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Xu C, Lau CL, Clark J, Rafferty AC, Mills DJ, Ramsey L, Gilbert B, Doi SAR, Furuya-Kanamori L. Immunogenicity after pre- and post-exposure rabies vaccination: A systematic review and dose-response meta-analysis. Vaccine 2021; 39:1044-1050. [PMID: 33478786 DOI: 10.1016/j.vaccine.2021.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are a myriad of vaccine schedules for rabies pre- (PrEP) and post-exposure prophylaxis (PEP) that differ in the number and timedoses, number of visits, length of schedule, and route of administration. The objective of this study was to systematically review the evidence and investigate how thedifferences in schedules influence titres over time. METHODS Four databaseswere searched from inception to January 2020 for rabies PrEP and PEP studies. Adose-response meta-analysis was utilised to pool geometric mean titres (GMT) over time. Subgroup analyses by route of administration, age group, and schedule were conducted. RESULTS 80 studies met the inclusion criteria and contributed with 191 datasets and 12,413 participants. Both intradermal (ID) and intramuscular (IM) PrEP/PEP produce adequate GMTs. Significantly lower GMT levels were achieved in older (>50yrs) compared to younger (<50yrs) participants. Short 1-week schedules were as effective as longer schedules that can take between 3 and 12 weeks to complete. CONCLUSIONS Several effective ID and IM schedules were identified, the selection of a schedule should take into account the patient's needs, costs, availability to return for subsequent doses, and the time required to complete the schedule. Older individuals warrant special attention as they develop lower antibody response.
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Affiliation(s)
- Chang Xu
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar
| | - Colleen L Lau
- Research School of Population Health, Australian National University, Canberra, Australia; Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Anna C Rafferty
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Deborah J Mills
- Research School of Population Health, Australian National University, Canberra, Australia; Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, Australia
| | - Lani Ramsey
- Travel-Bug Vaccination Clinic, Adelaide, Australia
| | | | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar
| | - Luis Furuya-Kanamori
- Research School of Population Health, Australian National University, Canberra, Australia.
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2
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Denis M, Knezevic I, Wilde H, Hemachudha T, Briggs D, Knopf L. An overview of the immunogenicity and effectiveness of current human rabies vaccines administered by intradermal route. Vaccine 2018; 37 Suppl 1:A99-A106. [PMID: 30551985 DOI: 10.1016/j.vaccine.2018.11.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/16/2018] [Accepted: 11/26/2018] [Indexed: 12/01/2022]
Abstract
Pre- as well as post-exposure prophylaxis plays an important role in controlling the number of deaths associated with human rabies. Rabies vaccines, classically injected intramuscularly, are now also administered by intradermal (ID) route. Vaccines to be administered by the ID route should meet the same quality, safety and efficacy specifications as vaccines for intramuscular (IM) use. The aim of this paper is to provide information based on publicly available data regarding the ID use of rabies vaccines and to identify potential needs for further analysis of the potency, immunogenicity and effectiveness of rabies vaccines administered by this route. A first literature search, focused on the immunogenicity of rabies vaccines given by ID route, identified 338 publications in the period 1997-2018, 40 of which were included in our analyses. A second search investigating the effectiveness of ID vaccination resulted in 371 hits for the period 2007-2018, of which 13 suitable publications were retained. The immunogenicity of current rabies vaccines was analyzed in 3 ways: proportion of subjects reaching the antibody threshold of 0.5 IU/ml after ID vaccination, relationship between potency and immunogenicity of the vaccine given intradermally, and comparison of antibody responses after IM or ID vaccination. Overall, vaccines administered intradermally were found immunogenic. Post-exposure prophylaxis by ID route appeared at least as immunogenic as by IM regimens. By contrast, ID pre-exposure prophylaxis trended towards lower antibody titers than IM vaccination, but the observation was not associated with any clinical relevance. Vaccine effectiveness was assessed by investigating survival after exposure. Data from more than 30,000 patients who sought rabies post-exposure prophylaxis did not indicate that current vaccines administered by ID route lack efficacy. These results support current recommendations for ID vaccination against rabies. However, published data on ID performance were associated with significant weaknesses that future research should better address.
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Affiliation(s)
| | - Ivana Knezevic
- Department of Essential Medicines and Health Products, Norms and Standards for Biologicals, World Health Organization, Geneva, Switzerland
| | - Henry Wilde
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thiravat Hemachudha
- World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Deborah Briggs
- Kansas State University, College of Veterinary Medicine Manhattan, USA
| | - Lea Knopf
- Neglected Zoonotic Diseases, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Vescovo P, Rettby N, Ramaniraka N, Liberman J, Hart K, Cachemaille A, Piveteau LD, Zanoni R, Bart PA, Pantaleo G. Safety, tolerability and efficacy of intradermal rabies immunization with DebioJect™. Vaccine 2017; 35:1782-1788. [PMID: 28317660 DOI: 10.1016/j.vaccine.2016.09.069] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 09/02/2016] [Accepted: 09/12/2016] [Indexed: 10/19/2022]
Abstract
In a single-center study, 66 healthy volunteers aged between 18 and 50years were randomized to be immunized against rabies with three different injection routes: intradermal with DebioJect™ (IDJ), standard intradermal with classical needle (IDS), also called Mantoux method, and intramuscular with classical needle (IM). "Vaccin rabique Pasteur®" and saline solution (NaCl 0.9%) were administered at D0, D7 and D28. Antigen doses for both intradermal routes were 1/5 of the dose for IM. Tolerability, safety and induced immunogenicity of IDJ were compared to IDS and IM routes. Pain was evaluated at needle insertion and at product injection for all vaccination visits. Solicited Adverse Event (SolAE) and local reactogenicity symptoms including pain, redness and pruritus were recorded daily following each vaccination visit. Adverse events (AE) were recorded over the whole duration of the study. Humoral immune response was measured by assessing the rabies virus neutralizing antibody (VNA) titers using Rapid Fluorescent Focus Inhibition Test (RFFIT). Results demonstrated that the DebioJect™ is a safe, reliable and efficient device. Significant decreases of pain at needle insertion and at vaccine injection were reported with IDJ compared to IDS and IM. All local reactogenicity symptoms (pain, redness and pruritus) after injection with either vaccine or saline solution, were similar for IDJ and IDS, except that IDJ injection induced more redness 30min after saline solution. No systemic SolAE was deemed related to DebioJect™ and classical needles. No AE was deemed related to DebioJect™. No Serious Adverse Event (SAE) was reported during the study. At the end of the study all participants were considered immunized against rabies and no significant difference in humoral response was observed between the 3 studied routes.
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Affiliation(s)
| | - Nils Rettby
- Vaccine and Immunotherapy Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Julie Liberman
- Vaccine and Immunotherapy Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Karen Hart
- Vaccine and Immunotherapy Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | | | - Reto Zanoni
- Institute of Virology and Immunology in cooperation with the Vetsuisse Faculty of the University of Bern, Bern, Switzerland
| | - Pierre-Alexandre Bart
- Vaccine and Immunotherapy Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Giuseppe Pantaleo
- Vaccine and Immunotherapy Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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4
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Rupprecht CE, Kuzmin IV. Why we can prevent, control and possibly treat – but will not eradicate – rabies. Future Virol 2015. [DOI: 10.2217/fvl.15.26] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Rabies is an acute, progressive viral encephalitis. Despite historical recognition, millions still remain exposed annually. Most fatalities are of children, although this zoonosis is a vaccine-preventable disease. All developed countries interrupted canine transmission and increasingly, Asian and African communities recognize what Latin Americans demonstrated – dog rabies can be eliminated – by mass application of veterinary vaccines. Realistically, rabies is not a candidate for eradication. Management is lacking for major reservoirs, such as bats. Increasing pre-exposure immunization of individuals at risk, simplification of postexposure schedules, enhancing vaccine delivery by alternative routes, development of less expensive biologics and antiviral drugs, may lessen its impact if applied strategically in a One Health context.
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Affiliation(s)
| | - Ivan V Kuzmin
- University of Texas Medical Branch, Galveston, TX, USA
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5
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Tantawichien T, Sibunruang S, Tantawichien T, Angsanakul J, Benjavongkulchai M, Limsuwan K, Udomchaisakul P, Khomvilai S, Sitprija V. Safety and immunogenicity of chromatographically purified Vero cell rabies vaccine for intradermal pre- and post-exposure rabies prophylaxis. Expert Rev Vaccines 2014; 13:1593-601. [DOI: 10.1586/14760584.2014.971764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Madhusudana SN, Mani RS. Intradermal vaccination for rabies prophylaxis: conceptualization, evolution, present status and future. Expert Rev Vaccines 2014; 13:641-55. [DOI: 10.1586/14760584.2014.901893] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Shampur Narayan Madhusudana
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research on Rabies, National Institute of Mental Health and Neurosciences (NIMHANS),
Bangalore, Karnataka 560029, India
| | - Reeta Subramaniam Mani
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research on Rabies, National Institute of Mental Health and Neurosciences (NIMHANS),
Bangalore, Karnataka 560029, India
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Hu Q, Liu MQ, Zhu ZG, Zhu ZR, Lu S. Comparison of safety and immunogenicity of purified chick embryo cell vaccine using Zagreb and Essen regimens in patients with category II exposure in China. Hum Vaccin Immunother 2014; 10:1645-9. [PMID: 24632727 DOI: 10.4161/hv.28420] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The aim was to compare the safety and immunogenicity of purified chick embryo cell vaccine (PCECV) with Zagreb 2-1-1 and Essen 1-1-1-1-1 regimens in patients with WHO category II exposure in China. Side effects including systemic and local symptoms were recorded for all patients during vaccination with purified chick embryo cell vaccine (PCECV) under Zagreb 2-1-1 or Essen 1-1-1-1-1 regimens, and the rabies neutralization antibody titers in patients' serum at days 0, 7, 14, 45, 365 post-immunization were measured to determine the immunogenicity. Fever and pain were the most common events for systemic and local symptoms respectively, and most side effects (86.78%, 105/121) occurred after the first dose of vaccination. Safety analysis showed differences in side effects in<5-year-old patients between Zagreb and Essen regimens, especially after the first dose of vaccination (P = 0.043). Immunogenicity analysis indicated that Zagreb can achieve higher neutralization antibody titers and a greater seroconversion rate in a shorter time but had less persistence than Essen. When compared with the Essen regimen, the Zagreb regimen had a different immunogenicity in all study subjects, and different safety profile in young children, and a further study with a larger population and longer surveillance is warranted.
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Affiliation(s)
- Quan Hu
- Wuhan Centers for Disease Prevention and Control; Wuhan, PR China
| | - Man-Qing Liu
- Wuhan Centers for Disease Prevention and Control; Wuhan, PR China
| | - Zheng-Gang Zhu
- Wuhan Centers for Disease Prevention and Control; Wuhan, PR China
| | - Ze-Rong Zhu
- Wuhan Centers for Disease Prevention and Control; Wuhan, PR China
| | - Sha Lu
- Wuhan Centers for Disease Prevention and Control; Wuhan, PR China
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8
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Kappagoda S, Ioannidis JPA. Prevention and control of neglected tropical diseases: overview of randomized trials, systematic reviews and meta-analyses. Bull World Health Organ 2014; 92:356-366C. [PMID: 24839325 DOI: 10.2471/blt.13.129601] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/18/2013] [Accepted: 01/02/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To analyse evidence from randomized controlled trials (RCTs) on the prevention and control of neglected tropical diseases (NTDs) and to identify areas where evidence is lacking. METHODS The Cochrane Central Register of Controlled Trials and PubMed were searched for RCTs and the Cochrane Database of Systematic Reviews and PubMed were searched for meta-analyses and systematic reviews, both from inception to 31 December 2012. FINDINGS Overall, 258 RCTs were found on American trypanosomiasis, Buruli ulcer, dengue, geohelminth infection, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, rabies, schistosomiasis or trachoma. No RCTs were found on cysticercosis, dracunculiasis, echinococcosis, foodborne trematodes, or human African trypanosomiasis. The most studied diseases were geohelminth infection (51 RCTs) and leishmaniasis (46 RCTs). Vaccines, chemoprophylaxis and interventions targeting insect vectors were evaluated in 113, 99 and 39 RCTs, respectively. Few addressed how best to deliver preventive chemotherapy, such as the choice of dosing interval (10) or target population (4), the population coverage needed to reduce transmission (2) or the method of drug distribution (1). Thirty-one publications containing 32 systematic reviews (16 with and 16 without meta-analyses) were found on American trypanosomiasis, dengue, geohelminths, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, schistosomiasis or trachoma. Together, they included only 79 of the 258 published RCTs (30.6%). Of 36 interventions assessed, 8 were judged effective in more than one review. CONCLUSION Few RCTs on the prevention or control of the principal NTDs were found. Trials on how best to deliver preventive chemotherapy were particularly rare.
