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Appears in Collections:Biological and Environmental Sciences Journal Articles
Peer Review Status: Refereed
Title: The need to improve access to rabies post-exposure vaccines: Lessons from Tanzania
Author(s): Changalucha, Joel
Steenson, Rachel
Grieve, Eleanor
Cleaveland, Sarah
Lembo, Tiziana
Lushasi, Kennedy
Mchau, Geofrey
Mtema, Zacharia
Sambo, Maganga
Nanai, Alphoncina
Govella, Nicodem J
Dilip, Angel
Sikana, Lwitiko
Ventura, Francesco
Hampson, Katie
Keywords: Post-exposure prophylaxis
Dog-mediated rabies
Rabies prevention
Canine rabies
Vaccine regimen
Supply chain
Issue Date: Oct-2019
Date Deposited: 20-Nov-2020
Citation: Changalucha J, Steenson R, Grieve E, Cleaveland S, Lembo T, Lushasi K, Mchau G, Mtema Z, Sambo M, Nanai A, Govella NJ, Dilip A, Sikana L, Ventura F & Hampson K (2019) The need to improve access to rabies post-exposure vaccines: Lessons from Tanzania. Vaccine, 37 (Supplement 1), pp. A45-A53.
Abstract: Background Rabies is preventable through prompt administration of post-exposure prophylaxis (PEP) to exposed persons, but PEP access is limited in many rabies-endemic countries. We investigated how access to PEP can be improved to better prevent human rabies. Methods Using data from different settings in Tanzania, including contact tracing (2,367 probable rabies exposures identified) and large-scale mobile phone-based surveillance (24,999 patient records), we estimated the incidence of rabies exposures and bite-injuries, and examined health seeking and health outcomes in relation to PEP access. We used surveys and qualitative interviews with stakeholders within the health system to further characterise PEP supply and triangulate these findings. Results Incidence of bite-injury patients was related to dog population sizes, with higher incidence in districts with lower human:dog ratios and urban centres. A substantial percentage (25%) of probable rabies exposures did not seek care due to costs and limited appreciation of risk. Upon seeking care a further 15% of probable rabies exposed persons did not obtain PEP due to shortages, cost barriers or misadvice. Of those that initiated PEP, 46% did not complete the course. If no PEP was administered, the risk of developing rabies following a probable rabies exposure was high (0.165), with bites to the head carrying most risk. Decentralized and free PEP increased the probability that patients received PEP and reduced delays in initiating PEP. No major difficulties were encountered by health workers whilst switching to dose-sparing ID administration of PEP. Health infrastructure also includes sufficient cold chain capacity to support improved PEP provision. However, high costs to governments and patients currently limits the supply chain and PEP access. The cost barrier was exacerbated by decentralization of budgets, with priority given to purchase of cheaper medicines for other conditions. Reactive procurement resulted in limited and unresponsive PEP supply, increasing costs and risks to bite victims. Conclusion PEP access could be improved and rabies deaths reduced through ring-fenced procurement, switching to dose-sparing ID regimens and free provision of PEP.
DOI Link: 10.1016/j.vaccine.2018.08.086
Rights: This is an open access article distributed under the terms of the Creative Commons CC-BY license (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. You are not required to obtain permission to reuse this article.
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