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Kewcharoenwong C, Freeouf S, Nithichanon A, Petsophonsakul W, Pornprasert S, Khamduang W, Suzuki T, Onodera T, Takahashi Y, Lertmemongkolchai G. One-dose intradermal rabies booster enhances rabies antibody production and avidity maturation. Med Microbiol Immunol 2024; 213:7. [PMID: 38761268 PMCID: PMC11102368 DOI: 10.1007/s00430-024-00791-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/21/2024] [Indexed: 05/20/2024]
Abstract
The incidence of rabies in Thailand reached its peak in 2018 with 18 human deaths. Preexposure prophylaxis (PrEP) vaccination is thus recommended for high-risk populations. WHO has recently recommended that patients who are exposed to a suspected rabid animal and have already been immunized against rabies should receive a 1-site intradermal (ID) injection of 0.1 mL on days 0 and 3 as postexposure prophylaxis (PEP). In Thailand, village health and livestock volunteers tasked with annual dog vaccination typically receive only a single lifetime PrEP dose and subsequent boosters solely upon confirmed animal bites. However, the adequacy of a single PrEP dose for priming and maintaining immunity in this high-risk group has not been evaluated. Therefore, our study was designed to address two key questions: (1) sufficiency of single-dose PrEP-to determine whether a single ID PrEP dose provides adequate long-term immune protection for high-risk individuals exposed to numerous dogs during their vaccination duties. (2) Booster efficacy for immune maturation-to investigate whether one or two additional ID booster doses effectively stimulate a mature and sustained antibody response in this population. The level and persistence of the rabies antibody were determined by comparing the immunogenicity and booster efficacy among the vaccination groups. Our study demonstrated that rabies antibodies persisted for more than 180 days after cost-effective ID PrEP or the 1st or the 2nd single ID booster dose, and adequate antibody levels were detected in more than 95% of participants by CEE-cELISA and 100% by indirect ELISA. Moreover, the avidity maturation of rabies-specific antibodies occurred after the 1st single ID booster dose. This smaller ID booster regimen was sufficient for producing a sufficient immune response and enhancing the maturation of anti-rabies antibodies. This safe and effective PrEP regimen and a single visit involving a one-dose ID booster are recommended, and at least one one-dose ID booster regimen could be equitably implemented in at-risk people in Thailand and other developing countries. However, an adequate antibody level should be monitored before the booster is administered.
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Affiliation(s)
- Chidchamai Kewcharoenwong
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- The Centre for Research & Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Lanna Dog Welfare, Chiang Mai, Thailand
| | - Saranta Freeouf
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Arnone Nithichanon
- The Centre for Research & Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wilaiwan Petsophonsakul
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Lanna Dog Welfare, Chiang Mai, Thailand
| | - Sakorn Pornprasert
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Woottichai Khamduang
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Taishi Onodera
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshimasa Takahashi
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ganjana Lertmemongkolchai
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.
- The Centre for Research & Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.
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Wirawan IMA, Matsee W, Astuti PAS, Sutarsa IN. Enhancing rabies prevention in tourist destinations such as Indonesia. J Travel Med 2023; 30:taad103. [PMID: 37552057 DOI: 10.1093/jtm/taad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/09/2023]
Affiliation(s)
- I Made Ady Wirawan
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali 80232, Indonesia
- Travel Medicine Unit, Faculty of Medicine, Udayana University, Bali 80232, Indonesia
| | - Wasin Matsee
- Faculty of Tropical Medicine, Thai Travel Clinic, Hospital for Tropical Diseases, Mahidol University, Bangkok 10400, Thailand
- Travel Medicine Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Putu Ayu Swandewi Astuti
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali 80232, Indonesia
| | - I Nyoman Sutarsa
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali 80232, Indonesia
- Rural Clinical School, ANU Medical School, The Australian National University, Canberra 2601, Australia