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Affiliation(s)
- Shanthi Kappagoda
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, United States of America (USA)
| | - John P A Ioannidis
- Stanford Prevention Research Center, Stanford University School of Medicine, 1265 Welch Road, MSOB X306, Stanford, California, 94305-5411, USA
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Gogtay N, Nagpal A, Mallad A, Patel K, Stimpson S, Belur A, Thatte U. Demographics of animal bite victims & management practices in a tertiary care institute in Mumbai, Maharashtra, India. Indian J Med Res 2014; 139:459-62. [PMID: 24820842 PMCID: PMC4069742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND & OBJECTIVES Rabies is an important public health problem worldwide and more than 55,000 people die annually of the disease. The King Edward Memorial Hospital, Mumbai, is a tertiary referral centre where a rabies clinic runs 24 hours. In view of lack of information about the demographics of the disease in an urban environment the present study was carried out. METHODS Data on 1000 consecutive animal bite victims presenting to the institute in 2010 were collected over a 15 wk period. An electronic database was specially created for capturing information and was modelled on the information available from the WHO expert consultation on rabies, 2005. Economic burden from the patients' perspective was calculated using both direct and indirect costs. RESULTS The victims were largely males (771 subjects). The dog was the major biting animal (891, 89.1%).Bites were mainly of Category III (783, 78.3%). One twenty three subjects used indigenous treatments only for local wound care. Of the Category III bites, only 21 of 783 (2.7%) patients were prescribed human rabies immunoglobulin (HRIG) which was primarily for severe bites or bites close to or on the face. A total of 318 patients did not complete the full Essen regime of the vaccine. The median cost to the patient per bite was Rs. 220 (3.5 USD). INTERPRETATION & CONCLUSIONS Our findings showed that the use of HRIG was low with less than 2 per cent of the Category III patients being prescribed it. As vaccine and HRIG continue to remain expensive, the intradermal vaccine, shorter regimes like the Zagreb regime and monoclonal antibodies may offer safer and cost-effective options in the future. Further studies need to be done in different parts of the country.
