Analysis of seroprevalence in target wildlife during the oral rabies vaccination programme in Lithuania

BACKGROUND

Rabies vaccination of wildlife carnivores is a powerful tool to prevent, control and eliminate rabies. The presence of neutralizing rabies antibodies in blood is considered a reliable indicator of adequate vaccination. The main purpose of the present study was to analyze the seroprevalence of specific antibodies in target populations of Lithuanian red fox (RF) and raccoon dog (RD) during the oral rabies vaccination (ORV) campaigns during the 2010-2019 period.

RESULTS

Over the ten-year period, 7,261 RF and 2,146 RD sera samples were collected post-mortem in field conditions and tested using a commercial standardized enzyme-linked immunosorbent assay (ELISA) kit in Lithuania. In the ORV spring and autumn vaccination periods, 31.8% (20.3-43.4 95% CI - 95% confidence interval) and 31.7% (21.2-42.1 95% CI) of RF, and 34.1% (22.5-45.7 95% CI) and 34.7% (22.7-46.7 95% CI) of RD sera samples, respectively, were identified as ELISA-positive (seroconversion ≥ 0.5 EU/mL-Equivalent Units per Millilitre). The seroprevalence analysis in adult/ juvenile animal subpopulations indicated that 34.9% (27.2-42.5 95% CI) and 29.2% (20.3-37.9 95% CI) of RF, and 35.6% (25.2-46.0 95% CI) and 30.6% (20.2-40.9 95% CI) of RD sera samples, respectively, were identified as ELISA-positive (seroconversion ≥ 0.5 EU/mL). Statistically strong determinate correlations (r) between the serological results (pos.%) in RF adult/juvenile animal subpopulations (r = 0.937) and between RF and RD positive seroconvert (pos.%) sera samples during the spring vaccinations (r = 0.864) were demonstrated. In different ORV periods, 14-29% of RF and 7-25% of RD sera samples were identified as ELISA-negative (seroconversion < 0.5 EU/mL), but with low (0.125 < 0.49 EU/mL) antibody (Abs) titres.

CONCLUSIONS

The 2010-2019 ORV programme has been an effective tool in both RF and RD populations in Lithuania. The rabies-free status of Lithuania was self-declared in 2015 with only three rabies cases identified in buffer zones since then. The percentage of ELISA-positive serum samples (seroconversion ≥ 0.5 EU/mL) during the different periods of vaccination was similar in RF and RD populations-32% and 34% respectively. The identified seroconversion average of 21.5% in RF and 16% in RD sera samples were officially identified as ELISA-negative (seronversion < 0.5 EU/mL), but with low 0.125 < 0.49 EU/mL Abs titres. That low, but positive seroconversion participated in the formation of populations overall immune status and can influence the interpretation of oral vaccination efficacy.

Dried blood spot cards: A reliable sampling method to detect human antibodies against rabies virus

Background

Although preventable by vaccination for more than a century, rabies virus still causes numerous fatalities every year. To determine antibody levels in humans, blood collected with a finger prick and applied on dried blood spot (DBS) cards is an alternative for venipuncture. The use of DBS is specifically valuable in remote areas, as it is easy to perform, store and transport. Therefore, the technique is frequently used for epidemiological studies of tropical diseases. Up to present, determination of rabies virus antibody levels on human DBS has not been validated.

Methodology/Principal findings

We evaluated the use of human DBS for rabies serology and analyzed 99 pre- or post-vaccination serum and DBS samples with a fluorescent antibody virus neutralization test (FAVNt), which is the gold standard to detect protective antibody levels, and a Bio-Rad Platelia Rabies II ELISA. Sensitivity and specificity of DBS eluates tested with the FAVNt were 97% and 92%, respectively and 87% and 96% when tested with the Platelia-II ELISA. Antibody levels measured in serum with the FAVNt, correlated best with antibody levels measured in DBS with the FAVNt (R = 0.88).

Conclusions/Significance

This is the first study that applies DBS for reliable detection of human antibodies against rabies virus. Both the FAVNt and Platelia-II ELISA demonstrate an acceptable performance on DBS, providing opportunities for rabies serology in remote areas. This technique could drastically ease studies evaluating (novel) rabies vaccination strategies and monitoring persisting immunity in humans at risk, living in rabies endemic regions.

Rabies is a nearly 100% fatal disease in humans. However, available vaccines are effective in preventing rabies infection. To investigate if a person is protected against rabies, rabies virus neutralizing antibody levels in the blood are determined. The World Health Organization defines protective immunity as a rabies virus antibody concentration of at least 0.5 IU/ml detected in serum using a virus neutralization test. Yet, in remote areas serum may be rather difficult to collect, process and transport. Whole blood collected with a finger prick and applied on filter paper cards, also known as dried blood spots (DBS), are an easier alternative. This collection method is frequently used for serology of several tropical infectious diseases, but never studied for rabies serology in humans. Therefore, we compared antibody levels measured in serum with those measured in DBS eluates, using the gold standard FAVNt and related it to another commonly used test for human rabies serology, the Platelia-II ELISA. We found that both assays had a good performance on DBS eluates. The reported high specificities provide confidence that unprotected individuals will rarely be missed. Therefore, the DBS is a promising sampling technique for evaluations of vaccination strategies and monitoring persisting immunity after vaccination in populations at risk for rabies.

Responsiveness of various reservoir species to oral rabies vaccination correlates with differences in vaccine uptake of mucosa associated lymphoid tissues

Oral rabies vaccination (ORV) is highly effective in foxes and raccoon dogs, whereas for unknown reasons the efficacy of ORV in other reservoir species is less pronounced. To investigate possible variations in species-specific cell tropism and local replication of vaccine virus, different reservoir species including foxes, raccoon dogs, raccoons, mongooses, dogs and skunks were orally immunised with a highly attenuated, high-titred GFP-expressing rabies virus (RABV). Immunofluorescence and RT-qPCR screenings revealed clear differences among species suggesting host specific limitations to ORV. While for responsive species the palatine tonsils (tonsilla palatina) were identified as a main site of virus replication, less virus dissemination was observed in the tonsils of rather refractory species. While our comparison of vaccine virus tropism emphasizes the important role that the tonsilla palatina plays in eliciting an immune response to ORV, our data also indicate that other lymphoid tissues may have a more important role than originally anticipated. Overall, these data support a model in which the susceptibility to oral live RABV vaccine infection of lymphatic tissue is a major determinant in vaccination efficacy. The present results may help to direct future research for improving vaccine uptake and efficacy of oral rabies vaccines under field conditions.

