Date Published:
9 January 2007 |
WHO increases treatment for victims of rabies and snake bites
Although more than 12 million people each year are bitten by dogs or snakes,
or stung by scorpions, the world's capacity to treat them is inadequate. Effective
treatment for these conditions is critically dependent on therapeutic sera,
but this essential drug is often unavailable or unaffordable in the countries
where it is most needed.
To address this neglected public health issue, the World Health Organization
(WHO) is creating a five-year plan to boost production in developing countries,
help authorities forecast market needs and strengthen regulatory capacity.
On 10 January, the health agency will bring together the top experts in the
area as well as recipient and donor countries, international organizations
and manufacturers to agree to a global action plan.
Production of therapeutic sera in industrialized countries is dropping due
to inadequate profitability, linked to uncertainty about the quantities needed.
In developing countries, affordability is an issue, and production is also
quantitatively limited and often does not reach the quality standard required
to make these treatments effective and safe. WHO estimates its plan to boost
access to treatment will cost US$ 10 million.
" We need to boost local manufacturers' capacity and improve the
delivery of products to remote rural areas," said Dr Howard Zucker, WHO Assistant
Director-General for Health Technologies and Pharmaceuticals.
" There
are effective solutions that could save millions of lives."
Rabies is the tenth most common cause of death due to infections in humans.
It is 100% fatal but 100% preventable when post-exposure treatment using therapeutic
sera is readily available. An estimated eight million people need to receive
anti-rabies serum each year after being exposed to animals suspected of carrying
rabies. Almost half of those requiring the therapeutic sera and those dying
of rabies are children less than 15 years old. More than 99% of all human deaths
from rabies occur in Africa and Asia.
Close to five million snake bites and scorpion stings are recorded each year
in the world (mostly in Africa, Asia and Latin America), 50 to 75% of which
need treatment with therapeutic sera to prevent death, amputation or severe
neurological disorders. The main populations affected are young agricultural
workers and children. Available epidemiological data on the incidence of snake
bites, including the degree of associated mortality and long-term morbidity
are largely hospital-based and therefore underestimate the true scale of the
problem. A majority of snake-bite victims seek traditional treatment and may
die at home unrecorded.
Since the 1970s, the number of manufacturers of anti-venoms against African
snake bites has dropped dramatically. It is estimated that there are one million
snake bites each year in Africa alone resulting in over 20,000 deaths and a
much higher incidence of chronic disability resulting from neurological sequelae
and physical handicap from necrotic effects requiring amputation.
Over 10 million vials of anti-venom sera would be needed to treat snake and
scorpion bites worldwide, with an estimated 2 million vials required for Africa
alone. An estimated 16 million vials of anti-rabies serum would be needed each
year if current international guidelines for post-exposure prophylaxis were
to be fully implemented.
The crisis in the availability of therapeutic sera calls for an international
effort to facilitate the transfer of technology to affected countries and address
major logistic problems in distribution, particularly in ensuring maintenance
of a cold chain. In addition, a lack of knowledge about the correct medical
management of bites and stings from venomous animals, including the appropriate
use of sera, further compromises the efficient clinical use of the limited
quantity of product available.
WHO is planning the following actions, which will be discussed at the 10 January
meeting:
- Define a global standard for the production, quality control, and regulation
of therapeutic sera to be used as guidance by local regulatory authorities
and manufacturers;
- Conduct regional educational workshops to help the implementation of quality
and safety requirements for production of therapeutic sera following the
principles of good manufacturing practices;
- Train inspectors and manufacturers on the critical parameters of the production
of therapeutic sera;
- Facilitate transfer of technology to developing countries;
- Establish a therapeutic sera pre-qualification scheme based on WHO experience
in pre-qualification of other therapeutic products;
- Develop guidance and training materials on the prevention, diagnosis
and management of diseases treatable by therapeutic sera.
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