Travellers beware: Fake rabies vaccine raises stakes in deadly global trade

Criminals have taken the manufacture of counterfeit drugs to lethal new levels by creating a fake human rabies vaccine that is being sold in the Philippines.

The vaccine is a convincing ‘knock-off’ of an Indian-made rabies vaccine, Rabipur, which is sold widely across Asia and has a reputation for reliable quality in protecting people from the deadly virus.
The fake vaccine was detected at Tabuk City, the capital of Kalinga Province on Luzon Island, according to a public warning issued by the Philippines’ Food and Drug Administration (FDA). Authorities are trying to determine where it originated.
It is unclear how long the fake vaccine has been available, but vials are being sold in the city’s vaccination clinics and drug stores, as well as online, the FDA said in a statement.
While canine rabies control programs and increased public awareness in some parts of the country have reduced the incidence of the disease, the Philippines remains a hot spot for rabies in Asia. 

New war on counterfeit drugs

News of the rabies vaccine fakes comes as the United Nation’s Global Fund to Fight AIDS, Tuberculosis and Malaria renewed its war on fake drugs last week. The UN body joined forces with the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), planning global initiatives and creating a ‘Fight The Fakes’ website to highlight the dangers of the deadly trade.

Counterfeit drugs are thought to account for 1% of medication sold in high-income countries, but worldwide that figure could rise to 10% or higher, experts say. The WHO estimates that up to a third of malaria medicines in Africa may be counterfeit, ‘posing a public health risk that can lead to treatment failure, antibiotic resistance, extended illness, disability, and even death’. 
However, a counterfeit rabies vaccine takes the fake drug trade to a new low as it potentially exposes animal bite victims to a disease which is always fatal once symptoms appear.
Indeed, it would be tantamount to murder if someone died as a result of receiving the fake rabies vaccine, according to Dr David Shlim, president of the International Society of Travel Medicine (ISTM).


Fake vaccine ‘equivalent of murder’

“Although most of you (travel medical professionals) will have been aware of the risk of counterfeit medications sold in pharmacies throughout the world, there has been less concern about counterfeit vaccines,” Dr Shlim said in a statement alerting ISTM members around the world to the fake vaccine.
“It’s especially troublesome when the vaccine is known to be life-saving. A fake vaccine could be the equivalent of murder if the patient were to subsequently die.”
For Filipinos who may have received the fake vaccine as part of the post-exposure treatment for rabies, the news means costly revaccination. Those who received the course of vaccine to prevent the disease should be re-immunised with a legitimate vaccine as soon as possible.
As yet, no Australian has come forward to say they had received rabies vaccine in the Philippines recently.
However, any international travellers who were not vaccinated against rabies before they arrived in the Philippines but who received some or all of the 4-5 doses involved in post-exposure treatment while there should be revaccinated as a matter of urgency, Medical Director of Travelvax Australia, Dr Eddy Bajrovic said.
They should contact their doctor or state or territory health department to begin the course of vaccine as soon as possible. The post-exposure vaccine is free to Australians potentially exposed overseas.


Symptoms can appear within days

Rabies symptoms can appear within days, but may take months – even years – to manifest, which is why travellers should always seek urgent treatment if they even suspect that they may have been exposed to the virus through a bite or scratch that punctured the skin.
“Rabies is invariably fatal once the symptoms appear,” Dr Bajrovic said.
“That is why those people who get bitten or scratched, or have a wound licked by a rabies-infected animal, need to act quickly – even to the point of cutting short their holiday and returning home if rapid, effective treatment is not readily available where they are overseas.”
If potentially exposed to rabies from an encounter with an animal, travellers should also take immediate steps to reduce the risk of infection: washing out the wound thoroughly with lots of soap and water, and applying alcohol or iodine, but not binding it. (Read more about rabies prevention and treatment.)
“After that they need to start a series of injections which begins with rabies immunoglobulin (RIG). RIG is followed by 4 or 5 doses of vaccine (depending on the location of the bite and the person’s immune status) over 2-4 weeks to kill the virus before it reaches the nervous system.
“Unfortunately, once the virus enters the nervous system and travels to the brain there’s no effective treatment and invariably the disease rapidly progresses to death. That’s why effective post-exposure vaccination is so vitally important.”
Rabies impacts 5 billion people worldwide, causing tens of thousands of deaths every year. The highest incidence is in Asia, particularly India. (The Global Alliance for Rabies Control believes canine rabies could be eliminated by vaccination for as little as $6 billion, saving the world $124 billion annually, as well as the lives of thousands of people and tens of thousands of dogs. Read more.) 


Beware of fake medicines overseas

The fake rabies vaccine was further proof that the counterfeit drug trade is a sophisticated business run by major drug syndicates with no thought for their victims, Dr Bajrovic said. 
“It’s especially worrying that the fake vaccine was being sold online,” he said.
“It’s just another reason not to buy medication from markets or shops in a foreign country or online unless you are absolutely certain of its quality.
“But, it’s difficult to be certain of quality because in many cases the medication and its packaging appear identical to the real thing.
“It seems the people selling this rabies vaccine through vaccination centres and other outlets in the Philippines have been fooled by the appearance of the outer packaging and the vial inside it.”



However, there are legitimate reasons to buy legal drugs overseas, Dr Bajrovic said.
“It could be a risk becomes apparent only after you arrive, or you run out of medication because you extend your stay,” he said.
“However, use only reputable pharmacies and enquire if they are properly licensed.”
Travelvax Australia also advises travellers to:
 Take sufficient quantities of medication for your journey, including a few day’s extra to cover delays.
 Keep a copy of your prescriptions. Make a note of the brand or generic name and manufacturer of your regular medicine, including those prescribed for your trip (i.e. malaria, traveller’s diarrhoea medicines).
 Avoid buying medicine in market places. Buy it only from licensed pharmacies and ask for a receipt.
 Have the pharmacist check that medication you are getting has the same active ingredient at the same dosage as the one that you’ve taken previously.
 Ensure that the medicine is in its original packaging.
 Look closely at the packaging. Dodgy packaging with poor-quality printing is a tell-tale sign of a fake.

For more advice on pre- or post-exposure rabies vaccination, and carrying medication overseas, call Travelvax Australia’s obligation free travel health advisory service on 1300 360 164 (toll-free for landlines). You can also make an appointment for a pre-travel medical consultation at a clinic to receive vaccines, any medication required, accessories, and personalised advice tailored to your itinerary and your medical history.