Rabies virus-neutralising antibodies in healthy, unvaccinated individuals: What do they mean for rabies epidemiology?

Rabies has been a widely feared disease for thousands of years, with records of rabid dogs as early as ancient Egyptian and Mesopotamian texts. The reputation of rabies as being inevitably fatal, together with its ability to affect all mammalian species, contributes to the fear surrounding this disease. However, the widely held view that exposure to the rabies virus is always fatal has been repeatedly challenged. Although survival following clinical infection in humans has only been recorded on a handful of occasions, a number of studies have reported detection of rabies-specific antibodies in the sera of humans, domestic animals, and wildlife that are apparently healthy and unvaccinated. These 'seropositive' individuals provide possible evidence of exposure to the rabies virus that has not led to fatal disease. However, the variability in methods of detecting these antibodies and the difficulties of interpreting serology tests have contributed to an unclear picture of their importance. In this review, we consider the evidence for rabies-specific antibodies in healthy, unvaccinated individuals as indicators of nonlethal rabies exposure and the potential implications of this for rabies epidemiology. Our findings indicate that whilst there is substantial evidence that nonlethal rabies exposure does occur, serology studies that do not use appropriate controls and cutoffs are unlikely to provide an accurate estimate of the true prevalence of nonlethal rabies exposure.

Rapid fluorescent focus inhibition test optimization and validation: Improved detection of neutralizing antibodies to rabies virus

The rabies rapid fluorescent focus inhibition test (RFFIT) is the most widely used cell-based assay for detecting and quantitating rabies virus neutralizing antibodies (RVNA) in human serum. However, it is a complex, labor intensive, and somewhat subjective manual assay, the performance of which may be affected by a number of factors including the quality of cells and virus, variability of assay reagents and the skill and expertise of analysts. This study sought to identify and evaluate conditions that may impact RFFIT performance and RVNA detection by evaluating assay parameters including: different serial dilution scheme of serum samples in a 96-well microplate using semi-automated pipetting systems, the range of dose of challenge virus standard (CVS-11) strain of rabies virus, the effect of complement (C'), the effect of cell seeding density and passage number, the effect of diethylaminoethyl (DEAE) dextran concentration on virus infectivity, and the assay incubation period prior to immunostaining. In addition the evaluation of counting fluorescent foci using a microscope versus using scanned images from a cell imaging reader was performed in an effort to ease the reading of slides and have permanent records of the raw data. The results from optimization of each parameter are presented along with subsequent assay validation in accordance with the International Conference on Harmonization (ICH) guidelines. The improved and optimized RFFIT accuracy, linearity and sensitivity was demonstrated by testing World Health Organization (WHO)-1 and WHO-2 Standard Rabies Immune Globulins (SRIGs) and complete assay development and validation was performed in compliance with Good Clinical Laboratory Practice (GCLP) guidelines.

Diagnostic tests for human rabies

The lack of reliable data concerning the number of human deaths from rabies presents one of the principal difficulties in a realistic assessment of the importance of this disease, and this lack of an accurate assessment has led to its underestimation and neglect. Priority should therefore be given to establishing a diagnostic test that can confirm human rabies on the basis of biological results. Indeed, only a laboratory diagnosis can properly identify infection, because clinical diagnosis remains difficult to interpret and is insufficiently specific. Historically, diagnosis has been based solely on post-mortem analysis of a cerebral biopsy using immunofluorescence techniques. Although this remains the standard method, considerable progress has been made with the advent of new molecular techniques and the evaluation of new, less-invasive sampling methods that are more easily accepted by the patient's family. Intra-vitam diagnosis of human rabies is now possible using reliable, robust, validated techniques that can be used everywhere, including in regions with limited resources, using minimally invasive or non-invasive sampling (such as saliva or skin biopsies). In practice, one of the major challenges with the diagnosis of human rabies is still the transfer and accessibility of such validated techniques in centralised reference laboratories located in low-income enzootic countries, in order to achieve the biological confirmation of each suspected case of rabies. At the same time, it is necessary to develop easy, fast and low-cost diagnostic methods that can be used in rural and remote areas in peripheral laboratories, or ideally at the patient's bedside.

Utility of rabies neutralizing antibody detection in cerebrospinal fluid and serum for ante-mortem diagnosis of human rabies

Background

Early ante-mortem laboratory confirmation of human rabies is essential to aid patient management and institute public health measures. Few studies have highlighted the diagnostic value of antibody detection in CSF/serum in rabies, and its utility is usually undermined owing to the late seroconversion and short survival in infected patients. This study was undertaken to examine the ante-mortem diagnostic utility and prognostic value of antibody detection by rapid fluorescent focus inhibition test (RFFIT) in cerebrospinal fluid (CSF)/serum samples received from clinically suspected human rabies cases from January 2015 to December 2017.

Methodology/Principal findings

Samples collected ante-mortem and post-mortem from 130 and 6 patients with clinically suspected rabies respectively, were received in the laboratory during the study period. Ante-mortem laboratory confirmation was achieved in 55/130 (42.3%) cases. Real time PCR for detection of viral nucleic acid performed on saliva, nuchal skin, brain tissue and CSF samples could confirm the diagnosis in 15 (27.2%) of the 55 laboratory confirmed cases. Ante-mortem diagnosis could be achieved by RFFIT (in CSF and/or serum) in 45 (34.6%) of the 130 clinically suspected cases, accounting for 81.8% of the total 55 laboratory confirmed cases. The sensitivity of CSF RFFIT increased with the day of sample collection (post-onset of symptoms) and was found to be 100% after 12 days of illness. Patients who had received prior vaccination had an increased probability of a positive RFFIT and negative PCR result. Patients who were positive by RFFIT alone at initial diagnosis had longer survival (albeit with neurological sequelae) than patients who were positive by PCR alone or both RFFIT and PCR.

