WHO announces updated guidance on rabies

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WHO is delighted to announce the publication of two new guidance documents, each the product of months of expert review.

Since the launch of the global framework to eliminate human rabies transmitted by dogs by 2030 in 2015, WHO has worked with the Food and Agriculture Organization of the United Nations, the World Organisation for Animal Health, the Global Alliance for Rabies Control and other stakeholders and partners to prepare a global strategic plan. This includes a country-centric approach to support, empower and catalyse national entities to control and eliminate rabies.

In this context, WHO convened its network of collaborating centres on rabies, specialized institutions, members of the WHO Expert Advisory Panel on Rabies, rabies experts and partners to review strategic and technical guidance on rabies to support implementation of country and regional programmes.

The 2018 WHO expert report on rabies

The new WHO Expert Consultation on Rabies: WHO TRS N°1012 report provides updated guidance based on evidence and programmatic experience on the multiple facets of rabies prevention, control and elimination. Key updates include: (i) surveillance strategies, including cross-sectoral linking of systems and suitable diagnostics; (ii) the latest recommendations on human and animal immunization; (iii) palliative care in low resource settings; (iv) risk assessment to guide management of bite victims; and (v) a proposed process for validation and verification of countries reaching zero human deaths from rabies.

The meeting supported the recommendations endorsed by the WHO Strategic Advisory Group of Experts on Immunization in October 2017 to improve access to affordable rabies biologicals, especially for underserved populations, and increase programmatic feasibility in line with the objectives of universal health coverage.

The collaborative mechanisms required to prevent rabies are a model for collaboration on One Health at every level and among multiple stakeholders and are a recipe for success.

Rabies is a vaccine-preventable disease. The provision of support to countries will end the pain and suffering due to rabies that burdens people, especially children. Investing in rabies control and elimination strengthens health systems, improves equity and access to health care and contributes to sustainable development.

Investment in rabies elimination is not only for elimination of this fatal but preventable disease but also for building capacity in the world’s most neglected regions.

This report, requested by countries, provides hands-on guidance to drive progress towards rabies elimination.

WHO Vaccine position paper, 2018

The new WHO position paper on Rabies Vaccine, was published April is part of WHO’s series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. They summarize essential background information on diseases and vaccines and conclude with the current WHO position on the use of vaccines worldwide.

The papers are reviewed by external experts and WHO staff, and reviewed and endorsed by the WHO Strategic Advisory Group of Experts (SAGE) on immunization. The GRADE methodology is used to systematically assess the quality of the available evidence. The SAGE decision-making process is reflected in the evidence-to-recommendation tables.

The position papers are intended for use mainly by national public health officials. They may also be of interest to international funding agencies, vaccine advisory groups, vaccine manufacturers, the medical community, the scientific media and the general public.

This position paper replaces the 2010 WHO position on rabies vaccines. It presents new evidence in the field of rabies and the use of rabies vaccines, focusing on programmatic feasibility, simplification of vaccination schedules and improved cost-effectiveness. The recommendations concern the 2 main immunization strategies, namely vaccination for post-exposure prophylaxis and vaccination for pre-exposure prophylaxis. In the context of post-exposure prophylaxis, recommendations are also provided on the use of rabies immunoglobulins.

Recommendations on the use of rabies vaccines were discussed by SAGE in October 2017; evidence presented at the meeting can be accessed here.

Contributed by Bernadette Abela-Ridder and Lea Knopf of the WHO Department of Control of Neglected Tropical Diseases