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Khamduang W, Hongjaisee S, Pothita T, Kongyai N, Surajinda S, Petsophonsakul W, Pornprasert S. Antibody response to rabies pre-exposure vaccination among village health volunteers in a northern region of Thailand. Prev Vet Med 2021; 199:105555. [PMID: 34883362 DOI: 10.1016/j.prevetmed.2021.105555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rabies is a lethal, however the disease is preventable through vaccination either before or immediately after an exposure. This study aimed to provide a pre-exposure prophylaxis rabies immunization to village health volunteers (VHV) who provide rabies vaccination for pets and free-roaming dogs in their villages and evaluate the antibody level and adverse effects after vaccination. We also assessed the knowledge related to rabies of these VHVs before field trip for pet vaccination. METHODS This study was conducted at Mae Kha sub district, San Pa Tong district, Chiangmai, Thailand between January and March 2020. Consenting participants were interviewed using a questionnaire, received an intradermal two-dose, seven-day pre-exposure rabies vaccination, and sera were tested for anti-rabies antibody levels with the cost effective easy competitive enzyme-linked immunosorbent assay (CEE-cELISA) before and after vaccination. RESULTS A total of 27 VHVs were recruited from 14 villages in Mae Kha sub district. All of them were male and had a median age of 61.5 years (interquartile range: 55-64). After vaccination, seroconversion rate was 92 % (23/25) with a median of 12.4 EU/mL (interquartile range: 8.9-20.1). Two participants who had rabies vaccination one year previously still had adequate levels before receiving a booster dose. All participants did not show any serious adverse reactions after vaccination. CONCLUSION A regimen of two-dose, seven-day vaccination series in high-risk health volunteers using an intradermal administration provides a high seroconversion rate, efficacy and safe for pre-exposure vaccination schedule. In addition, rabies-related knowledge should be provided to village health volunteers before their fieldwork.
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Affiliation(s)
- Woottichai Khamduang
- Infectious diseases research unit, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.
| | - Sayamon Hongjaisee
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Tippayathida Pothita
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Natedao Kongyai
- Infectious diseases research unit, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sirithorn Surajinda
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Wilaiwan Petsophonsakul
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sakorn Pornprasert
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Schlagenhauf P, Patel D, Rodriguez-Morales AJ, Gautret P, Grobusch MP, Leder K. Variants, vaccines and vaccination passports: Challenges and chances for travel medicine in 2021. Travel Med Infect Dis 2021; 40:101996. [PMID: 33631338 PMCID: PMC7899929 DOI: 10.1016/j.tmaid.2021.101996] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Epidemiology Biostatistics and Prevention Institute, Switzerland.
| | - Dipti Patel
- National Travel Health Network and Centre, UCLH NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, United Kingdom
| | - Alfonso J Rodriguez-Morales
- Grupo de Investigacion Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de las Americas, Pereira, Risaralda, Colombia
| | | | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Public Health, Amsterdam Infection & Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
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Heitkamp C, Stelzl DR, Ramharter M, Bühler S. Rabies exposure in travellers to Asia, the Middle East, Africa, South and Central America-a German Airport study. J Travel Med 2020; 27:5822104. [PMID: 32307548 DOI: 10.1093/jtm/taaa058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Rabies causes thousands of deaths worldwide and trips to rabies endemic countries are popular. Travellers are often uncertain whether pre-exposure prophylaxis (PrEP) is advisable since they find it difficult to estimate the exposure risk during travel and the availability of post-exposure prophylaxis in endemic regions. The aim of this study was to determine the potential rabies exposures in travellers and to assess their knowledge on rabies. Secondly, we explored the access to appropriate post-exposure medical care in respective countries. METHODS We conducted a cross-sectional study at Frankfurt Airport. Returning adult travellers arriving from Asia, the Middle East, Africa, South and Central America were invited to participate in this questionnaire-based study while waiting in the baggage claim area. RESULTS Over a one-month recruitment phase in March 2019, we enrolled 3066 travellers; 2929 were included in the analysis. The gender ratio was balanced; the median age was 42 years (range 18-83 years). Participants arrived from Asia (46%), Africa (29%), Central/South America (13%), the Middle East (8%) and the Caribbean (8%). Forty-five per cent sought pretravel advice and 22% received ≥2 injections of rabies PrEP. Travellers with pretravel advice from tropical medicine specialists reached significantly higher knowledge scores than others. We found that potential rabies exposure occurred in 2.0% (57/2915) of travellers with 31% (13/42) of the contacts being unprovoked; 19% (8/42) of the exposed sought medical care and 3/8 were adequately treated before returning to Germany. Risk factors for animal exposure were: male sex, young age, trips to Asia and a long stay abroad (>4 weeks). CONCLUSIONS A total of 2% of returning travellers (n = 2915) experienced a potential rabies exposure during their journey. A majority of the exposed individuals did not seek medical care; those seeking medical care were often treated inadequately. Rabies information must be emphasised during pretravel counselling and PrEP should be offered generously, especially to travellers with high exposure risks.