Conclusions/Significance

Detection of antibodies in the CSF/serum is a valuable ante-mortem diagnostic tool in human rabies, especially in patients who survive beyond a week. It was also found to have a limited role as a prognostic marker to predict outcomes in patients.

Ante-mortem diagnosis of human rabies is essential for patient management and public health measures. The detection of virus specific antibodies in the CSF/serum of patients with suspected rabies is thought to have a limited diagnostic role owing to late seroconversion and short survival in rabies. We examined the diagnostic and prognostic utility of antibody detection by rapid fluorescent focus inhibition test (RFFIT) in CSF/serum samples received from clinically suspected human rabies cases (2015–2017). RFFIT (in CSF and/or serum) could confirm ante-mortem diagnosis in 45 (34.6%) of the 130 clinically suspected cases, accounting for 81.8% of the total 55 laboratory confirmed cases. The sensitivity of CSF RFFIT increased with the day of sample collection (post-onset of symptoms) and was found to be 100% after 12 days of illness. Patients who had received prior vaccination had an increased likelihood of a positive RFFIT and negative PCR result. Patients who were positive by RFFIT alone at initial diagnosis had longer duration of survival, although with poor functional outcomes. Antibody detection by RFFIT in CSF/serum was found to have a diagnostic utility especially in patients who survived beyond a week and a limited prognostic role in human rabies.

Detection of lyssavirus antigen and antibody levels among apparently healthy and suspected rabid dogs in South-Eastern Nigeria

OBJECTIVES

Domestic dogs are the main reservoir of rabies virus (RABV) infection in Nigeria, thus surveillance of rabies in dog populations is crucial in order to understand the patterns of spread of infection and ultimately devise an appropriate rabies control strategy. This study determined the presence of lyssavirus antigen in brain tissues and anti-rabies antibodies in sera of apparently healthy and suspected-rabid dogs slaughtered for human consumption at local markets in South-Eastern Nigeria.

RESULTS

Our findings demonstrated that 8.3% (n = 23) of brain tissues were lyssavirus positive and 2.5% (n = 25) of sera had rabies antibody levels as percentage blocking of 70% and above correlating with a cut-off value ≥ 0.5 IU/mL in the fluorescent antibody neutralization test. There was an inverse correlation between lyssavirus positivity and rabies antibody levels confirming that infected individuals most often do not develop virus neutralizing antibodies to the disease. The low percentage of rabies antibodies in this dog population suggests a susceptible population at high risk to RABV infection. These findings highlight a huge challenge to national rabies programs and subsequent elimination of the disease from Nigeria, considering that majority of dogs are confined to rural communal areas, where parenteral dog vaccination is not routinely undertaken.

Development and pre-validation of a quantitative multi-dose serological assay for potency testing of inactivated rabies vaccines for human use

It is mandatory to ensure the quality of biological products used in the prevention of rabies, a zoonosis with nearly 100% lethality. Fifteen million people receive post-exposure prophylaxis yearly. The vaccine batches are assessed by the National Institutes of Health (NIH) test which has several disadvantages such as significant variability and animal welfare issues. The estimation of immunogenicity based on titration of neutralizing antibodies (NA) is not applied to the human vaccine yet. Despite this, a satisfactory concentration of NA (0.5 IU/ml) can be used as a predictor of the clinical efficacy and for estimating rabies vaccine potency. The objective of this study was to develop and pre-validate a Serological Potency Test (SPT) using the modified Rapid Fluorescent Focus Inhibition Test (mRFFIT) to determine the potency of rabies vaccines for human use, demonstrating its relevance and reliability. The results show good agreement between the potencies determined by the SPT and the NIH test. The assay was able to distinguish between potent and sub-potent lots of vaccines. The results demonstrated that SPT is a viable candidate for validation and inclusion in pharmacopeias as a reduction and refinement for the NIH test.

Detection of rabies antibodies in dog sera

In the presented work, we compared the results of determination of rabies antibodies using three in vitro methods: rapid fluorescent focus inhibition test (RFFIT), fluorescent antibody virus neutralisation test (FAVNT) and the immunoenzymatic assay (ELISA). 196 dog sera samples were examined with FAVNT, RFFIT methods and the ELISA test. Sera with low and sufficiently high titre of antibodies had a similar result in determining by all methods. A critical level of rabies antibodies close to the required protection level (0.5 IU/cm3) was seen in sera of 18 dogs (9.18%); these were the sera obtained after primary vaccination of dogs. At this level, even small differences can cause a change in the assessment of the patient's serum seronegativity or seropositivity. Therefore, it is important to choose the appropriate method that has sufficiently strict criteria while having a good reproducibility.

Evidence of rabies virus exposure among humans in the Peruvian Amazon

In May of 2010, two communities (Truenococha and Santa Marta) reported to be at risk of vampire bat depredation were surveyed in the Province Datem del Marañón in the Loreto Department of Perú. Risk factors for bat exposure included age less than or equal to 25 years and owning animals that had been bitten by bats. Rabies virus neutralizing antibodies (rVNAs) were detected in 11% (7 of 63) of human sera tested. Rabies virus ribonucleoprotein (RNP) immunoglobulin G (IgG) antibodies were detected in the sera of three individuals, two of whom were also seropositive for rVNA. Rabies virus RNP IgM antibodies were detected in one respondent with no evidence of rVNA or RNP IgG antibodies. Because one respondent with positive rVNA results reported prior vaccination and 86% (six of seven) of rVNA-positive respondents reported being bitten by bats, these data suggest nonfatal exposure of persons to rabies virus, which is likely associated with vampire bat depredation.

