Economic issues in postexposure rabies treatment

Rabies remains a worldwide public health problem even though means to control this disease are known. Logistic problems and cultural barriers for effective dog control in many countries and the high cost of human postexposure treatment, account for much of the remaining worldwide human toll. Efforts to make vaccines, with effective and safe tissue or avian culture products and immune globulin, more affordable have been only marginally successful. Second generation rabies vaccines (purified Vero-, chick and duck embryo cell products) are effective, safe and less expensive than human diploid cell rabies vaccine. Reduced dose intradermal postexposure vaccination works, is affordable, and has helped abolish the use of dangerous and poorly immunogenic brain tissue-derived vaccines in Thailand, the Philippines, and Sri Lanka. The use of purified equine rabies immune globulin has been found to be safe and cost-effective. It is, unfortunately, in short supply worldwide. Preexposure rabies vaccination for travelers to endemic regions is recommended and should be administered by the intramuscular route whenever possible.