Why isn't a rabies vaccine given to children?

Submitted by EmbarrassedActive4 t3_yh4ue1 in askscience

> https://www.who.int/activities/vaccinating-against-rabies-to-save-lives/rabies-vaccines

> Approximately 59 000 people die from rabies each year. The vast majority of these deaths occur in Asia and Africa. Children are at particular risk.

If children are at risk, why isn't it in the schedule for US and India children vaccinations?

https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html#birth-15

https://www.unicef.org/india/stories/know-your-childs-vaccination-schedule

https://immunizationdata.who.int/pages/schedule-by-country/ind.html

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iayork t1_iuci24o wrote

In the US, human rabies is extremely rare, so the very small risk from the vaccine might still be higher than the avoided risk of rabies. (If there are 1 in a million serious side effects, that would still be 100 times more risky than the actual case rate.).

Note that people genuinely at high risk - veterinarians, mainly - do in fact get vaccinated, because that changes the risk calculation.

In African countries, and India, it becomes more of a cost calculation. There are almost certainly more effective ways to use that money to save lives in those countries.

If the money was available, it would almost certainly be more cost and safety effective to increase vaccination of animals - the US approach. Removing the source of human rabies, while not putting humans at any increased risk, is probably a much better approach.

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GeriatricZergling t1_iue2c1m wrote

>Note that people genuinely at high risk - veterinarians, mainly - do in fact get vaccinated, because that changes the risk calculation.

I know a lot of bat biologists, and all of them get vaccinated for rabies. "Let's deliberately catch the most common vector for this disease" is a pretty big shift in risk, after all.

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Mlpaddict t1_iudpp60 wrote

At the local veterinary college, the jobs with animals all require rabies vaccination.

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Cannie_Flippington t1_iugnyjy wrote

Some states that have theoretically eradicated rabies in their animal populations actually drop salt blocks with vaccine in them in high animal traffic areas on their borders to help prevent outbreaks.

https://www.usnews.com/news/news/articles/2022-08-26/usda-scattering-rabies-vaccines-for-wildlife-in-13-states

This article is about a recent effort by the fed but I'm certain some individual states have been doing it for far longer.

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girnigoe t1_iucfmxk wrote

  1. it would be expensive

https://news.vin.com/doc/?id=4825471

  1. immunity from the vaccine only lasts a limited time so it’d have to be redone all the time, like flu shots or like thecrabies shots in animals.

https://immunizeindia.org/content/rabies-vaccination/

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Photo_DVM t1_iudg2ja wrote

The rabies vaccine can provide “adequate” protection for long periods of time. 10+ years in a lot of cases. That being said, what constitutes adequate can not be known conclusively.

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Collin_the_doodle t1_iudsn9m wrote

Adequate protection might be okay for the flu, but with the stakes of rabies I don’t think anyone wants to make that gamble.

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Photo_DVM t1_iudzezw wrote

I never said anything about gambling. There are established post exposure prophylaxis protocols that should obviously be followed. The post I responded to implied rabies vaccines need to be given like the flu vaccine which is incorrect.

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[deleted] t1_iudyxuk wrote

[removed]

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AbzoluteZ3RO t1_iudzxiq wrote

afaik that's not true at all. Rabies isnt a "few hours" sort of disease unless you got bit on the neck maybe. Most bites are on extremities. If you are bit you have to get the vaccine within a limited amount of time, like a day or 2 (before it spreads to the brain) in order for it to be effective. If you get it too late it's a done deal. Something like 1 person ever has survived untreated rabies (last i read about it 10 years ago maybe more now) and basically that person was put into an induced coma to give the brain a chance to recover from the virus on its own. There's no "treatment" for rabies

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Rhekinos t1_iue501c wrote

Yea and its actually a fluke that that person survived from that method of treatment. Until now we’re still unable to replicate the success of the first Milwaukee Protocol.

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Uncynical_Diogenes t1_iueh302 wrote

Nope. By the time you have symptoms you are already dead. There is no treatment at that point; the prognosis is a wooden box.

The treatment for rabies is the vaccine, because that prevents the disease from progressing from the exposure part to the “you’re already dead” part.

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Coomb t1_iuejjw9 wrote

You are incorrect. The rabies vaccine is the most effective prophylaxis against rabies. The post exposure protocol involves injecting immunoglobulin into the area around the wound, to bind to rabies virus in the vicinity of the wound, as well as administering the rabies vaccine (which is itself a protocol of multiple shots spaced out in time). It is the immunoglobulin which is the delaying treatment intended to give you more time for your immune system to develop its own antibodies against rabies virus after being stimulated by the vaccine.

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Alwayssunnyinarizona t1_iue0e3x wrote

I think you're a little confused. The vaccine is protective and provides outstanding immunity, though it's standard protocol to get a booster if there's suspected exposure.

For those who are unvaccinated when exposed, there's a more involved post-exposure prophylaxis that involves vaccination +/- immunoglobulin injections. That, again, provides excellent protection.

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f1newhatever t1_iuergc0 wrote

The vaccine is the treatment here. I don’t know that I’d go out of my way to spread misinformation on this one

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mfb- t1_iuci4cz wrote

Since 2009, only one child died from rabies in the US: CDC has a table. The US has 3.6 million children per year. Vaccinating all of them would cost billions every year and have hundreds of thousands of children with side effects, only to save a child every decade or so. You can still vaccinate someone after a possible exposure, that's generally the better approach.