Potency testing of inactivated rabies vaccines using a serological method

Batch potency testing of rabies vaccines could be done by challenge, measurement of serum response or antigen quantification. Here, we show the development of a serological test that was successfully validated for use in batch release. The serological test is based on serum neutralization (SNT). The correlation to the NIH challenge was demonstrated by batches passing respectively failing equivalently in the NIH and SNT. The SNT provides information on immunogenicity and exhibits several advantages to the NIH: 1) SNT uses many fewer animals for batch release. 2) SNT allows quantitative information on the individual serum response, in contrast to the "dead"/"alive" interpretation of the NIH. 3) SNT is quicker than the NIH and needs fewer working hours. 4) SNT avoids the highly disturbing intra-cerebral injection and suffering from rabies for mice and spares the staff the emotional stress of massively harming animals.

Prevalence of antibody against rabies among confined, free-roaming and stray dogs in a transit city of Nigeria

The prevalence of anti-glycoprotein antibodies against rabies virus is studied in the sera of confined, free-roaming and stray dogs in Ilorin, the capital city of Kwara State, Nigeria. A quantitative indirect enzyme-linked immuno-sorbent assay (i-ELISA) was used to detect rabies virus anti-glycoprotein antibodies in sera from 116 confined, 61 free-roaming, and 13 stray dogs. The sera were collected between June and December 2008 from apparently healthy dogs. Of these 190 dogs, 81 (42.6%), consisting of 57 confined (49.1%), 23 free-roaming (37.7%) and 1 stray (7.7%), had antibody titres that exceeded the positive threshold of 0.5 equivalent units (eu)/ml against rabies, while 109 (57.4%) presented titres that were below the threshold. Prevalence of rabies anti-glycoprotein antibody was higher in the confined dogs compared to free-roaming and stray dogs. Our results indicated low anti-rabies sero-prevalence (42.6%) in the dog population of Ilorin, a transit city that lies between northern and southern Nigeria. This is the first community-based prevalence report on the anti-rabies serological profile of dogs in Nigeria. The need for primary and booster mass vaccination of dogs and the impact of these findings on rabies control in Nigeria are discussed.

[Generation and preliminary immunological efficacy of a recombinant human adenovirus-rabies virus glycoprotein]

To construct a recombinant human adenovirus type 5 expressing glycoprotein (GP) of attenuated rabies virus SRV9 and testing immunological efficacy on the immunized mice. Open reading frame of rabies virus GP gene of SRV9 strain was cloned into the shuttle vector of adenovirus expression system in multiple cloning sites to construct the recombinant shuttle plasmid pacAd5 CMV-Gs9, cotransfection was performed into 293AD cells mediated by FuGENE Transfection Reagent with linearized backbone plasmid and recombinant shuttle plasmid, cell cultures were collected after CPE appearance and were identified by PCR and electronmicroscopy, virus titer was measured in 293AD cells. Kunming mice were intraperitoneally injected with 10(6) TCID50 adenovirus, blood for serum preparation was collected through caudal vein pre-immune and post-immune and tested for VNA appearance by fluorescent antibody virus neutralization test (FAVN) detection. Recombinant shuttle plasmid pacAd5 CMV-Gs9 was constructed correctly. A recombinant human adenovirus type 5 was obtained expressing GP protein of rabies virus SRV9. The virus titer reached 10(6) CFU/mL at the least. All mice developed a certain amount of the anti-rabies neutralizing antibody 14 days after intraperitoneal inoculation, while the effective protection rates were 90%. In conclusion, Recombinant adenovirus expressing the rabies virus GP was constructed successfully and a certain amount of neutralizing antibodies were induced in mice, which laid the material foundation for further development of new rabies vaccine.

Presumptive abortive human rabies - Texas, 2009

Rabies is a serious zoonotic disease. Recovery has been well documented in only six human patients worldwide. Five of those patients had received rabies vaccinations before illness; one had not received rabies vaccination but survived infection after prolonged intensive care. In most of these survivors, moderate to profound neurologic sequelae occurred. In all six survivors, rabies was diagnosed based on exposure history, compatible clinical symptoms, and detection of rabies virus-neutralizing antibodies (VNA). This report describes the clinical course and laboratory findings of an adolescent girl with encephalitis who had not had rabies vaccination and who had been exposed to bats 2 months before illness. Antibodies to rabies virus were detected in specimens of the girl's serum and cerebrospinal fluid (CSF) by indirect fluorescent antibody test (IFA). However, the presence of rabies VNA was not detected until after she had received single doses of rabies vaccine and human rabies immune globulin (HRIG). Although the patient required multiple hospitalizations and follow-up visits for recurrent neurologic symptoms, she survived without intensive care. No alternate etiology was determined, and abortive human rabies (defined in this report as recovery from rabies without intensive care) was diagnosed. Public education should emphasize avoiding exposure to bats and other potentially rabid wildlife and seeking prompt medical attention after exposure to such animals. Rabies is preventable if rabies immune globulin and vaccine are administered soon after an exposure; however, this case also suggests the rare possibility that abortive rabies can occur in humans and might go unrecognized.

The rapid fluorescent focus inhibition test is a suitable method for batch potency testing of inactivated rabies vaccines

The European Pharmacopoeia proposes two methods for potency determination of inactivated rabies vaccines for veterinary use: The first one is a classical mouse challenge test, which is imprecise, time-consuming, and causes severe distress to the test animals. Alternatively, the potency may be determined serologically by measuring the neutralizing antibody titers induced after vaccination of mice by using a rapid fluorescent focus inhibition test (RFFIT). Although this method is faster and less painful for the animals, it is not widely used yet, and only little data exist concerning the comparability of both methods. We have therefore performed a comparative study, in which we demonstrated a good correlation between the challenge test results and the mean titers determined by RFFIT. Furthermore, all vaccine batches failing the challenge test were also recognized as insufficient in the serological assay. This publication further describes the influence of different vaccine administration routes on the resulting antibody titers, and it proposes various modifications to the serological assay protocol which could improve its overall practicability. Finally, we recommend that the serological assay be used for the potency testing of inactivated rabies vaccines.

[Protective activity of panavir in experimental rabies infection]

Significant and reliable activity of panavir was shown in experiments on mice intramuscularly infected with the rabies virus. The animal protection depended on the dose of panavir and the treatment scheme. The reliable protection (30-45% of the mice, p<0.05-0.01) was observed only after the panavir intramuscular injection to the site of the virus inoculation (the infection atrium), but not after the systemic (intraperitoneal) administration. High titers of the virus-neutralizing antibodies (7.92-10.45 IU/ml), comparable to the antibody titers in the combined suspensions of the brain tissues (6.01-10.45% IU/ml), were detected in the combined sera of the survived animals treated with panavir. For the first time a quantitative method for determination of the virus-neutralizing antibody levels in IU/ml was used (the FAVN test, the gold standard for comparative evaluation of the level of the vaccinal and infective antirabies immunity).

Development and evaluation of a competitive ELISA for estimation of rabies neutralizing antibodies after post-exposure rabies vaccination in humans

OBJECTIVES

Currently three tests are approved for the estimation of neutralizing antibodies after rabies vaccination: the mouse neutralization test (MNT), the rapid fluorescent focus inhibition test (RFFIT), and the fluorescent antibody virus neutralization (FAVN) test. Performance of these tests requires a lot of expertise and is generally carried out in reference laboratories and, hence, they are not available to many people. The aim of the present study was to develop and evaluate a competitive ELISA (C-ELISA) for estimation of neutralizing antibodies in order to make this testing more widely available.

METHODS

The C-ELISA was designed based on competition between a murine neutralizing monoclonal antibody (Mab) and the antibodies in serum of vaccinated people. The test was initially standardized using known negative and known positive serum samples for determining the optimal dilution of the Mab as well as the cut-off value (%) for ascertaining the level of inhibition. Nine hundred and ninety serum samples were tested from 250 people who had been administered purified chick embryo cell vaccine (PCECV). Serum samples were collected on days 0, 14, 30 and 90 post-vaccination, and were tested by C-ELISA.

RESULTS

All the serum samples that were positive by RFFIT were also positive by C-ELISA. The titers obtained with C-ELISA were marginally higher than the RFFIT titers, but a significant correlation was noted between the two tests (r=0.897). None of the negative controls were detected to be positive for rabies antibodies by either of these tests. Therefore the C-ELISA was found to be 100% specific and sensitive in comparison to RFFIT. Further, the initial rise and fall of antibody titers on different days post-vaccination was comparable for both tests.

CONCLUSIONS

The C-ELISA described herein can be used to quantify rabies neutralizing antibody levels after vaccination. This test is simple and can be conveniently used under field conditions for monitoring seroconversion after post-exposure rabies vaccination. Moreover it does not require handling of infectious virus by the end user.

Rabies antibody levels in bat handlers in the United Kingdom: immune response before and after purified chick embryo cell rabies booster vaccination

Periodic rabies booster injections are recommended for persons who are at continued risk of rabies exposures, but literature on booster intervals is not comprehensive. We recruited bat workers who received rabies vaccinations between September 2002 and March 2003 either as a primary rabies vaccination course (primary group) or rabies booster vaccination (secondary group). From September 2004, those bat workers in the primary group had two blood tests to determine their rabies antibody level; one immediately prior to their first booster vaccination and one approximately one month after the booster vaccination. Bat workers in the secondary group had one blood test, approximately two years after their last booster vaccination. Overall, 185 bat workers participated in the study: 145 in the primary group, 40 in the secondary group. Sixteen (11.1%) in the primary group were below the minimum recognized rabies antibody level of 0.5 IU/ml prior to their first booster vaccination; all were above this level one-month after their booster. All bat workers in the secondary group had a rabies antibody level above 0.5 IU/ml. In the primary group, age of the bat worker at primary immunization and rabies vaccine type were significantly associated with antibody response to the rabies booster. We recommend that the first rabies booster vaccination is given one year after the primary course and subsequent boosters are given every three to five years thereafter.

A novel double-antigen sandwich enzyme-linked immunosorbent assay for Measurement of Antibodies against rabies virus

A novel double-antigen sandwich enzyme-linked immunosorbent assay (ELISA) was developed to measure rabies antibodies in dogs. In contrast to the 4 days required for detecting rabies antibody with conventional rabies antibody virus neutralization assays, this ELISA can be completed in hours, without using live virus, in routine laboratories.

Rabies antibody seroprotection rates among travelers in Nepal: "rabies seroprotection in travelers"

BACKGROUND

Rabies preexposure immunization is recommended for international travelers who are at risk for exposure to rabid animals, especially in areas where postexposure treatment may be limited. Rabies antibody seroprotection rates among international travelers has not been previously investigated.

OBJECTIVE

To assess preexisting rabies seroprotection among travelers presenting to a health clinic in Nepal.

METHODS

A prospective convenience sample of international travelers evaluated at a health center in Kathmandu, Nepal during a 2-month period. Subjects were eligible for inclusion if they had received rabies preexposure vaccination within the previous 5 years. Demographic information and vaccination records of rabies preexposure prophylaxis were obtained. Consenting subjects provided serum for rabies antibody measurement measured using the rapid fluorescent focus inhibition test. A dilution greater than or equal to 1:5 (0.5 IU/mL) was considered positive. Data were analyzed using chi-squares and two-sample t-tests with unequal variances.

RESULTS

A total of 43 patients consented to enroll. Complete data were available for 38 patients. Subjects had received human diploid cell vaccine (HDCV) or purified Vero cell rabies vaccine (PVRV) vaccine, either via the intradermal or intramuscular route. All patients had adequate antibody titers except one, who had a titer below 0.5 IU/mL. There was no statistically significant relationship between antibody titer and type of vaccine, route of administration, time since vaccination, number of vaccinations, or patient age.

