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Towards rationale vaccine policy: A case against inclusion of rabies vaccine into routine national immunization programme in India

机译：制定基本疫苗政策：反对将狂犬病疫苗纳入印度常规国家免疫计划的案例

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In India about 20 000 deaths are estimated to occur due to rabies annually also accounts for more than 50% of all rabies cases and 80% of the world's rabies fatalities worldwide, half of the victims are children [1]. Many paediatricians advocate for the inclusion for inclusion of rabies pre-exposure prophylactic vaccination into the routine childhood immunization schedule [2] and [3]. World Health Organisation (WHO) has recommended pre-exposure prophylaxis only for high risk group i.e., veterinarians and animal handlers etc. The author has already published public health criteria for new vaccines [4] and now advocates against inclusion of Rabies vaccine national routine immunization programme covering entire country for the reasons to follow. The pre exposure vaccination with three doses offers very limited immunity. The individual even if given pre exposure vaccine has to be followed up with post exposure vaccination of two doses, if bitten by a rabid dog. Prophylacticrabies vaccine will have to be given not only to every newly born child but also to every adult as they remain susceptible to rabies infection throughout out their adulthood as natural infection/immunization during childhood will not protect them in adulthood. If every individual in India were to be given prophylactic immunization with three doses then India with a population of 1.2 billion would require about 3.6 billion doses. Presently after a suspected rabid dog bite, a total of 5 doses of post exposure rabies vaccination is required Rabies vaccine on day 0, 3, 7, 14, 28. Now if rabies vaccination is included in routine immunization then a rabid dog bite victim require one of the following schedules [5].
机译：在印度，据估计每年约有2万死于狂犬病，也占所有狂犬病病例的50％以上，占全世界狂犬病死亡人数的80％，一半的受害者是儿童[1]。许多儿科医生主张将狂犬病暴露前预防性疫苗接种纳入常规的儿童免疫接种计划[2]和[3]。世界卫生组织（WHO）仅建议对高风险人群（如兽医和动物操作者等）进行暴露前预防。作者已经发布了新疫苗的公共卫生标准[4]，现在主张不要将狂犬病疫苗纳入国家常规免疫接种该计划涵盖了整个国家，其原因如下。三剂预暴露疫苗的免疫力非常有限。即使给了个体暴露前疫苗，该个体也必须接受暴露后疫苗的两次接种，如果被狂犬病犬咬伤了。预防狂犬病疫苗不仅要给每个新生婴儿，而且要给每个成年人，因为他们在整个成年期仍然容易受到狂犬病的感染，因为儿童期的自然感染/免疫并不能保护他们成年。如果要对印度的每个人进行三剂预防性免疫，那么印度12亿人口将需要约36亿剂。目前，在怀疑有狂犬病咬伤之后，在暴露的第0、3、7、14、28天总共需要接种5剂狂犬病暴露后狂犬病疫苗。现在，如果常规免疫中包括狂犬病疫苗接种，则需要狂犬病咬伤受害者以下计划之一[5]。

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    《Vaccine》 |2013年第42期|共1页
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    Patil Rajan R.;

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