1
|
Garcia Garrido HM, van Put B, Terryn S, de Pijper CA, Stijnis C, D'Haens GR, Spuls PI, van de Sande MG, Gucht S, Grobusch MP, Goorhuis A. Immunogenicity and one-year boostability of a 3-dose intramuscular rabies pre-exposure prophylaxis schedule in adults receiving immunosuppressive monotherapy: a prospective single-Centre clinical trial. J Travel Med 2022; 30:6883953. [PMID: 36477981 PMCID: PMC10075057 DOI: 10.1093/jtm/taac148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND For immunocompromised patients (ICPs), administration of rabies immunoglobulins (RIG) after exposure is still recommended regardless of prior vaccination, due to a lack of data. We aimed to assess the one-year boostability of a 3-dose rabies pre-exposure prophylaxis (PrEP) schedule in individuals using immunosuppressive monotherapy. METHODS In this prospective study, individuals on immunosuppressive monotherapy with a conventional immunomodulator (cIM) or a TNF-alpha inhibitor (TNFi) for a chronic inflammatory disease received a 3-dose intramuscular PrEP schedule (days 0,7,21-28) with 1 mL Rabipur®, followed by a 2-dose simulated post-exposure prophylaxis (PEP) schedule (days 0,3) after 12 months. Rabies neutralizing antibodies were assessed at baseline, on Day 21-28 (before 3rd PrEP dose), Day 60, Month 12 and Month 12 + 7 days. The primary outcome was one-year boostability, defined as the proportion of patients with a neutralizing antibody titre of ≥ 0.5 IU/mL at Month 12 + 7 days. Secondary outcomes were geometric mean titres and factors associated with the primary endpoint. RESULTS We included 56 individuals, of whom 52 completed the study. The one-year boostability was 90% (47/52) with a GMT of 6.16 (95% CI 3.83-9.91). All participants seroconverted at some point in the study. Early response to PrEP (at day 21-28) was significantly associated with 100% boostability (Odds ratio 51; 95% confidence interval [5.0-6956], p < 0.01). The vaccination schedule was safe and well tolerated. No vaccine-related serious adverse events occurred. CONCLUSION In patients using immunosuppressive monotherapy, a 3-dose rabies PrEP schedule followed by a 2-dose PEP schedule is immunogenic, with all patients seroconverting at some point in the study. Although boostability 7 days after PEP was not 100%, nobody would wrongly be denied RIG when only administered to those who responded early to PrEP, while reducing administration of RIG by 73%.
Collapse
Affiliation(s)
- Hannah M Garcia Garrido
- Amsterdam UMC, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Bridget van Put
- Amsterdam UMC, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | | | - Cornelis A de Pijper
- Amsterdam UMC, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Cornelis Stijnis
- Amsterdam UMC, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Geert R D'Haens
- Amsterdam UMC, Department of Gastroenterology, University of Amsterdam, Amsterdam, The Netherlands
| | - Phyllis I Spuls
- Amsterdam UMC, Department of Dermatology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marleen G van de Sande
- Amsterdam UMC, Department of Rheumatology and Clinical Immunology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Martin P Grobusch
- Amsterdam UMC, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Amsterdam UMC, Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| |
Collapse
|