CONCLUSIONS

Among 38 travelers to Nepal who had received documented preexposure rabies HDCV or PVRV vaccination series, 37 demonstrated adequate titers of > or =0.5 IU/mL and would be considered boostable if exposed to rabies virus. One traveler had a titer of <0.5 IU/mL. Type of vaccine, method of administration, number of vaccinations, and time since vaccination did not influence rabies antibody titer. Rabies vaccination with HDCV and PVRV vaccine was effective in stimulating adequate seroprotection in this sample of travelers.

Collaborative study to evaluate a new ELISA test to monitor the effectiveness of rabies vaccination in domestic carnivores

To prevent any introduction of rabies, many rabies-free countries have adopted a scheme requiring the rabies vaccination of pets associated with a serological test. FAVN test and RFFIT are the current OIE prescribed techniques to perform this assay. A qualitative indirect ELISA (Serelisa) test has been recently described as a screening test to monitor the effectiveness of rabies vaccination of pets. A lack of sensitivity requires ELISA negative samples to be retested using an OIE confirmatory test. This raised the question whether this new test could be reasonably proposed as an alternative tool in the context of international trades of pets. The Community Reference Institute of Nancy organized a short trial to answer this question. In this study, 16 laboratories tested a panel of their own samples with FAVN test/RFFIT and the Serelisa. The comparison of results revealed that the performance of the Serelisa is highly heterogeneous. A lack of sensitivity was detected in 50% of participants, when 25% of laboratories obtained a significant rate of false positive results. This last point questions the pertinence of using the Serelisa in the context of international trades by preventing any movements of insufficiently or non-protected animals.

[The induction of protective immune response in mice vaccinated by recombinant avian adenovirus CELO expressing glycoprotein G of the rabies virus]

The recombinant avian adenovirus CELO-gpRb expressing glycoprotein G of rabies virus (strain TS-80, ARRIW&M, Pokrov, Russia) was used for mice vaccination against rabies. Double intramuscular immunization by recombinant CELO-gpRb adenovirus in a dose 10(9) pfu per mouse caused the induction of virus neutralizing antibodies (VNA) synthesis in 78% of mice, while twice repeated intradermal injections of the recombinant adenovirus failed to induce the VNA production. The protection level in groups of vaccinated mice after intracerebral injection of CVS rabies virus in a dose of 100 MLD50 was equal to 45% at single intramuscular immunization and to 91% after twice repeated intramuscular immunization. The recombinant adenoviral vaccine against rabies, based on CELO viral genome, has a good perspective for domestic and wild animal vaccination, not only due to rather high protection level, but also because the production of adenoviral CELO vaccine in chicken embryos is of high technology and inexpensive.

Rabies diagnosis

A reliable diagnosis of rabies can only be made based on laboratory examination of specimens collected from suspected animals. Without data from diagnostic tests, it is not possible to establish rabies control policies. These data are also necessary for evaluating the impact of control measures on the disease and to adapt veterinary and human health policies to the rabies situation. This paper presents the routine laboratory techniques for rabies diagnosis that are published and recommended by both the OIE and WHO and which form the basis of rabies surveillance. They are presented along with more recent techniques which have proved useful in epidemiological and phylogenetic studies. The first step in controlling a disease is to be able to identify it consistently. A reliable and sensitive diagnostic test is therefore essential for use in epidemiological studies and disease control. Reliable diagnosis is also needed by official medical and veterinary services to decide how to deal with infected humans or animals. Without knowing where rabies is present in a country, it is difficult to establish a solid, long-term control policy. A viral disease may be diagnosed on the basis of clinical signs or after laboratory examination. Clinical diagnosis is based on the observation of symptoms and on observation of specific or at least highly evocative signs. Laboratory tests reveal the presence of infection using either indirect or direct methods. The most frequently used indirect methods are based on serological testing. Direct methods aim to detect the virus itself, its proteins, genetic material or traces of its replication in tissues.

Tools for rabies serology to monitor the effectiveness of rabies vaccination in domestic and wild carnivores

Serology remains the only way to monitor the effectiveness of vaccination of humans and animals against rabies. Many techniques for determining the level of rabies antibodies have been described, including seroneutralisation techniques such as tests for fluorescent antibody virus neutralisation (FAVN) and rapid fluorescent focus inhibition (RFFIT), enzyme-linked immunosorbent assay (ELISA), and in-vivo tests (the mouse neutralisation test, MNT). The need to verify the effectiveness of rabies vaccination has become widespread, particularly in the context of international trading of domestic carnivores from infected to rabies-free territories. The standardisation of serological techniques, approval of laboratories and proficiency tests are key concepts to ensure the practicability of such systems. Serological tests for rabies are also often used by laboratories in infected territories to assess the efficacy of campaigns aimed at the eradication of the disease via oral vaccination of wildlife. The adaptation of these methods should provide the means to titrate specific antibodies in dogs during mass parenteral vaccination in countries infected by canine rabies. However, in most cases these serological tests are carried without any standardised procedure. On the basis of our experience in rabies serology and its harmonisation throughout laboratories worldwide, we propose here an adapted standard technique for the serological monitoring for rabies in wildlife at the European level. Such harmonisation would allow the monitoring of vaccination campaigns to be enhanced by increasing the exchange of epidemiological data, with the ultimate goal being the eradication of rabies in Europe.

