http://www.straightdope.com/mailbag/mrabies.html#update
The above rabies column didn’t answer the question: Why is the dog vaccine so much cheaper than the human? They’re both rabies antigens, right?
Are they prepared differently? Are there different safety standards? It’s incredibly frustrating when Cecil himself doesn’t answer the question…
Why would dogs need to be vacinnated against people???
Moving this to the forum on Mailbag answers.
I asked Cecil this question last August and here is the exact reply I recieved from JKFabian:
“People most certainly do get rabies shots. You don’t need to get them often. Seems I had one about 5 years ago and I’m due again in a couple of years.”
Does JKFabian work with animals or travel to underdeveloped countries and work with animals there? Or is JKFabian confusing rabies with tetnus? I’d just like to know.
I’m guessing that JKFabian was thinking of tetanus shots. Rabies shots are not generally given to travelers.
Jill
“From Nov. 1987 - Oct. 1988, 4,014 Peace Corps volunteers went in for rabies shots immediately after possible exposures.” The 4,104 figure is wrong. There were only about 8,000 PCVs worldwide in 1987-88.
“This is a treatment rate of 43.6 per 1000 volunteers per year, which is very high.” This is very high but it could be correct.
“These people are at real risk of coming into contact with rabies as it’s a common disease in much of the developing world.” You bet. A PCV in Kenya died of rabies in about 1984.
“Still, it was estimated that the cost of pre-exposure vaccination for all Peace Corps volunteers would be 1.8 to 4.2 times greater than the cost of post-exposure treatment, even with the much higher incidence of exposure.” Yeah, but try using that argument on the dead PCV’s parents. Better still, explain to their congressional representative that PC can’t afford to vaccinate Volunteers against the deadly diseases to which they are exposed when serving humanity and their country. In fact, in 1987-88, all PC trainees heading for countries with rabies (most PC countries) in 1987-88 received the pre-exposure series of three rabies immunizations using HDCV. If PC does not continue to routinely immunize against rabies all PC trainees serving in countries where rabies is a problem I will be extremely surprised.
Regarding the cost of rabies vaccine license for humans as compared with the cost of rabies vaccine licensed for animals: 1. What do you think it costs to prove that a candidate rabies vaccine is safe for animals as compared with what it costs to prove that it is safe for humans?
What do you think it costs to prove that a candidate rabies vaccine is effective in humans as compared with what it costs to prove that it effective in humans?
If you were selling liability insurance to pharmaceutical companies, which would you charge more, someone selling a vaccine to prevent a fatal disease in animals or someone selling a vaccine to prevent a fatal disease in humans?
The cost of production of vaccines (or, for that matter, of most medicines) is relatively inconsequential when it comes to setting a price.
Although most “travellers” don’t need rabies pre-exposure immunization, many “long-term travellers/residents” do, especially small children who may be exposed to rabies but not report their exposure.
[[In fact, in 1987-88, all PC trainees heading for countries with rabies (most PC countries) in 1987-88 received the pre-exposure series of three rabies immunizations using HDCV. If PC does not continue to routinely immunize against rabies all PC trainees serving in countries where rabies is a problem I will be extremely surprised.]]
You also disputed the statement at the beginning of the mailbag article, saying that around 4400 PCVs received post-exposure prophylaxis. I got these numbers from a CDC document. Those studies in such publications go through much review, and I expect that it is accurate. I will find the cite, though.
Jill
Bernard KW, Fishbein DB: Pre-exposure rabies prophylaxis for travellers: Are the benefits worth the cost? Vaccine 1991; 9: 833-836
“The number of courses of postexposure prophylaxis given to North Americans abroad is unknown. Of 4014 at-risk US Peace Corps volunteers, 175 received postexposure treatments during the 12-month period from 1 November, 1987, to 31 October, 1988 – an overall postexposure treatment rate of 43.6 per 1000 volunteers per year, which is considered to be an exceptionally high rate.”
So it wasn’t 4014 who received the treatment. I’m sure I read this higher figure somewhere, but it’s clearly in error.
Jill
[[“Still, it was estimated that the cost of pre-exposure vaccination for all Peace Corps volunteers would be 1.8 to 4.2 times greater than the cost of post-exposure treatment, even with the much higher incidence of exposure.” Yeah, but try using that argument on the dead PCV’s parents. Better still, explain to their congressional representative that PC can’t afford to vaccinate Volunteers against the deadly diseases to which they are exposed when serving humanity and their country.]]
Peace Corps doesn’t take many chances with the health of their volunteers. I got vaccinated for practically everything when I served in Peace Corps in 89-91(including painful gamma globulin shots every six months, even though I already had Hepatitis A and was immune). Another study done on pre-exposure vaccination against rabies with Peace Corps volunteers showed poor antibody response in a large percentage of volunteers. It is suspected that some other vaccination or medical treatment - maybe malaria prophylaxis - was affecting the effectiveness of the rabies vaccine.
Jill
“I got vaccinated for practically everything when I served in Peace Corps in 89-91(including painful gamma globulin shots every six months, even though I already had Hepatitis A and was immune).” The chief medical officer of the PC during most of the 1980’s believed that regular injections of immune globulin might protect against hepatitis B as well as A and possibly against other infectious diseases as well. This might have been the case in the 1970s or early 1980s, although I know of no evidence for it. However, by 1989 the pool of IG donors excluded most people with risk factors for hepatitis B infection so it is doubtful that the IG used when you were a PCV had any anti-HBV to speak of in it.
“Another study done on pre-exposure vaccination against rabies with Peace Corps volunteers showed poor antibody response in a large percentage of volunteers. It is suspected that some other vaccination or medical treatment - maybe malaria prophylaxis - was affecting the effectiveness of the rabies vaccine.” This study was done by the same KW Bernard you cite. He was the CDC epidemiologist who investigated the rabies death in Kenya. As I recall, the subjects of the study included not only PCVs but also veterinary students in the U.S. and the conclusion was that malaria prophylaxis with chloroquine interfered the development of protective rabies antibody in people immunized against rabies.
[[However, by 1989 the pool of IG donors excluded most people with risk factors for hepatitis B infection so it is doubtful that the IG used when you were a PCV had any anti-HBV to speak of in it.]]
I was already immunized against Hep B. I tell ya, I’d have taking the risk over having to ride a bus for four hours, get thus humungous shot in the butt, and ride four hours home. I could hardly walk after getting off that bus.