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Mills DJ, Lau CL, Mills C, Furuya-Kanamori L. Long-term persistence of antibodies and boostability after rabies intradermal pre-exposure prophylaxis. J Travel Med 2022; 29:6454967. [PMID: 34875078 DOI: 10.1093/jtm/taab188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/26/2021] [Accepted: 11/26/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Currently, there is limited data on long-term persistence of antibodies and boostability of intradermal (ID) rabies pre-exposure prophylaxis (PrEP) schedules. This study investigated travellers who received a primary ID PrEP schedule at least 5 years previously to determine the persistence of antibodies and subsequent antibody response after one 0.1-ml ID booster dose. METHODS Adults (age ≥ 18 years) who had previously received ID PrEP at a specialist travel medicine clinic in Brisbane, Australia were included. At Day 0, blood was collected for serology and one dose of 0.1-ml ID rabies vaccine (Verorab®) was administered. At Day 7, serology was repeated. At Day 14, participants were given results and enquired if they experienced adverse events following immunization (AEFIs). Antibodies were measured using Platelia Rabies II ELISA; levels ≥0.5 EU/mL were considered antibody-positive. RESULTS 158 participants were included [64.6% female, median age at enrolment 56.4 years, interquartile range (IQR) 42.4-65.2 years], and median time since the primary ID PrEP was 8.5 years (IQR 6.9-11.7 years). The majority of participants (82.3%) were antibody-positive at Day 0. The proportion of participants who were antibody-positive at Day 0 was higher among those who were younger at primary vaccination (87.0% if aged<50 years, 75.8% of aged ≥50 years). The proportion of participants who were antibody-positive declined as median time since primary vaccination increased, though the trend was not statistically significant (p-trend = 0.187). All except one participant (99.4%) were antibody-positive after one ID booster dose. AEFIs were reported by 42.4% of participants and were mainly mild. CONCLUSIONS Rabies antibodies persist for many years after ID PrEP and can be rapidly boosted with a single ID dose. Future studies are needed to confirm that ID PrEP primes the immune system sufficiently so that boosters are not routinely needed, and only given in the event of a rabies-prone exposure.
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Affiliation(s)
- Deborah J Mills
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, QLD, Australia.,Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Colleen L Lau
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, QLD, Australia.,Research School of Population Health, Australian National University, Canberra, ACT, Australia.,School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Christine Mills
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, QLD, Australia
| | - Luis Furuya-Kanamori
- Research School of Population Health, Australian National University, Canberra, ACT, Australia.,UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
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2
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Soentjens P, De Koninck K, Tsoumanis A, Herssens N, Van Den Bossche D, Terryn S, Van Gucht S, Van Damme P, Van Herrewege Y, Bottieau E. Comparative Immunogenicity and Safety Trial of 2 Different Schedules of Single-visit Intradermal Rabies Postexposure Vaccination. Clin Infect Dis 2020; 69:797-804. [PMID: 30566636 DOI: 10.1093/cid/ciy983] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/10/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Effective and safe single-visit rabies vaccination for pre- and postexposure prophylaxis (PrEP and PEP) could substantially simplify rabies prevention and therefore increase compliance. METHODS In a comparative trial, 303 healthy adults received a primary vaccination that consisted of 2 intradermal (ID) doses of 0.1 mL of the purified chicken embryo cell vaccine (PCEV) during a single visit. One year later, participants were randomly assigned to receive either 4 or 2 ID PEP booster doses of 0.1 mL PCEV during a single visit. The primary endpoint for immunogenicity was the percentage of participants with an adequate antibody level (>0.5 IU/mL) 7 days after the booster doses. The safety endpoint was the proportion of participants who developed adverse events (AEs) following primary and/or booster vaccination. RESULTS All participants, except 1 (99.3%) in each study group, had a rabies antibody titer >0.5 IU/mL on day 7 following the booster schedules. Participants exposed to the 4-dose PEP schedule had a geometric mean titer of 20 IU/mL vs 14 IU/mL for the 2-dose PEP schedule (P = .0228). Local reactions at the injection site following PrEP and PEP were mild and transient and only seen in 14.9% and 49.6%-53% of the participants, respectively. No serious AEs were reported. CONCLUSIONS In healthy adults, a 2-dose (2 × 0.1 mL) single-visit ID PEP schedule was as immunologically adequate and safe as a 4-dose (4 × 0.1 mL) single-visit PEP schedule 7 to 28 months following a 2-dose (2 × 0.1 mL) single-visit ID PREP. CLINICAL TRIALS REGISTRATION EudraCT 2014-00183612.