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Ahmad N, Nawi AM, Jamhari MN, Nurumal SR, Mansor J, Zamzuri M‘AIA, Yin TL, Hassan MR. Post-Exposure Prophylactic Vaccination against Rabies: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:967-977. [PMID: 36407746 PMCID: PMC9643235 DOI: 10.18502/ijph.v51i5.9412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/19/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Post-exposure prophylaxis (PEP) is an effective method for preventing rabies, a highly fatal infection in exposed persons. Malaysia is currently using the purified Vero cell rabies vaccine (PVRV). Nonetheless, there are other commercially available vaccine types and regimens. This systematic review aimed at comparing the effectiveness of the different PEP vaccines, regimens and routes of administration among Asian populations. METHODS We systematically reviewed the PubMed and Web of Science databases for articles reporting on the effectiveness of PEP vaccination against rabies among Asian populations between 2015 and 2019. RESULTS Our search identified 11 relevant studies. Majority of study either used PCECV or PVRV type of vaccine, with different regimes and method. All are non-inferior to the other. Most of the studies recorded adequate response by Day 14 of vaccination. Nonetheless, the intradermal (ID) vaccination used minimal volume of vaccine used in all settings, thus cost less and the concurrent administration of RIG to the wound(s) doesn't affect the RVNA GMT response. CONCLUSION PCECV, using either the Essen or Zagreb regimen, might be a useful alternative for the healthy population in the context of PVRV shortage, especially during an outbreak. Use of the Zagreb or Thai Red Cross (TRC) regimens can be considered (either PVRV or PCECV), as both demonstrate good immunogenic outcomes in Asian populations.
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Affiliation(s)
- Norfazilah Ahmad
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Mohd Nazrin Jamhari
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
- Ministry of Health, Malaysia, Federal Government Administrative Centre, 62590 Putrajaya, Malaysia
| | - Siti Rohani Nurumal
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
- Ministry of Health, Malaysia, Federal Government Administrative Centre, 62590 Putrajaya, Malaysia
| | - Juliana Mansor
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
- Ministry of Health, Malaysia, Federal Government Administrative Centre, 62590 Putrajaya, Malaysia
| | - Mohd ‘Ammar Ihsan Ahmad Zamzuri
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
- Ministry of Health, Malaysia, Federal Government Administrative Centre, 62590 Putrajaya, Malaysia
| | - Teh Li Yin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
- Ministry of Health, Malaysia, Federal Government Administrative Centre, 62590 Putrajaya, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
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Tiwari HK, Gogoi-Tiwari J, Robertson ID. Eliminating dog-mediated rabies: challenges and strategies. ANIMAL DISEASES 2021. [DOI: 10.1186/s44149-021-00023-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AbstractRabies is an acute encephalitis caused by a lyssavirus. It is primarily transmitted through bites of infected dogs which results in the worldwide death of an estimated 59000 humans every year. The disease is preventable through the application of post-exposure prophylaxis (PEP) and its elimination has been demonstrated in many countries by applying multiple interventions simultaneously. Nonetheless, rabies is still widespread in many developing countries, primarily due to the poor implementation of intervention strategies that include inadequate dog-bite wound management practices, unavailability/unaffordability of PEP by the communities, failure to control the disease in free-roaming dogs and wildlife, improper dog population management, weak surveillance and diagnostic facilities and a lack of a One Health approach to the disease. In this review, strategies to control dog-mediated rabies through a One Health approach were discussed. We recommend applying multiple interventions against the disease by involving all the concerned stakeholders in selected urban and rural areas of the countries where rabies is endemic. An empirical demonstration of disease freedom in the selected areas through a One Health approach is needed to convince policymakers to invest in rabies prevention and control on the national level. This multifaceted One Health control model will enhance the likelihood of achieving the goal of global rabies eradication by 2030.