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Affiliation(s)
- Christian Heitkamp
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
| | - Daniel Robert Stelzl
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
| | - Silja Bühler
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
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De Pijper CA, Terryn S, Van Gucht S, Grobusch MP, Goorhuis A, Stijnis C. Antibody response in Dutch marines to a single intramuscular rabies booster immunization 1–2.5 years after an intradermal pre-exposure schedule: An observational study. Travel Med Infect Dis 2020; 38:101907. [DOI: 10.1016/j.tmaid.2020.101907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/23/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
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Factors influencing the immune response after a single-dose 3-visit pre-exposure rabies intradermal vaccination schedule: A retrospective multivariate analysis. Travel Med Infect Dis 2020; 37:101867. [PMID: 32871278 DOI: 10.1016/j.tmaid.2020.101867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends intradermal (ID) rabies vaccination as a safe and immunogenic alternative to intramuscular administration. The aim of this study is to determine which factors influence the levels of rabies virus neutralizing antibodies (RVNA) after a 3-visit ID rabies vaccination. METHODS This is a retrospective secondary data analysis study based on electronic health record vaccination data of Belgian military subjects who received ID rabies Pre-exposure prophylaxis (PrEP) with a single-dose 3-visit regimen during the period 2014-2017. Logistic regression was performed to identify predictive factors of RVNA level ≥3.0 IU/mL and >10 IU/mL. RESULTS The second analysis performed on the 2025 subjects (100% seroconverted with a RVNA ≥ 0.5 IU/mL) shows a significantly better immune response in subjects younger than 30 years compared to all other age-groups, a gender-difference to predict RVNA ≥ 3.0 IU/mL (OR 2.30 [1.26-4.22] comparing "female" to "male") and the influence of the vaccination schedule (OR 2.28 [1.15-4.53] comparing "late - very variable" to "correct" schedule) to predict > 10 IU/ml. Multivariate analysis also demonstrates that a postponed serology control significantly influences the Rapid Fluorescent Focus Inhibition Test (RFFIT). CONCLUSION Gender and age significantly influence the response to ID rabies vaccine. Timing of RVNA determination is important to correctly assess the response to vaccination. A single-dose 3-visit ID rabies PrEP schedule is a dose-sparing effective alternative to the double-dose 2-visit ID schedule. When the minimum time interval between doses is respected, RVNA determination is not necessary.
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Epidemiology of rabies cases among international travellers, 2013-2019: A retrospective analysis of published reports. Travel Med Infect Dis 2020; 36:101766. [PMID: 32525075 DOI: 10.1016/j.tmaid.2020.101766] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/18/2020] [Accepted: 05/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sixty cases of rabies in international travellers from 1990 to 2012 were previously reviewed. We present here an update of rabies cases in international travellers from 2013 to 2019. METHODS We systematically reviewed the existing literature and collected 23 cases of rabies in individuals who crossed an international border between the time of infection and diagnosis, or who were infected following expatriation or migration. RESULTS Most cases were in male adult travellers and diagnosed in Europe and the Middle East, with most exposures in Asia or in Africa. Migrants originating from rabies-endemic low-and-middle income countries and their descendants accounted for two thirds of cases. Other cases were in tourists, business travellers and expatriates. Median travel duration (excluding migration trip) was 60 days (range 7-240 days). Most cases were due to dog bites and most common clinical presentation was furious rabies. In most patients (74%), no rabies post-exposure prophylaxis (RPEP) was administered before rabies symptoms appeared. Other patients received incomplete RPEP series. CONCLUSION Rabies should be suspected in any patient with encephalitis or paralysis who travelled to, or migrated from a rabies-endemic country. Comprehensive information about a rabies risk should be given to travellers to rabies endemic countries, notably migrants visiting friends and relatives.
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Moulenat T, Petit C, Bosch Castells V, Houillon G. Purified Vero Cell Rabies Vaccine (PVRV, Verorab ®): A Systematic Review of Intradermal Use Between 1985 and 2019. Trop Med Infect Dis 2020; 5:E40. [PMID: 32156005 PMCID: PMC7157209 DOI: 10.3390/tropicalmed5010040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/31/2020] [Accepted: 03/02/2020] [Indexed: 12/25/2022] Open
Abstract
The purified Vero cell rabies vaccine (PVRV; Verorab®, Sanofi Pasteur) has been used in rabies prevention since 1985. Evolving rabies vaccination trends, including shorter intradermal (ID) regimens with reduced volume, along with WHO recommendation for ID administration has driven recent ID PVRV regimen assessments. Thus, a consolidated review comparing immunogenicity of PVRV ID regimens during pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) is timely and beneficial in identifying gaps in current research. A search of seven databases for studies published from 1985 to November 2019 identified 35 studies. PrEP was assessed in 10 studies (n = 926) with 1-3-site, 1-3-visit regimens of up to 3-months duration. Seroconversion (rabies virus neutralizing antibodies [RVNA] ≥ 0.5 IU/mL) rates of 90-100% were reported within weeks, irrespective of regimen, with robust booster responses at 1 year (100% seroconversion rates by day 14 post-booster). However, data are lacking for the current WHO-recommended, 2-site, 1-week ID PrEP regimen. PEP was assessed in 25 studies (n = 2136) across regimens of 1-week to 90-day duration. All ID PEP regimens assessed induced ≥ 99% seroconversion rates (except in HIV participants) by day 14-28. This review confirms ID PVRV suitability for rabies prophylaxis and highlights the heterogeneity of use in the field.
