title: Rabies Vaccine and Rabies Immunoglobulin in Cambodia: Use and Obstacles to Use.
abstract: BACKGROUND
  Authorities have pledged to eliminate canine rabies by 2020 in Cambodia, a country with a very high rabies burden. Logistic and financial access to timely and adequate postexposure prophylaxis (PEP) is essential for preventing rabies in humans.
  
  
  METHODS
  We undertook a survey of the few identified sites where PEP rabies vaccination and rabies immunoglobulin (RIG) are available in Cambodia. We examined the Rabies Prevention Center at Institut Pasteur du Cambodge (rpc@ipc) database and rpc@ipc order forms for 2012 to assess vaccine and RIG use. We conducted a rapid internet survey of centers that provide rabies vaccine and RIG in Cambodia, other than rpc@ipc.
  
  
  RESULTS
  The cost of a full course of intramuscular or intradermal PEP in Cambodia, with and without RIG, was also estimated. Rabies vaccination is free of charge in one foundation hospital and is accessible for a fee at Institut Pasteur du Cambodge (IPC), some institutions, and some Cambodian private clinics. In 2012, 27,500 rabies vaccine doses (0.5 mL) and 591 equine RIG doses were used to provide intradermal PEP to 20,610 persons at rpc@ipc following animal bites. Outside of rpc@ipc, an estimated total of 53,400 vaccine doses and 200 RIG doses were used in Cambodia in 2012. The wholesale cost of full rabies PEP was estimated at 50% to 100% of a Cambodian farmer's monthly wage.
  
  
  CONCLUSIONS
  Local populations and travelers cannot be sure to locally access adequate and timely PEP due to high costs and low access to RIG. Travelers to high-endemic areas such as Cambodia are strongly encouraged to undergo pre-exposure vaccination or seek expert advice, as per World Health Organization (WHO) recommendations. State-subsidized, pre-positioned stocks of human vaccine and RIG in bite management centers would extend the rabies prevention centers network. Support from Institut Pasteur du Cambodge for staff training, cold chain, and quality control would contribute to reducing the risk of rabies deaths in Cambodia.
authors.affiliation: Institut Pasteur du Cambodge, Unité d'Epidémiologie et Santé Publique, Phnom Penh, Cambodia.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Tarantola
authors.affiliation: Institut Pasteur du Cambodge, Unité d'Epidémiologie et Santé Publique, Phnom Penh, Cambodia.
authors.forename: Sowath
authors.initials: S
authors.lastname: Ly
authors.affiliation: Institut Pasteur du Cambodge, Unité d'Epidémiologie et Santé Publique, Phnom Penh, Cambodia.
authors.forename: Sotheary
authors.initials: S
authors.lastname: In
authors.affiliation: Institut Pasteur du Cambodge, Unité de Virologie, Phnom Penh, Cambodia.
authors.forename: Sivuth
authors.initials: S
authors.lastname: Ong
authors.affiliation: Institut Pasteur du Cambodge, Unité d'Epidémiologie et Santé Publique, Phnom Penh, Cambodia.
authors.forename: Yiksing
authors.initials: Y
authors.lastname: Peng
authors.affiliation: Institut Pasteur du Cambodge, Unité d'Epidémiologie et Santé Publique, Phnom Penh, Cambodia.
authors.forename: Nayyim
authors.initials: N
authors.lastname: Heng
authors.affiliation: Institut Pasteur du Cambodge, Unité de Virologie, Phnom Penh, Cambodia.
authors.forename: Philippe
authors.initials: P
authors.lastname: Buchy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002160:Cambodia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004285:Dogs; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis; D011818:Rabies / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission; D011819:Rabies Vaccines / Q000008:administration & dosage*; D011820:Rabies virus / Q000276:immunology*; D014195:Travel; D055815:Young Adult
chemical_list: D011819:Rabies Vaccines