of whom were not vaccinated for rabies before transplantation, received rabies post-exposure prophylaxis (PEP) with rabies immune globulin and 5 doses of rabies vaccine as soon as the diagnosis of rabies was made in the donor (18 months after their transplant surgeries). We describe their clinical management. METHODS As the 3 recipients were all on immunosuppressive medications, post-vaccination serologic testing was performed using the rapid fluorescent focus inhibition test to measure rabies virus neutralizing antibodies (RVNAs). An acceptable antibody response to administration of rabies vaccine was defined as detection of RVNAs at a concentration ≥0.1 IU/mL from a serum specimen collected ≥7 days after the fifth vaccine dose. RESULTS All 3 recipients demonstrated an acceptable antibody response despite their immunosuppressed states. More than 36 months have passed since their transplant surgeries, and all 3 recipients have no evidence of rabies. CONCLUSIONS The survival of 3 previously unvaccinated recipients of solid organs from a donor with rabies is unexpected. Although the precise factors that led to their survival remain unclear, our data suggest that PEP can possibly enhance transplant safety in settings in which donors are retrospectively diagnosed with rabies.
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Affiliation(s)
- N M Vora
- Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.,Poxvirus and Rabies Branch, CDC, Atlanta, Georgia, USA
| | - L A Orciari
- Poxvirus and Rabies Branch, CDC, Atlanta, Georgia, USA
| | - M Niezgoda
- Poxvirus and Rabies Branch, CDC, Atlanta, Georgia, USA
| | - G Selvaggi
- Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - V Stosor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - G M Lyon
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - R M Wallace
- Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.,Poxvirus and Rabies Branch, CDC, Atlanta, Georgia, USA
| | - J Gabel
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - D R Stanek
- Florida Department of Health, Tallahassee, Florida, USA
| | - P Jenkins
- Florida Department of Health, Tallahassee, Florida, USA
| | - M Shiferaw
- Poxvirus and Rabies Branch, CDC, Atlanta, Georgia, USA
| | - P Yager
- Poxvirus and Rabies Branch, CDC, Atlanta, Georgia, USA
| | - F Jackson
- Poxvirus and Rabies Branch, CDC, Atlanta, Georgia, USA
| | - C A Hanlon
- Poxvirus and Rabies Branch, CDC, Atlanta, Georgia, USA
| | - I Damon
- Poxvirus and Rabies Branch, CDC, Atlanta, Georgia, USA
| | - J D Blanton
- Poxvirus and Rabies Branch, CDC, Atlanta, Georgia, USA
| | - S Recuenco
- Poxvirus and Rabies Branch, CDC, Atlanta, Georgia, USA
| | - R Franka
- Poxvirus and Rabies Branch, CDC, Atlanta, Georgia, USA
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Solomon T, Shiferaw M, Abreham W, Tayu B, Klinkenberg E, Loha E. Assigning focal persons to notify more tuberculosis patients: lessons learned in southern Ethiopia. Public Health Action 2014; 4:S18-24. [PMID: 26478508 DOI: 10.5588/pha.14.0055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/07/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Health centres in Southern Ethiopia. OBJECTIVE To determine factors contributing to the large variations in the notification of smear-positive tuberculosis (TB) cases. DESIGN A cross-sectional study in selected health centres from areas with high and low case notification was conducted and health system and health care worker (HCW) related determinants were examined. RESULTS A total of 50 (61.0%) health centres and 172 (65.2%) HCWs from high case notification areas, and 32 (39.0%) health centres and 92 (33.8%) HCWs from low case notification areas were included in the study. Assignment of a full-time TB focal person at the TB clinic (adjusted odds ratio [aOR] 5.8, 95%CI 1.5-22.4) and availability of TB recording tools (aOR 7.0, 95%CI 1.5-32.5) were independent predictors of high case notification rates. HCW knowledge about TB screening, diagnosis and treatment was positively associated with case notification (aOR 2.53, 95%CI 1.42-4.48). CONCLUSION Increased TB case notification was associated with the presence of a full-time focal person, availability of TB recording tools and good knowledge about TB among HCWs. Putting in place these measures in all health centres could increase TB notification in the region.
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Affiliation(s)
- T Solomon
- College of Medicine and Health Sciences, School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
| | - M Shiferaw
- Southern Nations, Nationalities and People Regional (SNNPR) State Health Bureau, Hawassa, Ethiopia
| | - W Abreham
- Southern Nations, Nationalities and People Regional (SNNPR) State Health Bureau, Hawassa, Ethiopia
| | - B Tayu
- Aleta Wondo Town Health Centre, SNNPR, Hawassa, Ethiopia
| | - E Klinkenberg
- KNCV Tuberculosis Foundation, The Hague, The Netherlands ; Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - E Loha
- College of Medicine and Health Sciences, School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
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