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Vaccine stockouts expose Kenyans to rabies


Lack of vaccines hurts rabies war

Counties found to be going for as long as nine months without the crucial medication

Two of the tried and proven methods of controlling rabies are vaccinating dogs or people.

Rabies, a disease transmitted by dogs and is fatal when the bitten person develops clinical signs, has been in Kenya for the last 100 years, and kills at least 2,000 people every year in the country.

However, stockouts of the life-saving vaccines are being experienced in the counties for as long as nine months.

A study conducted by Centre of Global Health Research, Kenya Medical Research Institute in Kisumu and Washington State University, now shows since rabies is not part of the routine vaccination, it makes eradication hard.

The researchers studied five counties in which rabies is rampant: Siaya and Makueni who have a strategy to curb the disease; Kwale and Marsabit that do not have; Nairobi to represent urban areas.

MULTIPLE BITES

In Siaya and Makueni stockouts are experienced for an average of four months, Kwale (nine months), Nairobi (eight months) and Marsabit (two months).

Counties go without exposure-prophylaxis (Pep), including vaccines, and rabies immunoglobulin (Rig). Pep is administered to a person bitten by a rabid dog to prevent them from developing signs.

According to Dr Thumbi Mwangi, the lead researcher, Rig is given alongside Pep to patients with high risk such as bites on the upper trunk or those who have multiple bites, before the effect of Pep takes over.

The study attributes the stockouts to the cost of the vaccines, and delays in procuring them by the counties. More people are also being bitten by dogs, contributing to the stockouts, says the study.

Kenya Veterinary Association chairman Samuel Kahariri has raised the alarm, saying the population of stray dogs is increasing rapidly in Kenya, making vaccination hard. “The dogs are not even brought for vaccination when the call is made,” says Dr Kahariri.

TRANSMISSION CHAIN

Apart from the stockouts, the researchers also say the vaccines for people are still not accessible.

Dr Mwangi says the safety of rabies vaccines has been improved over the last few decades.

According to the study, vaccinating 70 per cent of all dogs will effectively break the chain of transmission.

In 2014, Kenya launched a 15-year strategy to eradicate rabies, focusing on dog vaccinations, ensuring patients have Pep whenever and wherever they need them, educating the public and surveillance to ensure no bite or death occurs.

However, rabies is not part of the national vaccination programme.

For instance, Rig was rarely found in health facilities and has not been in the county for five years. “Kenya Medical Supplies Authority (Kemsa) stocked Rig previously, but the counties did not order it, leading to expiry of available stock and losses for Kemsa,” said the researchers.

TOO COSTLY

Data collection on the number of those affected and on the perception about vaccines, was found to be weak.

To get protection from Pep, a bitten person needs multiple doses, but the study found that “there was no system in place to ensure dose completion compliance”.

It is a matter of life and death but counties rely on goodwill of the people because “patients are advised to complete all five doses and dates are detailed in the patient’s card, however anti-rabies registers are not in use in counties and no follow-up is made on patients who do not complete their doses”.

Affordability is also a problem as many patients cannot afford the Sh1,500 vaccine.

“There are bite patients that do not access the first dose of the vaccine following bites from suspect rabid dogs; and only a few complete the dose required even after starting,” says Dr Mwangi.

Kenya, according to the World Health Organisation, accounts for nearly one in 10 of all rabies deaths in Africa — 2,000 of the total 21,476 — and without addressing the systems issues, more will die.