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Affiliation(s)
- Patrick Soentjens
- Center for Infectious Diseases, Queen Astrid Military Hospital, Brussels.,Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp
| | - Katrien De Koninck
- Center for Infectious Diseases, Queen Astrid Military Hospital, Brussels
| | | | - Natacha Herssens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp
| | - Dorien Van Den Bossche
- Center for Infectious Diseases, Queen Astrid Military Hospital, Brussels.,Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp
| | - Sanne Terryn
- National Reference Centre for Rabies, Sciensano, Brussels
| | | | - Pierre Van Damme
- Center for the Evaluation of Vaccination, University of Antwerp, Belgium
| | - Yven Van Herrewege
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp
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3
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Tollwutprophylaxe: So beraten Sie in der Hausarztpraxis. MMW Fortschr Med 2020; 162:53-58. [PMID: 32514954 PMCID: PMC7278249 DOI: 10.1007/s15006-020-0576-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Auch wenn von Reisen während der COVID-19-Pandemie gegenwärtig noch weitgehend abzusehen ist, bleibt Tollwut ein wichtiges Thema, dem Sie sich spätestens dann wieder widmen müssen, wenn die ersten Kurzentschlossenen zur Reiseberatung in Ihrer Praxis erscheinen werden. Dieser Beitrag frischt Ihr vorhandenes Wissen auf und informiert Sie insbesondere über das von der WHO propagierte verkürzte präexpositionelle Impfschema.
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Soentjens P, Andries P, Aerssens A, Tsoumanis A, Ravinetto R, Heuninckx W, van Loen H, Brochier B, Van Gucht S, Van Damme P, Van Herrewege Y, Bottieau E. Preexposure Intradermal Rabies Vaccination: A Noninferiority Trial in Healthy Adults on Shortening the Vaccination Schedule From 28 to 7 Days. Clin Infect Dis 2020; 68:607-614. [PMID: 29939243 DOI: 10.1093/cid/ciy513] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/14/2018] [Indexed: 12/25/2022] Open
Abstract
Background The existing 4-week preexposure rabies vaccination schedule is costly and often not practicable. Shorter effective schedules would result in wider acceptance. Methods We conducted a noninferiority trial in 500 healthy adults comparing the safety and immunogenicity of a 2-visit (days 0 and 7) intradermal (ID) primary vaccination (2 doses of 0.1 mL ID of the human diploid cell culture rabies vaccine [HDCV] at days 0 and 7) vs a standard 3-visit schedule (single dose of 0.1 mL ID at days 0, 7, and 28). One year to 3 years after primary vaccination, a single booster dose of 0.1 mL ID of HDCV was given to evaluate the anamnestic rabies antibody response. The primary endpoint for immunogenicity was the percentage of subjects with an adequate antibody level >0.5 IU/mL 7 days after the booster injection. The safety endpoint was the proportion of participants developing adverse reactions following the primary vaccination and/or booster dose. Results All subjects in both study groups possessed a rabies antibody titer >0.5 IU/mL on day 7 following the booster dose. Following the booster dose, subjects exposed to the double-dose 2-visit ID schedule had a geometric mean titer of 37 IU/mL, compared with 25 IU/mL for the single-dose 3-visit schedule (P < .001). Local reactions at the injection site following primary vaccination were mild and transient. Conclusions In healthy adults, ID administration of a double dose of 0.1 mL of HDCV over 2 visits (days 0 and 7) was safe and not inferior to the single-dose 3-visit schedule. Clinical Trials Registration NCT01388985, EudraCT 2011-001612-62.
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Affiliation(s)
- Patrick Soentjens
- Center for Infectious Diseases, Queen Astrid Military Hospital, Brussels.,Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp
| | - Petra Andries
- Center for Infectious Diseases, Queen Astrid Military Hospital, Brussels
| | - Annelies Aerssens
- Center for Vaccinology, Ghent University Hospital.,Department of Internal Medicine and Infectious Diseases, Ghent University Hospital
| | | | | | - Walter Heuninckx
- Center for Infectious Diseases, Queen Astrid Military Hospital, Brussels
| | - Harry van Loen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp
| | | | | | - Pierre Van Damme
- Center for the Evaluation of Vaccination, University of Antwerp, Belgium
| | - Yven Van Herrewege
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp
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5
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Langedijk AC, De Pijper CA, Spijker R, Holman R, Grobusch MP, Stijnis C. Rabies Antibody Response After Booster Immunization: A Systematic Review and Meta-analysis. Clin Infect Dis 2019; 67:1932-1947. [PMID: 29788204 DOI: 10.1093/cid/ciy420] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/10/2018] [Indexed: 12/24/2022] Open
Abstract
Although fatal once symptomatic, rabies is preventable by administration of pre- and post-exposure vaccines. International guidelines suggest lifelong protection by a pre-exposure vaccination scheme followed by timely post-exposure vaccines. Rapidity and magnitude of the antibody recall response after booster inoculation are essential, as many people have been previously immunized a long time ago. The objective of this study was therefore to systematically review the evidence on the boostability of rabies immunization to date. We included 36 studies, of which 19 studies were suitable for meta-analysis. Reduced antibody levels were found after intradermal primary schedules as compared to intramuscular schedules. However, responses after booster immunization were adequate for both routes. Although studies showed that antibody levels decline over time, adequate booster responses were still retained over long time intervals indicating that post-exposure treatment is effective without extra measures after long periods of time.