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Mujibur Rahaman M, Siddiqi UR, Sabuj AAM, Ahmed BN, Tahmina S, Faruque MR, Ghosh S, Uddin N. Knowledge, attitude, and practice of a local community towards the prevention and control of rabies in Gaibandha, Bangladesh. J Adv Vet Anim Res 2020; 7:414-420. [PMID: 33005666 PMCID: PMC7521811 DOI: 10.5455/javar.2020.g436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/02/2020] [Accepted: 05/12/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Knowledge, attitude, and practice (KAP) of rabies in the community are essential for developing post-exposure behavioral treatment and for understanding current prevention and control policy on rabies. This was a cross-sectional study in Gaibandha Sadar, a northern district of Bangladesh, investigating the level of KAP about rabies. MATERIALS AND METHODS A total of 368 interviewed respondents, of whom 280 (76.09%) were male, and 88 (23.91%) were female. A structured questionnaire was used for the data collection from respondents on socio-demographic information and KAP regarding rabies. The data analyzed with STATA-IC-11.0 and the association of independent variables with rabies KAP scores were calculated using Pearson's Chi-square. RESULTS Most respondents had adequate KAP levels and positive thoughts on rabies prevention. The KAP scores were strongly associated with education and employment status (p < 0.05). Most respondents said that stray dogs are a headache in the area and believed that control of the dog population in Gaibandha is essential. CONCLUSION These outcomes also revealed that there is an information gap about rabies that might improve by developing an education program for awareness.
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Affiliation(s)
- M. Mujibur Rahaman
- Department of Medicine and Surgery, Chattogram Veterinary and Animal Sciences University, Chattogram, Bangladesh
- Disease Control Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Umme Ruman Siddiqi
- Disease Control Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Abdullah Al Momen Sabuj
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Be-Nazir Ahmed
- Disease Control Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Sanya Tahmina
- Disease Control Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Md. Rayhan Faruque
- Department of Medicine and Surgery, Chattogram Veterinary and Animal Sciences University, Chattogram, Bangladesh
| | - Sumon Ghosh
- Emerging Infections Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Nasir Uddin
- Centre for Integrative Conservation, Xishuangbanna Tropical Botanical Garden, Chinese Academy of Sciences, Yunnan, China
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Penjor D, Dorji T. Circumstances of human conflicts with bears and patterns of bear maul injuries in Bhutan: Review of records 2015-2019. PLoS One 2020; 15:e0237812. [PMID: 32817716 PMCID: PMC7446927 DOI: 10.1371/journal.pone.0237812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/02/2020] [Indexed: 12/02/2022] Open
Abstract
Bhutan is one of the biological hotspots in the world where humans and natural flora and fauna co-exist in close proximity. Bhutan is home to two species of bears: Sloth Bear and Himalayan Black Bear. Human conflicts with bears are reported from all over the country. This study describes the profile of the victims and the pattern of injury resulting from bear attacks and circumstances around human conflicts with bears in Bhutan between 2015 and 2019. This was a cross-sectional study with a review of hospital records of patients treated at the National Referral Hospital from 01 January 2015 till 31 December 2019. Data were extracted into a structured pro forma and entered into EpiData Entry 3.1 and analysed in STATA 13.1. There were thirty-four patients who were provided care for bear maul injuries, with an average annual caseload of 6.8 cases per year. The injury prevalence was 100% and the kill prevalence was 0%. Bear attacks were reported from fourteen of twenty districts of the country. The mean age of the victims was 49 (±13) years. Males (26, 76%) and farmers (26, 76%) were the common victims; the risk of bear attacks was 0.16 per 100,000 farmers per year. The commonest region of the body attacked was the face (29, 85%) and victims were provided emergency and rehabilitative care within and outside the country. Thirty-three victims (97%) were provided post-exposure prophylaxis for rabies. All victims received antibiotics despite the lack of national guidelines on the choice of antibiotics post-bear maul. Human-bear conflict is multi-faceted, puts a considerable strain on bear-conservation efforts and requires multi-disciplinary efforts in the prevention of human injury and socioeconomic losses.
