Why casualty departments fall short of rabies vaccine

There are just two manufacturers of this medicine in Russia that aren’t handling supplies

Disruptions to supplies of a rabies vaccine has been seen in Russia for several months. People have complained about the same problem in Kazan too. Particularly, a citizen who is one of the victims who was bitten by a dog told Realnoe Vremya that she had received the last dose. After calling Kazan casualty departments, our correspondent managed to find out that, indeed, there was a deficit of the medicine in some cases. So Aviastroitelny District has just four ampoules. The Tatarstan Health Care Ministry assures that the disruptions to the rabies vaccine supply have already stopped. Heads of health establishments also claimed that last year’s problem that hit many regions of the country is solved step by step. A lack of the medicine was called a cause of the failure: after legislative restrictions were tightened, an analogue stopped being imported, while two Russian vaccine manufacturers aren’t handling supplies. Much turns on the promptness of chief physicians too: if they shake a leg and get the vaccine. If not, citizens who were bitten won’t receive help like it happened in Zelenodolsk.

Just one dose

A neighbour’s dog bit a Kazan citizen’s knee. As it turned out, the dog hadn’t been vaccinated. So the casualty department where the woman turned to had the last rabies vaccine, while she wasn’t inoculated against tetanus but was sent to a polyclinic. While a bitten person should receive six injections strictly on schedule, moreover, the first vaccine should be administered during the day.

A similar situation happened a month ago in Zelenodolsk District. Stray dogs attacked two fourth-year schoolgirls, one of them was bitten on her way to a music school, the other was near an urban lake. However, health establishments didn’t vaccinate the girls citing they didn’t have the necessary medicine. The indignant parents had to go to the city’s administration. The problem gets worse because Cocav or Rabipur, which are used to treat rabies in Russia, can’t be purchased over-the-counter — they are sold only to legal entities. Moreover, casualty departments receive citizens strictly according to their place of residence. And if the health establishment doesn’t have the vaccine, you can be denied in another place.

Chief doctor for infectious diseases of the Tatarstan Health Care Ministry, Docent of Kazan State Medical University’s Department for Infant Infections Khalit Khayertynov reminded us: rabies is a deadly and incurable infection nowadays.

“If a person has rabies, it is almost impossible to save him. This is why vaccination, which is crucial in the prevention of this disease, is the only way to avoid such consequences. Especially, it is unknown if the animal was vaccinated. Moreover, this applies not only to dogs but also animals living in the wild — foxes, hedgehogs, moles and others that can spread the rabies virus. This is why any bite is a foundation to go to a casualty department because vaccination takes place there, not in the hospital for infectious diseases.”

Is certification guilty?

A shortage of vaccines against rabies started to be felt in different Russian regions as early as last year. Only two Russian enterprises make the medicine — the Chumakov Federal Research Centre for Immunobiological Drugs, which holds nearly 70% of the market, and Microgen R&D Association.

The Tatarstan Ministry of Health Care didn’t manage to explain the reason for the supply problems assuming that there was a deficit of the amount of the good. Moreover, the Chumakov Centre was focused on making a coronavirus vaccine during the whole year:

“In any case, we are ordering the medicine, purchasing it as much as we can. At the moment health establishments have it at their disposal. Now batches are distributed as soon as supplies are received,” the press service of the Tatarstan Health Care Ministry told our newspaper.

The enterprises themselves cite new rules of vaccine certification due to which the procedure became longer. The quality control used to be selective, now every batch is examined. For instance, the Chumakov Centre didn’t supply the product to the market at all in the first quarter of 2020.

Khalit Khayertynov explained that the Health Care Ministry did its estimates regarding every vaccine.

“Since rabies is topical due to its consequences, it isn’t anyway such a widespread disease, a small amount of vaccines is made, they look at the annual statistics on the number of bitten victims. Stocks of vaccines should be held approximately for this number.”

“There was a problem but it was solved”

Realnoe Vremya called Kazan casualty departments. All the departments said they already had both tetanus anatoxin and a rabies vaccine. However, the casualty department in Hospital No. 12 admitted that they had just four ampoules in stock and only for patients from their area.

“Why so little?”

“The situation is the same across the city.”

However, the head of the casualty department in Novo-Savinovsky District claimed: “I don’t know the state of affairs in Kazan, but we don’t have such problems”. Head of Trauma and Orthopaedics Department in Hospital No. 18 in Privolzhsky District Ernest Gazizov noted in a talk with our newspaper that the problem of the rabies vaccine was already a thing of the past and it mainly depended on the promptness of health establishments themselves.

“When we had problems with the rabies vaccine, we solved them. Other polyclinics should solve them too. The medicine is distributed according to polyclinics’ applications. There is no problem with tetanus anatoxin, every polyclinic has it. If some doesn’t have it, they should go to their chief physician, might he or she solve the problem. They receive a salary for this. There were problems with the rabies vaccine, but they were solved as the vaccine was supplied, Tatchempharmpreparaty supplies it on demand. Purchases are made centrally.”

He also explained the situation with the Kazan citizen who wasn’t injected a serum against tetanus. The case is that it is a part of the Russian DTP vaccine whose components are designed to provide immunity to two diseases at once — diphtheria and tetanus. It is administered once in 10 years. The casualty department sent the woman to the polyclinic to figure out when she last time received such a vaccine.

“Such vaccines aren’t administered uncontrollably now. The polyclinic in one’s residence area has a vaccination room, there is an archive, the archive is checked out, only then the issue is resolved,” Gazizov explained.

No rabies case since New Year

The rabies virus is deadly not only for humans but also animals, both domestic and wild animals. Last year, 37 cases of infection were found in Tatarstan, which is 13 cases more than in 2019. Head of the Main Veterinary Office of the Tatarstan Cabinet of Ministers Almaz Khisamutdinov explained such growth at a panel meeting with the Tatarstan office of Russia’s agriculture safety watchdog — “the infection is cyclical”.

As Director of the Republican Veterinary Laboratory Ayrat Garayev told Realnoe Vremya, no case has been reported since the beginning of the year, though suspicious animals were brought for testing. He noted that domestic animals can catch the dangerous virus in the countryside or in nature via rodents, foxes, hedgehogs. An infected animal, sadly, can’t be treated.

“If the owner sees an animal is aggressive, has a fear of water, salivation, he or she should go to the local state veterinary service, which all cities and districts have. Before this, it is necessary to isolate the animal in a cage so that it won’t scratch or bite anybody. A new order of the Russian Ministry of Agriculture was issued on 1 March — the animal must be supervised by veterinarians for 14 days (previously, 10 days). If it is really infected with rabies, it dies within 10 days, and a diagnosis is made after autopsy. If the animal survived, it means rabies is ruled out, and it suffers from another disease,” Garayev explained.
By Eleonora Rylova