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Affiliation(s)
- Annefleur C Langedijk
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, The Netherlands
| | - Cornelis A De Pijper
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, The Netherlands
| | - Rene Spijker
- Medical Library, Academic Medical Center, University of Amsterdam, The Netherlands.,Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Rebecca Holman
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Martin P Grobusch
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, The Netherlands
| | - Cornelis Stijnis
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, The Netherlands
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6
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Evaluating new rabies post-exposure prophylaxis (PEP) regimens or vaccines. Vaccine 2018; 37 Suppl 1:A88-A93. [PMID: 30471958 DOI: 10.1016/j.vaccine.2018.10.103] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/12/2018] [Accepted: 10/31/2018] [Indexed: 12/25/2022]
Abstract
The development of human rabies vaccines has evolved dramatically from the first crude nerve tissue vaccine produced then administered in the presence of Louis Pasteur in 1885. New cell culture technology has enabled highly potent and well-tolerated rabies vaccines to be produced that have reduced the volume and number of doses required to save human lives after exposure. However, these highly potent vaccines are still unaffordable to many patients living at risk of exposure on a daily basis. The cost of post-exposure prophylaxis (PEP) is not only related to the direct cost of rabies biologicals and equipment but is also associated with indirect costs that patients incur as a result of travel, loss of work time (income loss), and accommodation over the period of time that a PEP regimen requires to be completed. This paper summarizes the particular criteria that the SAGE Working Group and WHO personnel reviewed as part of the evaluation process for recommending the new one-week intradermal vaccination regimen (2-2-2-0-0) for rabies post-exposure prophylaxis. These criteria included: Cost-effectiveness; evaluation of number of doses; seroconversion after vaccination; efficacy; safety; and patient follow-up.
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7
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Rabies Preexposure Prophylaxis: Application of Updated World Health Organization Position to Travelers. Clin Infect Dis 2018; 67:1948-1950. [DOI: 10.1093/cid/ciy422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/10/2018] [Indexed: 11/14/2022] Open
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8
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Kessels JA, Recuenco S, Navarro-Vela AM, Deray R, Vigilato M, Ertl H, Durrheim D, Rees H, Nel LH, Abela-Ridder B, Briggs D. Pre-exposure rabies prophylaxis: a systematic review. Bull World Health Organ 2016; 95:210-219C. [PMID: 28250534 PMCID: PMC5328107 DOI: 10.2471/blt.16.173039] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 09/15/2016] [Accepted: 09/28/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To review the safety and immunogenicity of pre-exposure rabies prophylaxis (including accelerated schedules, co-administration with other vaccines and booster doses), its cost-effectiveness and recommendations for use, particularly in high-risk settings. METHODS We searched the PubMed, Centre for Agriculture and Biosciences International, Cochrane Library and Web of Science databases for papers on pre-exposure rabies prophylaxis published between 2007 and 29 January 2016. We reviewed field data from pre-exposure prophylaxis campaigns in Peru and the Philippines. FINDINGS Pre-exposure rabies prophylaxis was safe and immunogenic in children and adults, also when co-administered with routine childhood vaccinations and the Japanese encephalitis vaccine. The evidence available indicates that shorter regimens and regimens involving fewer doses are safe and immunogenic and that booster intervals could be extended up to 10 years. The few studies on cost suggest that, at current vaccine and delivery costs, pre-exposure prophylaxis campaigns would not be cost-effective in most situations. Although pre-exposure prophylaxis has been advocated for high-risk populations, only Peru and the Philippines have implemented appropriate national programmes. In the future, accelerated regimens and novel vaccines could simplify delivery and increase affordability. CONCLUSION Pre-exposure rabies prophylaxis is safe and immunogenic and should be considered: (i) where access to postexposure prophylaxis is limited or delayed; (ii) where the risk of exposure is high and may go unrecognized; and (iii) where controlling rabies in the animal reservoir is difficult. Pre-exposure prophylaxis should not distract from canine vaccination efforts, provision of postexposure prophylaxis or education to increase rabies awareness in local communities.
