Rabies vaccine and immunoglobulin supply and logistics: Challenges and opportunities for rabies elimination in Kenya
In Kenya rabies is endemic and has been reported in the countryrnfor more than a hundred years 16. In 2014 Kenya launched a 15-rnyear strategy to end human deaths from dog rabies by 2030. Thernstrategy uses a progressive reduction in rabies risk starting elimina-rntion programs in five pilot counties Siaya Kisumu Makueni KituirnMachakos before extending to neighbouring counties until therncountry is free of rabies 1617. The elimination program is focusedrnon mass dog vaccinations prompt provision of PEP public healthrneducation and awareness on rabies strengthening rabies surveil-rnlance and operational research to aid in optimal delivery of theserninterventions. In 2010 Kenya adopted a new constitution thatrnchanged governance from a central government system to arndevolved system consisting of two levels of government: nationalrngovernment and 47 county governments. As a result in 2012 healthrnservices were devolved to be financed and run by the county govern-rnments. Although rabies elimination activities have commenced inrnparts of the country there is little data on PEP and RIG availabilityrnand accessibility in counties and nationally
This study addresses the strategy of prompt provision of PEP forrnpatients bitten by suspect rabid dogs. We assessed the rabies vac-rncine infrastructure including the logistics flow demand and sup-rnply and forecasting for PEP and RIG at the national county andrnsub-county levels. We compared it with the system used for rou-rntine vaccines to identify the challenges and opportunities forrnimproving the availability accessibility and affordability of rabiesrnPEP to achieve elimination of human rabies in the country.
We assessed the availability forecasting and supply chain logisticsrnfor rabies PEP in Kenya compared with the system used for vaccines in the expanded program of immu-rnnization routine vaccines. Semi-structured questionnaires capturing data on forecasting procurementrndistribution cold chain and storage monitoring and reporting for routine vaccines and rabies vaccinesrnand RIG were administered to 35 key personnel at the national county sub-county and health facilityrnlevels in five counties.
This study has shown considerable in-country variability in thernavailability of rabies vaccines and immunoglobulin a less robustrnand inadequate supply system for rabies biologicals operated sep-rnarately to that used by routine vaccines use of the intramuscularrnroute for PEP administration as opposed to the dose-saving intra-rndermal route and a high cost of rabies PEP and RIG to bite patients.rnTaken together our results point to a sub-optimal system requiringrnspecific improvements to achieve prompt provision of rabies PEPrnfor persons exposed to rabies.
Results showed large variability in PEP availability stockouts ranged from 3 torn36 weeks per year with counties implementing rabies elimination activities having shorter stockouts.rnPEP is administered intramuscularly using the 5-dose Essen regimen day 0 3 7 14 and 28. PEP costsrnto bite patients were reported to range from 10 to 15 US dollars per dose RIG was seldom available. Arnless robust supply and logistics infrastructure is used for rabies PEP compared to routine vaccines.
Prompt provision of rabies PEP remains a critical strategy tornKenya achieving zero human deaths from rabies by 2030. Integrat-rning the provision of rabies vaccines and immunoglobulin withinrnthe health system including using existing infrastructure forrnroutine vaccines extending the DHIS2 reporting system to coverrnPEP demand use and compliance supporting universal healthrncoverage better health financing and free provision of PEP as wellrnas adoption of ID vaccination regimens and creation of integratedrnbite management programs can all increase progress towardsrneliminating human rabies by 2030.
Publication Information
Focus County(s):
Makueni County
Programme Area(s):
Infectious and Parasitic Diseases
Research Priority Area(s):
Disease Domain(s):
Document History:
Publication Date: 03.Jun.2019
Conference Title: