AREB members proposed support for a new comprehensive demonstration project of PrEP vaccination in school children, to be implemented in the Philippines in early 2010. The aims of the project are to complement current experience, to confirm the feasibility of PrEP vaccination, to evaluate the efficacy of PrEP in preventing rabies in children MLN0128 cost who live in areas where dog rabies has not been eliminated, and to estimate the health and economic impact of the PrEP strategy. Administration of PrEP to infants is an alternative approach to vaccinating school age children and has the advantage that protection begins at an earlier age. Clinical

trials conducted in Thailand [9] and in Viet Nam [10] and [11] have shown that rabies vaccine can be safely and effectively administered at the same time as routine pediatric vaccines, e.g.: the Japanese encephalitis vaccine [9], or the combination vaccine against

diphtheria, tetanus, pertussis, and poliomyelitis (DTP-IPV) [10] and [11]. Integration of rabies vaccine into the Expanded Program of Immunization (EPI) would facilitate access to the targeted population and minimize operational costs. AREB members thus recommended that demonstration projects should be conducted to evaluate the feasibility of introducing rabies vaccination into the EPI in countries where the risk of rabies is high. PrEP implementation is not intended Quizartinib clinical trial to eliminate the need for

management of rabies exposure, nor to compromise vaccine availability for PEP. AREB members agreed that PrEP programs must be coupled with complementary strategies aiming at increasing dog vaccination coverage, raising public awareness and education, and increasing access to and compliance with PEP. In Thailand, the number of human rabies deaths decreased from 200–300 in the Terminal deoxynucleotidyl transferase early 1980s to the present level of less than 20 annually—this is thanks to outstanding management of dog bite victims and the use of modern cell-culture vaccines. However, rabies is not yet controlled in the dog population in Thailand [12] as 500,000 bite victims still required rabies PEP in 2008. Consequently, large-scale PrEP immunization of children has been advocated to further reduce the number of rabies deaths, but financial barriers have hindered its implementation until now. Cost-effectiveness studies have shown that childhood immunization programs increase the initial total annual expense of immunization (PrEP and PEP), but the cost gradually decreases, and in the long term would be equal to that of PEP without pre-exposure childhood immunization [13]. Another cost-analysis study showed that the total expense would reach equilibrium after 15 years and that the time required to reach breaking point can be shortened proportionally to successful implementation of dog population control measures.