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Bote et al. One Health Implement Res 2023;3:11-5 One Health &
DOI: 10.20517/ohir.2022.46
Implementation Research

Commentary Open Access

WHO’s latest rabies recommendations and guidance
save lives and reduce the cost of treatment

1,2
1
Katrin Bote , Deborah Nadal , Bernadette Abela 1
1
Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva 1211, Switzerland.
2
Department of Humanities, Ca' Foscari University of Venice, Venice 30123, Italy.
Correspondence to: Dr. Katrin Bote, Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue
Appia 20, Geneva 1211, Switzerland. Email: botek@who.int
How to cite this article: Bote K, Nadal D, Abela B. WHO’s latest rabies recommendations and guidance save lives and reduce the
cost of treatment. One Health Implement Res 2023;3:11-4. https://dx.doi.org/10.20517/ohir.2022.46
Received: 27 Dec 2022 Revised: 13 Mar 2023 Accepted: 15 Mar 2023 Published: 22 Mar 2023

Academic Editors: Gad Baneth, Jorg Heukelbach Copy Editor: Ke-Cui Yang Production Editor: Ke-Cui Yang

Abstract
Rabies vaccination is a crucial part of rabies post-exposure prophylaxis (PEP), but it tends to consist of long and
costly regimens of intramuscular (IM) injections. Most human rabies deaths are caused by delayed access,
unaffordability or ineffective delivery of PEP. Reducing these barriers is crucial to ensure that this incurable yet
preventable disease does not cost lives. In 2022, WHO published new guidance towards the introduction or
expansion of rabies vaccination into national immunization programmes to systematically drive down human
rabies deaths effectively and cost-efficiently. Such guidance grounds on the latest scientific recommendation
provided by WHO’s Strategic Advisory Group of Experts in 2018. WHO recommends a shortened 1-week rabies
vaccination schedule, with visits on days 0, 3 and 7. On each visit, a 2-site intradermal (ID) injection (using only 0.1
ml of vaccine in each site) is administered. ID administration allows for vials to be shared among several patients
within a 6-8 hours timeline. Compared to IM administration, ID is cost- and dose-sparing, even in low-throughput
clinics. Additionally, this regimen requires only 3 visits to the healthcare facility, improving patient compliance.
However, the uptake of this shortened ID regimen remains limited. It should now be a matter of urgency for Health
Ministries in rabies-endemic settings to adopt the WHO-recommended shortened ID vaccination schedule and
ensure appropriate medical training to improve PEP delivery. This will enable countries to improve PEP delivery and
allow underserved populations to access affordable, life-saving rabies vaccines.

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
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