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Affiliation(s)
- N.J. Gogtay
- Department of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Mumbai, India,Reprint requests: Dr N.J. Gogtay, Additional Professor, Department of Clinical Pharmacology, Seth G.S. Medical College & KEM Hospital, New M.S. Building 1st Floor, Acharya Donde Marg, Parel, Mumbai 400 012, India e-mail:
| | - A. Nagpal
- Department of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - A. Mallad
- Department of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - K. Patel
- University of Massachusetts Medical School, Boston, MA, USA
| | - S.J. Stimpson
- University of Massachusetts Medical School, Boston, MA, USA
| | - A. Belur
- Department of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - U.M. Thatte
- Department of Clinical Pharmacology, Seth GS Medical College & KEM Hospital, Mumbai, India
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Pearton M, Pirri D, Kang SM, Compans RW, Birchall JC. Host responses in human skin after conventional intradermal injection or microneedle administration of virus-like-particle influenza vaccine. Adv Healthc Mater 2013; 2:1401-10. [PMID: 23564440 DOI: 10.1002/adhm.201300006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Indexed: 11/06/2022]
Abstract
Miniaturized microneedle devices are being developed for painlessly targeting vaccines to the immune cell populations in skin. As skin immunization studies are generally restricted to animal models however, where skin architecture and immunity is greatly different to human, surprisingly little is known about the local human response to intradermal (ID) vaccines. Here surgically excised human skin is used to explore for the first time the complex molecular and cellular host responses to a candidate influenza vaccine comprising nanoparticulate virus-like-particles (VLPs), administered via conventional hypodermic injection or reduced scale microneedles. Responses at the molecular level are determined by microarray analysis (47,296 discrete transcripts) and validated by quantitative PCR (96 genes). Cellular response is probed through monitoring migration of dendritic cells in viable skin tissue. Gene expression mapping, ontological analysis, and qPCR reveal up-regulation of a host of genes responsible for key immunomodulatory processes and host viral response, including cell recruitment, activation, migration, and T cell interaction following both ID and microneedle injection of VLPs; the response from the microneedles being more subtle. Significant morphological and migratory changes to skin dendritic cells are also apparent following microneedle VLP delivery. This is the first study displaying the global, multifaceted immunological events that occur at the site of vaccine deposition in human skin and will subsequently influence the degree and nature of innate and adaptive immune responses. An increased understanding of the detailed similarities and differences in response against antigen administered via different delivery modalities will inform the development of improved vaccines and vaccine delivery systems.
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Affiliation(s)
- Marc Pearton
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, UK
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Franka R, Smith TG, Dyer JL, Wu X, Niezgoda M, Rupprecht CE. Current and future tools for global canine rabies elimination. Antiviral Res 2013; 100:220-5. [PMID: 23871797 DOI: 10.1016/j.antiviral.2013.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 07/01/2013] [Accepted: 07/07/2013] [Indexed: 12/25/2022]
Abstract
Even though rabies is almost uniformly fatal, it is readily preventable with currently available tools. Vaccination is highly efficacious for the pre-exposure prophylaxis (PrEP) of rabies in humans and animals, and prompt postexposure prophylaxis (PEP) with vaccine and rabies immune globulin (RIG) can reliably prevent disease in humans. However, access to these tools and knowledge of their proper use are often limited, especially in impoverished, rabies-enzootic countries with the highest disease burden. In the absence of reliable diagnostic capacity and risk assessments, vaccines and RIG are often administered inappropriately, leading to chronic supply shortages and otherwise preventable deaths. Rather than focusing solely on human prophylaxis, it is more cost-effective over the long term to eliminate canine rabies in its natural terrestrial reservoirs. Because more than 99% of human rabies deaths result from dog bites, prevention efforts should focus on dogs. A versatile "One Health" strategy for canine rabies elimination should aim to create sustainable herd immunity in dogs, using proven vaccination strategies at the local level, coupled with community education and humane population management. Such strategies have succeeded in both developed and developing countries, and can be adapted to any locality. Numerous examples in Africa, Asia, and Latin America have shown that community-based, locally guided vaccination and education programs, based on a shared vision and long-term commitment, can eliminate canine rabies. Such programs should have specific goals and measurable outcomes, and should be conducted under the guidance of supportive governments, in collaboration with international partners and nongovernmental organizations. In addition to currently available tools, rabies prevention can be augmented by new dose-sparing human vaccine schedules, alternative routes of vaccine administration, monoclonal antibodies as an alternative to RIG, sensitive and specific point-of-care diagnostics and the development of canine immunocontraceptive methods. Accurate risk assessments of potential human exposures and support for decentralized laboratory capacity will be essential to ensure the most effective utilization of vaccines and RIG until canine rabies has been eliminated.
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Affiliation(s)
- Richard Franka
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mail Stop G33, Atlanta, GA 30333, USA.
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13
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Antigen content versus volume of rabies vaccines administered intradermally. Biologicals 2011; 39:444-5. [DOI: 10.1016/j.biologicals.2011.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 08/11/2011] [Indexed: 11/19/2022] Open
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