The Philippine Information Agency has issued a press release detailing a rabies vaccination program for 5000 public school children in the province of Camiguin. This is prophylactic (preventive) vaccination, not post-exposure treatment.

Routine rabies vaccination is recommended for people at increased risk of exposure. Classically, this involves veterinary personnel, people working with wildlife, people working with strays or feral animals, and similar groups. Routine vaccination of the general public is not used because of the high cost and low need, given the average person’s low risk of exposure and the availability of effective post-exposure treatment. By providing vaccine prophylactically, authorities are implying that the rabies exposure risk is quite high for these children.

A Camiguin health office official is reported as saying that the pre-exposure series, consisting of 2 doses, will save money compared to the post-exposure regimen of 4 doses plus a shot of anti-rabies antibody. However, that doesn’t make any sense. From a cost standpoint, prophylactically treating everyone with 2 shots only saves money if over half of the population would otherwise need 4 shots. I know rabies is a problem in that area, but certainly half of the kids in the area won’t exposed. Further, what really blows a hole in this reasoning is the fact that a vaccinated person who is exposed to rabies should receive a booster series of 2 vaccines regardless, thus bringing the total to 4 shots. People who have been vaccinated don’t get the antibody shot if they are exposed, so that does save a little money.  (On a side note, routine vaccination usually involves 3 doses, and the release says people will get two doses but will get vaccinated on days 0, 7 and 21 or 28. That’s 3 doses, which makes the math even more questionable). 

If rabies is epidemic in the area, if it’s not being controlled well by other means and if there is rampant exposure of children, vaccination may be a reasonable option. However, rabies is basically 100% preventable with proper post-exposure treatment. Rabies deaths are usually because people don’t seek, or are not given, proper treatment in a timely fashion. Educating the public to reduce the risk of rabies exposure and to seek medical care, ensuring that there is adequate awareness about rabies among medical personnel and ensuring that adequate vaccine and antibody is available for exposed individuals seems to be a much more logical approach

I was actually wondering whether this press release was real. I did some searching and this agency is an official government agency and a member of the presidential communications group. It would be really nice to see more details about why this decision was made, particularly some of the evidence that was used to determine that this was needed.

It’s important to take rabies control seriously. The main problem with rabies in many areas is a lack of effort or adequate resources directed against stray animal control, animal vaccination, public education, medical education and availability of proper treatment. Working on those would seem to me to be a better approach than an expensive and somewhat questionable mass vaccination program of children. The reasoning in the press release is that kids might not report bites, and that is a good point to consider. But, does that actually occur and can it not be controlled by better education?

What’s the cost-benefit of rabies vaccination in a situation such as this? It’s hard to oppose vaccination of this fatal disease, but are there other ways to provide better overall protection?