A Snapshot of Veterinary Education Establishments and Veterinary Statutory Bodies in Asia and the Pacific Region: Issues Identified and OIE Activities to Address Them.

Veterinary education establishments (VEEs) and veterinary statutory bodies (VSBs) play key roles in ensuring the effectiveness of veterinary professionals and delivery of competent national veterinary services (VS). Recognizing the need to address the quality of veterinary education and the role of VSBs for its member countries/territories (Members), the World Organisation for Animal Health (OIE) has organized conferences, workshops, and ad hoc groups leading to the development of recommendations and guidelines and the introduction of active programmers on veterinary education. In Asia and the Pacific region, veterinary education and practice as well as regulatory approach among Members vary considerably, and limited information is currently available publicly. In 2018, the OIE organized a workshop for VEEs and VSBs in Asia and the Pacific region, for which participants completed a questionnaire regarding each country's situation relating to veterinary education, regulations, and professionals. The questionnaire results showed that most Members and Observers (Members/Observers) in Asia had at least one VEE and that the OIE guidelines for VEEs are widely used. Similarly, most Members/Observers in Asia had a VSB or equivalent authority that oversees the quality and competence of veterinarians. Some challenges were also revealed, including variations in the roles, responsibilities, and level of autonomy of VSBs and weak collaboration/coordination among the key in-country/territory stakeholders of veterinary education. The OIE offers Members recommendations and guidelines as well as several programs and activities aiming to strengthen the VS, VEEs, and VSBs, including the evaluation of veterinary services' performance, the VEE and VSB twinning projects, and conferences and workshops.

Rabies post-exposure prophylaxis initiation and adherence among patients in Vietnam, 2014-2016.

BACKGROUND: Adhering to post-exposure prophylaxis (PEP): wound treatment, vaccine, and rabies immunoglobulin (RIG) is a crucial step in preventing rabies mortality. When PEP is widely available, a lack of adherence to the recommended treatment guidelines can also lead to death. Our objective was to understand characteristics associated with adherence to the vaccine regimen and RIG in Vietnam. METHODS: We obtained individual-level data on PEP adherence from registries at 10 sites located in five provinces. From these registries, we extracted epidemiologic characteristics of patients including the timing of PEP initiation and completion. We used descriptive analyses and logistic regression to examine patient characteristics associated with initiation and completion of RIG and vaccine. Based on reported rabies mortality, the government defined provincial rabies burden as medium-burden (<5 and >2 deaths) and high-burden (≥5 deaths). RESULTS: During 2014-2016, 15,646 patients received PEP in our study. Among 14,296 vaccinated patients, only 41.4% (5847) completed their five-dose intramuscular (IM) injections and 81.6% (133) of patients completed their eight-dose intradermal (ID) injections. Approximately 26% of patients received RIG. Patient characteristics associated with vaccine completion were females (44%), <15 years of age (44%), category 1 exposure (68%, bite location on leg (46%), bite from bat (56%), bite from a healthy animal (45%), high-burden province (86%), and district preventive center (49%). Disparities were revealed among provinces, with high-burden provinces having highest (86%) and lowest (7%) vaccine completion rates. CONCLUSIONS AND RELEVANCE: Vietnam has made tremendous progress towards reducing the burden of rabies. However, despite the wide availability of PEP, we found relatively low rates of vaccine completion. Our findings suggest provider training and patient education is needed to ensure appropriate treatment is completed. Moreover, our data suggest changes to information reported through the national surveillance system for monitoring good clinical practice for rabies prevention and control.

Evaluation of Vietnam's post-exposure prophylaxis delivery system, 2017.

BACKGROUND: Canine-mediated human rabies deaths typically occur in poor and rural populations with limited access to rabies biologics: vaccine and immunoglobulin. A critical aspect of reducing rabies deaths is understanding how these countries procure, deliver, and forecast rabies biologics. Vietnam is one of the few endemic countries where biologics is widely available. However, a formal evaluation of its current rabies biologics distribution system has not been conducted. METHODS: In 2017, we conducted a formal evaluation of Vietnam's rabies biologics distribution system. Our goals were (1) to identify centers providing rabies biologics (2) identify costs to the patient and centers and (3) assess the rabies biologic procurement and delivery system at eligible district and provincial centers (provides and orders biologics for itself and other centers directly from the manufacture). To conduct the formal evaluation, we developed a standardized survey that was distributed to centers. RESULTS: Of the 780 designated rabies biologics centers in Vietnam, 659 (84%) of them provide rabies immunoglobulin (eRIG), vaccine, or both. Of the 177 eligible centers, 90% (160) responded to the survey. The average costs to patients were $8.45 (range: 5.43-12.77) for one dose of IM injection, $13.90 (range: 11.86-16.71) for domestic eRIG, and $23 (21.11-27.11) for imported eRIG. Respondents reported experiencing delays in receiving vaccine in 50 centers and eRIG in 14 centers within the past year. Respondents stated their top three challenges in providing biologics were: delays or shortages from manufactures, lack of funds to pay for biologics, and the high cost of biologics. CONCLUSIONS AND RELEVANCE: Despite the wide availability of biologics in Vietnam, more work is needed to provide affordable and reliable supply of biologics to patients. This includes the expansion of ID injection use throughout the country to lower vaccine demand, and decrease the costs to centers and patients. Furthermore, a more coordinated effort to share biologics among centers, possibly through a more centralized system at the provincial level may alleviate delays and shortages.