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raygundan t1_iuis7j7 wrote

The link you used shows cost is for post-exposure prophylaxis, which is much more expensive than up-front vaccination.

Which is not to say there's no cost associated with vaccination, just that it's probably an order of magnitude (or two) lower than if you were giving everybody the post-exposure treatment.

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mfb- t1_iuitrqr wrote

I found a range of $500 to $1200 that's explicitly for pre-exposure vaccination. Multiply that by 3.6 million children and we get costs of 2-4 billions every year, and that's assuming we only vaccinate every child once and then skip the follow-up measurements/doses discussed in other comments.

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sparks333 t1_iud1153 wrote

In addition to the answers that say it's riskier to get the vaccine than to be vaccinated, rabies is also the oddball disease where you can be vaccinated after exposure - it moves through the nervous system so slowly that it can take years to get to your brain. Of course, if it does, there is roughly a 100% fatality rate, but if you have an expected exposure (get bitten by a wild animal, or suspect you have been) there is still plenty off time to get the vaccine and have it be effective. This is a more cost- and risk-averse approach.

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Sk-yline1 t1_iudveuk wrote

It’s unnecessary, because it works with 100% efficacy if given immediately after exposure, so you only need to give it on a case by case basis. Unlike most illnesses where once you catch it, there’s nothing the vaccine can do to stop the illness

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SasquatchFingers t1_iugjh5f wrote

Distance to adequate facilities is a major hurdle in many or all of the most vulnerable countries.

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Puppy-Zwolle t1_iucojsu wrote

There is a good reason not to vaccinate. Vaccines do have a small risk. If the risk of complications (say 1 in 1000.000) is greater than yearly casualties (1 in 30.000.000) it's rather counter productive.

Also

Vaccinations are given to combat the spreading of a disease. Notably the more dangerous and contagious (human to human) a virus is the better the chance of Vaccination.

Rabies (compares to SARS for instance) is not a big risk and pretty hard to contract. In some area's you should vaccinate but usually any vaccination in those area's is a problem.

I agree the statistics are grim but they are not the only grim statistics if you look at the area's these statistics come from.

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Cephandrius17 t1_iuec12c wrote

  1. The dangerous symptoms take weeks or months to develop, as the virus has to travel to the brain. Because of this, if you are vaccinated after you are infected, but before it spreads too far, it will still be effective.
  2. The developed countries most capable of vaccine program like that generally have low rates of rabies.
  3. Because of the low rates of infection, even very rare side effects of the vaccine could end up being more common than actual infections.
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FriendlyCraig t1_iucfrrz wrote

Funds and infrastructure are limited, and need to be balanced against other diseases, costs, and time. In the USA it's not a big enough deal to mandate. Infections in the USA are extremely rare, literally only a few reported cases a year. In poorer regions where it is more prevalent, more dangerous and contagious diseases are prioritized.

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DR-JOHN-SNOW- t1_iuer11l wrote

The rabies vaccine is complicated, it requires 3 doses to complete a course. These have to be delivered in a 28 day timeframe which adds massive complications.

In addition you’ll still need 2 does of immunoglobulin if you’ve been exposed (which is basically any bite or scratch from a mammal).

The list price for the rabies vaccine in the UK is £40 per dose (£120 for a full three course dose). Even in many developing countries where it may cost a fraction of this it’s still prohibitive.

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EmbarrassedActive4 OP t1_iuhggav wrote

> The rabies vaccine is complicated, it requires 3 doses to complete a course. These have to be delivered in a 28 day timeframe which adds massive complications.

Only for post-infection.

Pre-infection requires only one

But your point still stands.

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DR-JOHN-SNOW- t1_iuhi5jr wrote

No a primary course is 3 doses.

For primary pre-exposure immunisation, which primes the immune system, three doses of rabies vaccine (2.5 IU) should be given intramuscularly on days 0, 7 and 28. The third dose can be given from day 21 if there is insufficient time before travel [6].

Alternatively, an accelerated schedule of primary pre-exposure vaccine may be given if there is insufficient time before travel to complete the 28 day course. Three doses of rabies vaccine (2.5 IU) should be given intramuscularly on days 0, 3 and 7, with an additional dose at one year if they will continue to travel to high risk areas [6].

https://travelhealthpro.org.uk/factsheet/20/rabies

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Twinkletoes1951 t1_iueh1fd wrote

It would be impossible to justify vaccinating everyone for a disease which causes 1-3 deaths per year in the US. If you get rabies, there is an effective treatment. Might be a different story in other countries, but not in the US.

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SasquatchFingers t1_iugk42u wrote

Rabies, like many diseases, is dependent on local ecosystem conditions. When we have wildlife outbreaks in the U.S., they seed likely feeding areas of foxes and raccoons with a baited oral vaccine.

India has an extraordinarily complex and destructive combination of lifestyle, livelihood, religion, and economy. A big likely contributor to rabies surging there in recent decades is a specific medication given to cattle.

https://en.wikipedia.org/wiki/Indian_vulture_crisis

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