DNA vaccine for rabies: relevance of the trans-membrane domain of the glycoprotein in generating an antibody response

Various studies have demonstrated the potential of immunization with DNA vaccines encoding the rabies virus glycoprotein (RV-G) to elicit humoral responses. In the present study, we have designed four constructs using a VR1020 vector, wherein the RV-G ectodomain has been cloned without the signal sequence (SS) and the trans-membrane domain (TD) (rGVR), without the SS but with the TD (rGVRt), with the SS but without the TD (rGVRs) and with the SS and the TD (rGVRst), under the control of a cytomegalovirus (CMV) promoter, and downstream of the tissue plasminogen activator (TPA) signal sequence. In addition, RV-G has been expressed as a His6 tag fusion protein, both in Escherichia coli as well as in baculovirus expression systems. Using a prime-boost strategy, BALB/cJ mice administered with the rGVRt construct either in saline (intramuscularly) or adsorbed onto gold microcarriers (delivered intradermally by gene gun) generated the highest rabies virus neutralizing antibody (RVNA) titers. Inclusion of the SS, in addition to the TD (rGVRst), led to a significant decrease in RVNA titers, compared to the rGVRt construct. The DNA vaccine construct lacking both the SS and the TD domain and the vaccine having only the SS generated lower antibody responses, compared to the rGVRt construct. After priming with DNA vaccine, boosting with both E. coli- as well as baculovirus-expressed rRV-G led to an increase in the RVNA titers. The present results demonstrate that a DNA vaccine encoding the full-length sequence of the ectodomain plus TD of the mature native RV-G is capable of expressing an 'ideal' immunogen to produce RVNA titers.

Serologic evidence of nonfatal rabies exposure in a free-ranging oncilla (Leopardus tigrinus) in Cotapata National Park, Bolivia

A clinically healthy free-ranging oncilla (Leopardus tigrinus) was live-trapped in Boliva in 2000. Based on serology, we concluded that this animal was exposed to feline panleukopenia virus, Toxoplasma gondii, and rabies virus. The rabies virus-neutralizing antibody titer (>70 IU/ml) in this oncilla was unusual for an asymptomatic animal exposed to street virus and at a level expected in animals exposed to a large amount of virus, clinically affected, or vaccinated. Based on a subsequent 18 mo of radiotracking, we concluded that the oncilla had a nonfatal exposure to rabies virus.

An immunogenicity study of a newly introduced purified vero cell rabies vaccine (Abhayrab) manufactured in India

Purified Vero cell culture rabies vaccine "Abhayrab" manufactured by Human Biologicals Institute, Ooty, India was subjected for immunogenicity studies. Pre-exposure study was undertaken on 60 healthy volunteers (Group I) with vaccination on days 0, 7 and 21. A group of 75 patients of category II (Group II), 67 of category III (Group III) were given post-exposure prophylaxis and 88 patients of category III were administered with rabies immunoglobulins (Group IV) along with post-exposure prophylaxis as per World Health Organization (WHO) recommendations with a booster on day 90. The volunteers and patients vaccinated showed very few adverse side effects. The blood samples collected from volunteers (Group I) on days 14, 35 and 365 and patients (Group II-IV) on days 14, 30, 90 and 365 showed geometric mean titres (GMT) of >0.5 IU/ml. The study indicated new rabies vaccine manufactured in India was found to be safe and immunogenic.

Development and evaluation of a latex agglutination test for rabies antibodies

BACKGROUND

The presently recommended tests for estimation of rabies neutralising antibodies like Rapid Fluorescent Focus Inhibition test (RFFIT) and Mouse Neutralisation test (MNT) are laborious, time consuming and not cost-effective for routine use. Simple, rapid and economical tests need to be developed for routine use.

OBJECTIVES

The main objective of the present study was to develop and evaluate a rapid Latex Agglutination Test (LAT) to detect rabies specific antibodies.

METHODS

Latex beads were coated with purified rabies glycoprotein at a concentration of 1 mg/ml followed by coating with 0.3% bovine serum albumin (BSA). These sensitised beads were used to detect antiglycoprotein antibodies in sera of 152 people who had taken a course of post exposure rabies vaccination with different cell culture vaccines and whose antibody titers were pre determined by MNT. Sera from 52 normal healthy people without any detectable levels of rabies antibodies were included as controls. The test was carried out on glass slides by mixing 20 micro l of sensitised beads and 20 micro l serum.

RESULTS

Preliminary evaluation with rabbit serum of known potency indicated that for clear agglutination of sensitised beads, a minimum of 2 IU/ml of rabies antibody should be present in the serum samples. Visible agglutination was noticed in positive sera with a titer > or =2 IU/ml within 3-5 min after mixing. Seven Sera whose MNT titers were less than 2 IU/ml did not show agglutinati or n. None of the negative control sera showed agglutination. Thus the specificity of the test was 100% and sensitivity was 95.4%.

CONCLUSIONS

The LAT described here detects rabies specific antibodies > or =2 IU/ml and can be used to screen large number of sera from vaccinated people to know the protective status after vaccination. This simple and rapid test may be used routinely in antirabies treatment centres to monitor sero conversion in vaccinated people.

Overexpression of the rabies virus glycoprotein results in enhancement of apoptosis and antiviral immune response

A recombinant rabies virus (RV) carrying two identical glycoprotein (G) genes (SPBNGA-GA) was constructed and used to determine the effect of RV G overexpression on cell viability and immunity. Immunoprecipitation analysis and flow cytometry showed that tissue culture cells infected with SPBNGA-GA produced, on average, twice as much RV G as cells infected with RV carrying only a single RV G gene (SPBNGA). The overexpression of RV G in SPBNGA-GA-infected NA cells was paralleled by a significant increase in caspase 3 activity followed by a marked decrease in mitochondrial respiration, neither of which was observed in SPBNGA-infected cells. Furthermore, fluorescence staining and confocal microscopy revealed an increased extent of apoptosis and markedly reduced neurofilament and F actin in SPBNGA-GA-infected primary neuron cultures compared with neuronal cells infected with SPBNGA, supporting the concept that RV G or motifs of the RV G gene trigger the apoptosis cascade. Mice immunized with SPBNGA-GA showed substantially higher antibody titers against the RV G and against the nucleoprotein than SPBNGA-immunized mice, suggesting that the speed or extent of apoptosis directly determines the magnitude of the antibody response.

