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dc.contributor.authorChangalucha, Joelen_UK
dc.contributor.authorSteenson, Rachelen_UK
dc.contributor.authorGrieve, Eleanoren_UK
dc.contributor.authorCleaveland, Sarahen_UK
dc.contributor.authorLembo, Tizianaen_UK
dc.contributor.authorLushasi, Kennedyen_UK
dc.contributor.authorMchau, Geofreyen_UK
dc.contributor.authorMtema, Zachariaen_UK
dc.contributor.authorSambo, Magangaen_UK
dc.contributor.authorNanai, Alphoncinaen_UK
dc.contributor.authorGovella, Nicodem Jen_UK
dc.contributor.authorDilip, Angelen_UK
dc.contributor.authorSikana, Lwitikoen_UK
dc.contributor.authorVentura, Francescoen_UK
dc.contributor.authorHampson, Katieen_UK
dc.description.abstractBackground 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.en_UK
dc.publisherElsevier BVen_UK
dc.relationChangalucha 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.
dc.rightsThis 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.en_UK
dc.subjectPost-exposure prophylaxisen_UK
dc.subjectDog-mediated rabiesen_UK
dc.subjectRabies preventionen_UK
dc.subjectCanine rabiesen_UK
dc.subjectVaccine regimenen_UK
dc.subjectSupply chainen_UK
dc.titleThe need to improve access to rabies post-exposure vaccines: Lessons from Tanzaniaen_UK
dc.typeJournal Articleen_UK
dc.citation.issueSupplement 1en_UK
dc.type.statusVoR - Version of Recorden_UK
dc.contributor.funderUBS Optimus Foundationen_UK
dc.contributor.funderWellcome Trusten_UK
dc.contributor.funderWellcome Trusten_UK
dc.contributor.funderBill and Melinda Gates Foundationen_UK
dc.contributor.funderWellcome Trusten_UK
dc.contributor.affiliationIfakara Health Instituteen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationIfakara Health Instituteen_UK
dc.contributor.affiliationMinistry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC)en_UK
dc.contributor.affiliationIfakara Health Instituteen_UK
dc.contributor.affiliationIfakara Health Instituteen_UK
dc.contributor.affiliationWorld Health Organizationen_UK
dc.contributor.affiliationIfakara Health Instituteen_UK
dc.contributor.affiliationIfakara Health Instituteen_UK
dc.contributor.affiliationIfakara Health Instituteen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
dc.contributor.affiliationUniversity of Glasgowen_UK
Appears in Collections:Biological and Environmental Sciences Journal Articles

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