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Affiliation(s)
- Thomas Moulenat
- Université Claude Bernard Lyon 1, Institut des Sciences Pharmaceutiques et Biologiques (ISPB)—Faculté de Pharmacie de Lyon, 69008 Lyon, France;
| | - Céline Petit
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France; (C.P.); (V.B.C.)
| | | | - Guy Houillon
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France; (C.P.); (V.B.C.)
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Factors influencing the immune response after a double-dose 2-visit pre-exposure rabies intradermal vaccination schedule: A retrospective study. Travel Med Infect Dis 2020; 33:101554. [PMID: 31931134 DOI: 10.1016/j.tmaid.2020.101554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Double-dose 2-visit intradermal rabies schedules (22ID) have recently been accepted by the World Health Organization (WHO) as Pre-Exposure Prophylaxis (PrEP). The aim of this study is to determine which factors influence the levels of rabies virus neutralizing antibodies (RVNA) after a 22ID rabies vaccination schedule. METHODS This is a retrospective study based on electronic health record vaccination data of subjects from the Belgian Armed Forces who received the 22ID rabies PrEP. An antibody titer ≥0.5 IU/mL, measured by rapid fluorescent focus inhibition test, is defined by the WHO as an adequate immune response after PrEP. Logistic regression was performed in order to identify predictive factors of RVNA level ≥3.0 IU/ml and >10 IU/ml. RESULTS 301 subjects were included. 297 (98,6%) seroconverted with a RVNA ≥ 0.5 IU/ml. Multivariate analysis shows a significant better immune response in the subjects where the second dose was administered later on than on day 7 (RVNA >10 IU/ml (OR: 3.01 [1.36-6.67])). Postponing the timing of the serology control also influenced significantly the rapid fluorescent focus inhibition test (RVNA ≥ 3.0 IU/ml (OR: 0.12 [0.06-0.24]) and RVNA > 10 IU/ml (OR: 0.14 [0.06-0.29])). CONCLUSION A 22ID rabies PrEP vaccination schedule is highly effective and provides an adequate immune response in most subjects in a real live setting. Timing of the second vaccine dose significantly influences the response to ID rabies vaccine. Timing of RVNA determination is important in order to correctly assess the response to vaccination.
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Gautret P, Schlagenhauf P, Fischer PR. One-week, two-visit, double-dose, intra-dermal (22ID) rabies vaccination schedule for travelers: Time/dose sparing, effective but “off label”. Travel Med Infect Dis 2020; 33:101563. [DOI: 10.1016/j.tmaid.2020.101563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
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De Pijper CA, Goorhuis A, Grobusch MP, Stijnis C. Reply to Zhao and Miao and to Chen et al." Is the rabies virus neutralizing antibody titerstable during long-term storage? Travel Med Infect Dis 2019; 32:101502. [PMID: 31593761 DOI: 10.1016/j.tmaid.2019.101502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
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Zhao L, Miao F, Chen Q, Wang Y, Zhao T, Chen T, Zhang S, Hu R, Zhao J. Is the rabies virus neutralizing antibody titer stable during long-term storage? Travel Med Infect Dis 2019; 32:101468. [PMID: 31446014 DOI: 10.1016/j.tmaid.2019.101468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/13/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
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Knopf L, Steffen R. Revised recommendations for rabies pre-exposure prophylaxis in travellers: avoid bumpy roads, select the highway! J Travel Med 2019; 26:5423366. [PMID: 30924855 DOI: 10.1093/jtm/taz021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 11/14/2022]
Affiliation(s)
- Lea Knopf
- Neglected Zoonotic Diseases, Department of the Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, World Health Organization Collaborating Centre for Traveller's Health, University of Zurich, Zurich, Switzerland.,Division of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas, Houston, TX, USA
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Schaumburg F, De Pijper CA, Grobusch MP. Intradermal travel vaccinations-when less means more. Travel Med Infect Dis 2019; 28:3-5. [PMID: 30878310 DOI: 10.1016/j.tmaid.2019.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Münster, Domagkstraße 10, 48149, Münster, Germany.
| | - Cornelis A De Pijper
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Infection & Immunity, Amsterdam Public Health, Meibergdreef 9, 1100, DD, Amsterdam, Netherlands
| | - Martin P Grobusch
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Infection & Immunity, Amsterdam Public Health, Meibergdreef 9, 1100, DD, Amsterdam, Netherlands
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De Pijper CA, Stijnis C, Grobusch MP. WHO bites back rabies pre-travel vaccination schedules – Implications for travel medicine. Travel Med Infect Dis 2018; 23:4-5. [DOI: 10.1016/j.tmaid.2018.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
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