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Affiliation(s)
- Jocelyn A Kessels
- School of Veterinary Science, University of Queensland Gatton Campus, Via Warrego Highway, Gatton, Queensland 4343, Australia
| | - Sergio Recuenco
- National Centre for Public Health, Instituto Nacional de Salud, Lima, Peru
| | - Ana Maria Navarro-Vela
- Directorate General of Strategic Interventions in Public Health, Ministry of Health, Lima, Peru
| | - Raffy Deray
- Diseases Prevention and Control Bureau, Department of Health, Manilla, Philippines
| | - Marco Vigilato
- Veterinary Public Health Unit, Pan American Health Organisation-World Health Organisation, Rio de Janeiro, Brazil
| | - Hildegund Ertl
- Wistar Institute Vaccine Center, Philadelphia, United States of America (USA)
| | - David Durrheim
- Hunter Medical Research Institution, University of Newcastle, Newcastle, Australia
| | - Helen Rees
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Louis H Nel
- Department of Microbiology and Plant Pathology, University of Pretoria, Pretoria, South Africa
| | | | - Deborah Briggs
- College of Veterinary Medicine, Kansas State University, Manhattan, USA
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9
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Abstract
Intradermal (ID) vaccination induces a more potent immune response and requires lower vaccine doses as compared with standard vaccination routes. To deliver ID vaccines effectively and consistently, an ID delivery device has been developed and is commercially available for adults. The clinical application of ID vaccines for infants and children is much anticipated because children receive several vaccines, on multiple occasions, during infancy and childhood. However, experience with ID vaccines is limited and present evidence is sparse and inconsistent. ID delivery devices are not currently available for infants and children, but recent studies have examined skin thickness in this population and reported that it did not differ in proportion to body size in infants, children, and adults. These results are helpful in developing new ID devices and for preparing new vaccines in infants and children.
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Affiliation(s)
- Akihiko Saitoh
- a Department of Pediatrics , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Yuta Aizawa
- a Department of Pediatrics , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
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10
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Giesen A, Gniel D, Malerczyk C. 30 years of rabies vaccination with Rabipur: a summary of clinical data and global experience. Expert Rev Vaccines 2015; 14:351-67. [DOI: 10.1586/14760584.2015.1011134] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Alexandra Giesen
- 1 Novartis Vaccines and Diagnostics GmbH, Global Medical Affairs, Emil-von-Behring-Strasse 76, 35041 Marburg, Germany
| | - Dieter Gniel
- 2 Novartis Vaccines and Diagnostics GmbH, Global Medical Affairs, Marburg, Germany
| | - Claudius Malerczyk
- 3 Novartis Vaccines and Diagnostics GmbH, Medical Affairs Region Europe & International, Marburg, Germany
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11
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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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12
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Trend of human rabies prophylaxis in developing countries: Toward optimal rabies immunization. Vaccine 2013; 31:4079-83. [DOI: 10.1016/j.vaccine.2013.06.083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/14/2013] [Accepted: 06/26/2013] [Indexed: 11/18/2022]
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13
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Malerczyk C, Vakil HB, Bender W. Rabies pre-exposure vaccination of children with purified chick embryo cell vaccine (PCECV). Hum Vaccin Immunother 2013; 9:1454-9. [PMID: 23571224 DOI: 10.4161/hv.24502] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Human rabies, mainly transmitted by dog bites, remains a major public health problem in developing countries. In Asian countries, such as India or the Philippines, where large free-ranging dog populations exist, the human death toll stays high. Children under the age of 15 y are at particular risk, representing up to half of the dog bite victims. While pre-exposure prophylaxis (PrEP) is commonly used in travelers from developed countries visiting areas of high endemicity, rabies vaccination is rarely used in highly endemic countries in contrast to post-exposure prophylaxis (PEP). Purified Chick Embryo Cell Vaccine (PCECV, Rabipur®/RabAvert®, Novartis Vaccines and Diagnostics) is approved for pre- and post-exposure prophylaxis, either by the intramuscular route, or--where registered--by the intradermal route of administration. In more than 25 y of use, PCECV has been widely used for PrEP in children. This review summarizes the pediatric pre-exposure clinical trials using PCECV. In total, PCECV has been administered to more than 1,200 children in clinical trials, from toddlers to those in elementary school, using intramuscular and intradermal schedules, demonstrating safety and immunogenicity. PrEP as part of routine pediatric vaccination programs may have a major role to play in human rabies prevention. Extensive clinical experience with PCECV supports intramuscular and intradermal PrEP in children as one pillar of human rabies prevention in developing countries.
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Affiliation(s)
- Claudius Malerczyk
- Novartis Vaccines and Diagnostics, Medical Affairs Vaccines International Region; Marburg, Germany
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