A shorter post-exposure prophylaxis regimen for rabies, Pakistan

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Pharmacoeconomics

Background:

• Rabies remains a significant public health threat, particularly in endemic regions.
• Traditional rabies post-exposure prophylaxis (PEP) regimens can be resource-intensive.
• The World Health Organization (WHO) updated its recommendations for rabies PEP in 2018.

Purpose of the Study:

• To evaluate the cost-effectiveness of the WHO's 2018 recommended 1-week intradermal rabies PEP regimen.
• To compare resource consumption and patient outcomes between the new and previous PEP protocols.

Main Methods:

• A comparative analysis of rabies vaccine and immunoglobulin ampoule usage and costs was conducted.
• The study compared a 2017 4-week intradermal/intramuscular regimen with the 2018 1-week intradermal regimen.
• Patient survival following bites from apparently rabid dogs served as a surrogate for treatment effectiveness.

Main Results:

• The 2018 regimen treated more patients (5370 vs. 4948) with fewer vaccine (140 fewer) and immunoglobulin (436 fewer) ampoules.
• Significant cost savings of $4202 USD were achieved with the new regimen.
• Of 56 patients bitten by rabid dogs, 50 were alive at 6-month follow-up, indicating comparable effectiveness.

Conclusions:

• The 1-week intradermal rabies PEP regimen is more economical than the previous 4-week regimen.
• The new regimen demonstrates equal effectiveness in preventing rabies.
• This updated protocol is recommended for rabies prevention in endemic countries with limited vaccine and immunoglobulin supply.