Rabies Vaccination in Amazonia: Challenges and Opportunities

Background: With successful canine rabies control programs implemented in most Latin American countries, vampire bats have emerged as the most important reservoir responsible for regular outbreaks and human deaths in the Amazon Basin. The extreme climatic, geographic, and socio-economic conditions in these remote communities make Amazon human populations especially susceptible to a multitude of zoonoses, and particularly to rabies transmitted by vampire bats. Long distances from healthcare services and the absence of  relevant infrastructure contribute to the delays in rabies post-exposure prophylaxis (PEP). Additionally, the unavailability of rabies immune globulins and modern cell culture vaccines, as well as unreliable cold-chain maintenance for biologics, and the need for multiple clinical visits, remain as challenges for adhering to the recommended PEP schedules under the specific conditions in this region. Innovative, cost efficient and practical solutions are necessary for these Amazon Basin populations, who are often under the risk of nightly predation by vampire bats.

Setting: Various public health settings, including local and national level, clinics, outreach, and educational settings.

Population: Indigenous people and new immigrants to the Amazon region for natural resource exploitation, such as logging, mining and farming.

Project Description: Potential solutions to the problem are proposed and discussed: 1) Use of intradermal vaccination schedules; 2) Consideration of reduced vaccination schedules; 3) Opportunities for single dose vaccination for boosters, and enhanced pre-exposure vaccination in highly endemic areas; 4) Applied research on modern recombinant and genetically modified vaccines. Each potential solution is described regarding efficiency, relevance, and perspectives for future availability.

Results/Lessons Learned: The urgency for application of proven PEP strategies, such as intradermal vaccination, and trials for novel rabies vaccines is proposed. Stakeholders in Amazon countries need to be engaged to develop more efficient and realistic solutions for these neglected populations.