Rabies vaccine and immunoglobulin supply and logistics: Challenges and opportunities for rabies elimination in Kenya.

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  • Additional Information
    • Source:
      Publisher: Elsevier Science Country of Publication: Netherlands NLM ID: 8406899 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2518 (Electronic) Linking ISSN: 0264410X NLM ISO Abbreviation: Vaccine Subsets: MEDLINE
    • Publication Information:
      Publication: Amsterdam, The Netherlands : Elsevier Science
      Original Publication: [Guildford, Surrey, UK] : Butterworths, [c1983-
    • Subject Terms:
      Immunoglobulins* ; Organization and Administration*; Immunologic Factors/*supply & distribution ; Post-Exposure Prophylaxis/*organization & administration ; Rabies/*prevention & control ; Rabies Vaccines/*supply & distribution; Health Services Accessibility ; Humans ; Kenya ; Surveys and Questionnaires
    • Abstract:
      Prompt provision of post-exposure-prophylaxis (PEP) including vaccines and rabies immunoglobulin (RIG) to persons bitten by suspect rabid dogs is a key strategy to eliminating human deaths from dog-mediated rabies in Kenya by 2030. We assessed the availability, forecasting and supply chain logistics for rabies PEP in Kenya, compared with the system used for vaccines in the expanded program of immunization (routine vaccines). Semi-structured questionnaires capturing data on forecasting, procurement, distribution, cold chain and storage, monitoring and reporting for routine vaccines and rabies vaccines and RIG were administered to 35 key personnel at the national, county, sub-county and health facility levels in five counties. Results showed large variability in PEP availability (stockouts ranged from 3 to 36 weeks per year) with counties implementing rabies elimination activities having shorter stockouts. PEP is administered intramuscularly using the 5-dose Essen regimen (day 0, 3, 7, 14 and 28). PEP costs to bite patients were reported to range from 10 to 15 US dollars per dose; RIG was seldom available. A less robust supply and logistics infrastructure is used for rabies PEP compared to routine vaccines. Forecasting and monitoring mechanisms for rabies PEP was poor in the study counties. The supply of vaccines from the national to the sub-national level is mainly through two government agencies and a private agency. Since government decentralization, the National Vaccine and Immunization Program has remained as the main supplier of the routine vaccines, playing a lesser role in the supply of rabies biologicals. Adoption of the dose-saving intradermal route for PEP administration, reduction of PEP costs to patients, and placing rabies vaccines within the routine vaccines supply and logistics system would significantly improve PEP availability and accessibility to persons at risk of rabies; a critical step to achieving elimination of human deaths from rabies.
      (Copyright © 2019. Published by Elsevier Ltd.)
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    • Grant Information:
      110330 United Kingdom WT_ Wellcome Trust; 207569 United Kingdom WT_ Wellcome Trust; United Kingdom WT_ Wellcome Trust; 001 International WHO_ World Health Organization; 110330/Z/15/Z United Kingdom WT_ Wellcome Trust; 207569/Z/17/Z United Kingdom WT_ Wellcome Trust
    • Contributed Indexing:
      Keywords: Immunoglobulins; Kenya; PEP; Rabies; Vaccines
    • Accession Number:
      0 (Immunoglobulins)
      0 (Immunologic Factors)
      0 (Rabies Vaccines)
    • Publication Date:
      Date Created: 20190722 Date Completed: 20200415 Latest Revision: 20220219
    • Publication Date:
      20221213
    • Accession Number:
      PMC7612384
    • Accession Number:
      10.1016/j.vaccine.2019.05.035
    • Accession Number:
      31326251