The Thai Red Cross protocol experience in Côte d'Ivoire

Rabies is a public health problem in the world especially in Cote d'Ivoire. The epidemiological surveillance of rabies revealed 10,197 exposures with 17 deaths in 2015 and 11,481 exposures with 18 deaths in 2016. The management of exposed people was based on WHO's intramuscular (IM) protocols (Essen and Zagreb). The usual results from these anti-rabies protocols showed low compliance corresponding to 45-50% exposed people who did not complete the Post Exposure Prophylaxis (PEP) schedule, mainly due to the cost of vaccines. The main objective of the project was to test the feasibility of a free rabies PEP based on the Thai Red Cross (TRC) protocol used by intradermal route. The study population was exposed people (patients) vaccinated in the anti-rabies center of Bouake and San Pedro which were two departments selected for this study. The TRC protocol was implemented in year 2017. Patients have been vaccinated according to IM post exposure protocols or by the TRC schedule. This new protocol was administered free of charge to exposed people with their consent. Patients who did not complete the PEP schedule were researched and interviewed for having the reasons related to this non-completion. In 2017, 1625 exposures were registered including 1121 in Bouake and 504 in San Pedro. Overall immunization compliance was 63%. Patients who received the TRC schedule were 829 (52%) With 70% PEP compliance The PEP compliance of Zagreb protocol was 67% and the Essen protocol recorded 38% of PEP compliance. The research of exposed people who did not complete the PEP schedule has shown that cost effectively remains the major limiting factor among exposed people vaccinated by Essen or Zagreb protocols. But negligence was main cause for the non-completion PEP among exposed people who accepted the TRC schedule. Introduction of free rabies PEP through the TRC protocol has found the population support. This experience has been successful with a better PEP compliance, which means safe protection of people from rabies. This study has demonstrate that free rabies vaccine used by ID route is one of the best solutions to improve the PEP compliance in Cote d'Ivoire. Nevertheless, alternatives ways should be provided in order to minimize vaccine wastage rates in anti-rabies center receiving very few exposed persons. Community engagement would be necessary for more rabies awareness raising and improving bite victim's follow-up.