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Affiliation(s)
- Dorji Penjor
- Department of Ear, Nose and Throat Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Thinley Dorji
- Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
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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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Acharya KP, Adhikari N, Tariq M. Fight against rabies in Nepal: Immediate need for government intervention. One Health 2019; 9:100114. [PMID: 32140536 PMCID: PMC7049658 DOI: 10.1016/j.onehlt.2019.100114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 01/06/2023] Open
Affiliation(s)
- Krishna P Acharya
- Animal Quarantine Office (AQO), Budhanilakantha, Kathmandu, Nepal.,Ministry of Land Management, Agriculture and Cooperatives (MoLMAC), Gandaki Province, Pokhara, Nepal
| | - Niran Adhikari
- Animal Health Training and consultancy Services (AHTCS), Pokhara, Nepal
| | - Muhammad Tariq
- Department of Livestock Management, University of Agriculture, Faisalabad, Sub-Campus Toba Tek Singh, Pakistan
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Kundu BK, Meshram GG, Bhargava S, Meena O. Cost Savings of Using Updated Thai Red Cross Intradermal Regimen in a High-Throughput Anti-Rabies Clinic in New Delhi, India. Trop Med Infect Dis 2019; 4:tropicalmed4010050. [PMID: 30909481 PMCID: PMC6473397 DOI: 10.3390/tropicalmed4010050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/15/2019] [Accepted: 03/20/2019] [Indexed: 12/25/2022] Open
Abstract
Replacement of the Essen intramuscular (EIM) by the updated Thai Red Cross intradermal (UTRCID) regimen for rabies post-exposure prophylaxis (PEP), in high-throughput hospitals of India, has been advocated since 2006 thanks to its cost-effectiveness. However, several anti-rabies clinics in India and other parts of the world have not initiated this switchover of regimens because of the paucity of financial literature, generated in realistic settings, regarding the same. We calculated the procurement costs of various items required for providing rabies vaccinations via the EIM regimen and UTRCID regimen, on an annual basis, a year before and after the switchover. From a healthcare provider’s perspective, the cost of vaccination per patient was calculated to be 5.60 USD for the EIM regimen and 2.40 USD for the UTRCID regimen. The switchover to the UTRCID regimen from the EIM regimen reduced the financial burden of the rabies vaccination by almost 60%. Procurement of vaccine vials contributed to the majority of the cost (>94%) in both of the regimens. Procurement of syringes with fixed needles contributed negligibly (<6%) to the financial burden in both the regimens. A policy to progressively switch over to the UTRCID regimen from the EIM in all high-throughput anti-rabies centers of India would dramatically reduce the economic burden of running a successful anti-rabies program.
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Affiliation(s)
- Bijit Kumar Kundu
- Department of Medicine, Postgraduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India.
| | - Girish Gulab Meshram
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India.
| | - Shrinath Bhargava
- Department of Dermatology, Postgraduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India.
| | - Omprakash Meena
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India.
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Warrell MJ. Rabies post-exposure vaccination in 2 visits within a week: A 4-site intradermal regimen. Vaccine 2019; 37:1131-1136. [PMID: 30691982 DOI: 10.1016/j.vaccine.2019.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 12/25/2022]
Abstract
Rabies is fatal in all unvaccinated patients bitten by dogs, and so post-exposure vaccine regimens must be robust enough to ensure their survival under all conditions. Treatment tends to be excessive for most people, but there is justified anxiety about reducing vaccine dosage and shortening regimens. Recently, World Health Organisation (WHO) recommended one week primary post-exposure intradermal regimens requiring 3 clinic visits, but these are unlikely to prove economical where rabies vaccination is most needed, in deprived rural areas of Africa and Asia. A highly immunogenic regimen involving two doses of intradermal vaccine given one week apart has advantages over other regimens. Anyone exposed to a possibly rabid animal would be given intradermal (ID) injections at 4 sites using a whole vial of vaccine. Those who had not been previously vaccinated would be given 2-site ID injections using half a vial one week later. Those who might be immunosuppressed could be given an optional single ID dose on day 28. The rationale for this regimen is discussed in the context of the recently revised WHO recommendations for rabies prophylaxis.
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Affiliation(s)
- M J Warrell
- Oxford Vaccine Group, University of Oxford, Centre for Clinical Vaccinology & Tropical Medicine, Churchill Hospital, Old Rd, Headington, Oxford OX3 7LE, United Kingdom.
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Rupprecht CE, Dietzschold B. Special Issue: Rabies Symptoms, Diagnosis, Prophylaxis, and Treatment. Trop Med Infect Dis 2017; 2:E59. [PMID: 30270916 PMCID: PMC6082069 DOI: 10.3390/tropicalmed2040059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 11/17/2022] Open
Abstract
Rabies is an acute, progressive, incurable viral encephalitis found throughout the world. Despite being one of the oldest recognized pathogens, its impact remains substantial in public health, veterinary medicine, and conservation biology.[...].
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Affiliation(s)
| | - Bernhard Dietzschold
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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