Serological responses of coyotes to two commercial rabies vaccines

Between August 1993 and September 1994 we documented serological responses of coyotes (Canis latrans) vaccinated with two commercial rabies vaccines licensed for use in domestic dogs. Serologic responses were documented by testing for rabies virus neutralizing antibodies with the rapid fluorescent focus inhibition test (RFFIT) at 30, 90, 180, 270, and 365 days post-vaccination. All coyotes vaccinated with Imrab 3 (Rhone-Merieux, Inc.), and 75% of those vaccinated with Dura-Rab 3 (Immunovet, Inc.) seroconverted, as evidenced by the presence of antirabies antibody titers > or = 1:5 in one or more of the five post-vaccination samples. The percent of coyotes showing a titer > or = 1:5 was generally greater and titer levels appeared higher and more persistent among animals vaccinated with Imrab 3 than Dura-Rab 3. Presence of titers via RFFIT tests demonstrates the antibodies produced in coyotes by these rabies vaccines functionally bind and neutralize rabies virus in vitro, but these results do not constitute a demonstration of protection required for licensure for use in coyotes.

Comparison of visual microscopic and computer-automated fluorescence detection of rabies virus neutralizing antibodies

The rapid fluorescent focus inhibition test (RFFIT) and the fluorescent antibody virus neutralization test (FAVNT) are both diagnostic tests for determining levels of rabies neutralizing antibodies. An automated method for determining fluorescence has been implemented to reduce the work time required for fluorescent visual microscopic observations. The automated method offers several advantages over conventional visual observation, such as the ability to rapidly test many samples. The antibody titers obtained with automated techniques were similar to those obtained with both the RFFIT (n = 165, r = 0.93, P < 0.001) and the FAVNT (n = 52, r = 0.99, P < 0.001).

The abbreviated 2-1-1 schedule of purified chick embryo cell rabies vaccination for rabies postexposure treatment

During August 1988 to January 1990, the immunogenicity and safety of purified chick embryo cell rabies vaccine (PCEC) given by the conventional and abbreviated regimens in 82 vaccinees moderately to severely exposed to laboratory proven rabid animals were studied. The 16 vaccinees received PCEC six doses as conventional schedule on days 0, 3, 7, 14, 28 and 90, the 11 vaccinees received six doses of PCEC plus human rabies immune globulin (HRIG) on day 0. The 29 vaccinees received an abbreviated schedule of PCEC as two doses on day 0, one dose each on days 7 and 21 and the 26 cases received PCEC abbreviated schedule plus HRIG on day 0. The kinetics of the neutralizing antibodies on days 0, 7, 14, 28, 56, 180 and 365 were studied for comparative purpose. All vaccinees had high antibody levels from day 14 which last longer than a year and were safe after one year follow up. The adverse reactions of the vaccine were mild and self-limited.

Immune activation in human rabies

Serum cytokines were compared by enzyme-linked immunosorbent assay among (i) 28 patients with rabies, (ii) 13 patients with non-fatal encephalitis due to other viruses, (iii) 16 patients with immune-mediated neurological diseases, and (iv) 15 patients with non-viral central nervous system infections and non-HTLV-I progressive spastic paraparesis. Levels of soluble interleukin 2 receptor (S-IL2R) were comparable in groups (i)-(iii). Fewer paralytic (1/6) than encephalitic (12/22) rabies patients had elevated S-IL2R. Only one patient with rabies and one with non-fatal viral encephalitis (group ii) had elevated S-CD8. Interleukin 6 (IL-6) was elevated in 5/22 rabies patients with encephalitis and in 0/6 paralytic rabies patients. Four individuals in groups (ii) and (iii) had elevated IL-6. Patterns of cytokine responses in group (iv) were similar to those in groups (i)-(iii). The results suggest defects in immune responsiveness in paralytic rabies.

Confirmed rabies exposure during pregnancy: treatment with human rabies immune globulin and human diploid cell vaccine

A review of the literature shows 24 cases of pregnant human exposure to rabies virus through confirmed rabid animal bites. Historically, these patients received passive immunization with equine rabies immunoglobulin and/or purified vero cell vaccine or duck embryo vaccine. With the recent development of human-derived rabies vaccines, we report an additional case of human gestational rabies exposure, which was treated with human rabies immune globulin and human diploid cell vaccine.

[Organizational and methodologic problems in a human rabies prevention service]

On the basis of attained experiences by Antirabies Centre of Milano are described the organization and structure of the antirabies services, the modality of correct performance of the immune prophylactic treatment, the estimation of the antibodies titre considered protective.

[Immune response during the course of chronic experimental rabies]

The immune response was studied in the time course in comparison with virus titers in the brain in chronic course of the disease in random-bred and BALB/c mice infected intracerebrally with street rabies virus, the Yak strain. The virus-neutralizing antibodies were first found in the blood by the end of the incubation period and in the brain tissue at 7-8 days of the disease. Then their titers increased as the disease progressed reaching maximum (in the blood 1:97,313, in the brain 1:63,090) by 42-55 days. From the moment of virus-neutralizing antibody detection in the brain tissue virus titres decreased progressively with the period of the disease and increasing antibody concentrations in the brain tissue. By 42-55 days of the disease virus titres did not exceed 1.0 lg LD50/0.03 ml. Similar virus titer--antibody concentration in brain tissue dependence was observed in experiments in rats and rabbits. Very high antibody titers in the blood and brain tissue had no effect on the progredient course of the disease and fatal outcome. The study allowed the diagnostic criteria of chronic infection to be determined as well as its differences from the acute and abortive forms of rabies.

[Detection of Babes-Negri bodies in blood erythrocytes of rabid white mice]

Large numbers of polymorphous dense Babes-Negri bodies were found in brain neurons of mice sick with street rabies and dying of it. Among blood cells filling the cerebral vessels of mice dead from rabies, erythrocytes containing small dense inclusions, Babes-Negri bodies, could be seen clearly.