John T J
Christian Medical College, Vellore, India.
Vaccine. 1997 Spring;15 Suppl:S12-5. doi: 10.1016/s0264-410x(96)00316-7.
Rabies continues to be an important public health problem in India and many other developing countries. In India, annually some 700,000 persons are given post-exposure vaccine prophylaxis using Semple (sheep brain) vaccine. It is manufactured by government institutions and given free to the public. It is presumed to be cheap, although the actual cost of production may not be low. However, it is not a safe vaccine as it causes demyelinating central or peripheral nervous system side-effects in 1/3000-7000 persons vaccinated; this adverse reaction is occasionally fatal. Cell culture rabies vaccines are also available in India; unlike the Semple vaccine they are safe and can be used for pre-exposure vaccination, but they are more expensive. The dilemma is whether it is ethically acceptable to continue to use the Semple vaccine in humans while safer products are available. What is urgently needed is a decision tree which would enable economical use of cell culture vaccines together with the backing of professional bodies in medical practice, who will declare that cost is not the only factor in choosing a rabies vaccine-safety is also of paramount importance. We must also strive to reduce the cost of cell culture vaccines.
狂犬病在印度和许多其他发展中国家仍然是一个重要的公共卫生问题。在印度，每年约有70万人使用森普尔（羊脑）疫苗进行暴露后疫苗预防。该疫苗由政府机构生产并免费提供给公众。人们认为它价格低廉，尽管实际生产成本可能并不低。然而，它并不是一种安全的疫苗，因为在每3000至7000名接种疫苗的人中，它会导致中枢或外周神经系统脱髓鞘副作用；这种不良反应偶尔会致命。细胞培养狂犬病疫苗在印度也有供应；与森普尔疫苗不同，它们是安全的，可用于暴露前接种，但价格更贵。两难的问题是，在有更安全产品的情况下，继续在人类身上使用森普尔疫苗在伦理上是否可以接受。迫切需要的是一个决策树，它能在医学实践中专业机构的支持下，实现细胞培养疫苗的经济使用，这些专业机构将宣称成本不是选择狂犬病疫苗的唯一因素——安全性同样至关重要。我们还必须努力降低细胞培养疫苗的成本。
