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Banović P, Mijatović D, Simin V, Vranješ N, Meletis E, Kostoulas P, Obregon D, Cabezas-Cruz A. Real-world evidence of rabies post-exposure prophylaxis in Serbia: Nation-wide observational study (2017-2019). Travel Med Infect Dis 2024; 58:102697. [PMID: 38369074 DOI: 10.1016/j.tmaid.2024.102697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/04/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Rabies remains a deadly zoonotic disease, primarily prevalent in Eastern European countries, with a significant global burden in Asia and Africa. Post-exposure prophylaxis (PEP) is critical to prevent clinical rabies. Serbia, a country with a relatively low animal rabies incidence, has been implementing a 4-dose Essen PEP regimen for 13 years. This real-world study aimed to assess the effectiveness of the 4-dose Essen regimen, considering demographic and clinical factors, after WHO Category III exposure. METHOD The study included 601 patients who received the 4-dose Essen PEP and 79 who received an additional 5th dose. RESULTS Age emerged as a critical factor influencing seroconversion rates after the 4-dose regimen, with older individuals exhibiting lower RVNA titers. Logistic regression indicated a 3.18% decrease in seroconversion odds for each added year of age. The Cox proportional hazards mixed model highlighted age-related risks, with age groups 45-60 and 75-92 at the highest risk of non-seroconversion. Human Rabies Immune Globulin (HRIG) administration was associated with lower RVNA values after the 4-dose regimen, suggesting interference with vaccine immunogenicity among people who received larger doses of HRIG. CONCLUSIONS This study provides valuable real-world evidence for rabies PEP in a non-homogeneous population with potential comorbidities. The results underscore the importance of optimizing PEP strategies, particularly in older individuals, and reconsidering HRIG dosing to improve seroconversion rates.
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Affiliation(s)
- Pavle Banović
- Department for Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, Novi Sad 21000, Serbia; Department of Microbiology with Parasitology and Immunology, Faculty of Medicine, University of Novi Sad, Novi Sad 21000, Serbia.
| | - Dragana Mijatović
- Department for Research & Monitoring of Rabies & Other Zoonoses, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
| | - Verica Simin
- Department of Microbiology, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
| | - Nenad Vranješ
- Department for Research & Monitoring of Rabies & Other Zoonoses, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
| | - Eleftherios Meletis
- Faculty of Public and One Health, School of Health Sciences, University of Thessaly, 24410 Karditsa, Greece
| | - Polychronis Kostoulas
- Faculty of Public and One Health, School of Health Sciences, University of Thessaly, 24410 Karditsa, Greece
| | - Dasiel Obregon
- School of Environmental Sciences University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - Alejandro Cabezas-Cruz
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort F-94700, France
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Song Y, He Y, Lu XX, Zhang XM, Jiang XL, Song Q, Huang XY, Ma HX, Yu PC, Zhu WY. Comparative Study on the Immunogenicity and Efficacy of Different Post-exposure Intramuscular Rabies Vaccination Regimens in China. Biomed Environ Sci 2024; 37:178-186. [PMID: 38582980 DOI: 10.3967/bes2024.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/10/2023] [Indexed: 04/08/2024]
Abstract
Objective This study aimed to compare the current Essen rabies post-exposure immunization schedule (0-3-7-14-28) in China and the simple 4-dose schedule (0-3-7-14) newly recommended by the World Health Organization in terms of their safety, efficacy, and protection. Methods Mice were vaccinated according to different immunization schedules, and blood was collected for detection of rabies virus neutralizing antibodies (RVNAs) on days 14, 21, 28, 35, and 120 after the first immunization. Additionally, different groups of mice were injected with lethal doses of the CVS-11 virus on day 0, subjected to different rabies immunization schedules, and assessed for morbidity and death status. In a clinical trial, 185 rabies-exposed individuals were selected for post-exposure vaccination according to the Essen schedule, and blood was collected for RVNAs detection on days 28 and 42 after the first immunization. Results A statistically significant difference in RVNAs between mice in the Essen and 0-3-7-14 schedule groups was observed on the 35th day ( P < 0.05). The groups 0-3-7-14, 0-3-7-21, and 0-3-7-28 showed no statistically significant difference ( P > 0.05) in RVNAs levels at any time point. The post-exposure immune protective test showed that the survival rate of mice in the control group was 20%, whereas that in the immunization groups was 40%. In the clinical trial, the RVNAs positive conversion rates on days 28 (14 days after 4 doses) and 42 (14 days after 5 doses) were both 100%, and no significant difference in RVNAs levels was observed ( P > 0.05). Conclusion The simple 4-dose schedule can produce sufficient RVNAs levels, with no significant effect of a delayed fourth vaccine dose (14-28 d) on the immunization potential.
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Affiliation(s)
- Yun Song
- Henan Provincial Center for Disease Control and Prevention, Infectious Disease Prevention and Control Institute, Henan Provincial Key Laboratory of Infectious Disease Pathogens, Zhengzhou 450000, Henan, China
| | - Ying He
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory of Biosafety, National Health Commission, Beijing 102206, China
| | - Xue Xin Lu
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory of Biosafety, National Health Commission, Beijing 102206, China
| | - Xiao Mei Zhang
- Shandong Provincial Center for Disease Control and Prevention, Jinan 250014, Shandong, China
| | - Xiao Lin Jiang
- Shandong Provincial Center for Disease Control and Prevention, Jinan 250014, Shandong, China
| | - Qing Song
- Qingdao Chengyang District Center for Disease Control and Prevention, Qingdao 266108, Shandong, China
| | - Xue Yong Huang
- Henan Provincial Center for Disease Control and Prevention, Infectious Disease Prevention and Control Institute, Henan Provincial Key Laboratory of Infectious Disease Pathogens, Zhengzhou 450000, Henan, China
| | - Hong Xia Ma
- Henan Provincial Center for Disease Control and Prevention, Infectious Disease Prevention and Control Institute, Henan Provincial Key Laboratory of Infectious Disease Pathogens, Zhengzhou 450000, Henan, China
| | - Peng Cheng Yu
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory of Biosafety, National Health Commission, Beijing 102206, China
| | - Wu Yang Zhu
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory of Biosafety, National Health Commission, Beijing 102206, China
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Wang L, Zhang J, Meng S, Ge L, You Y, Xu Q, Wang H, Yang J, Wang S, Wu H. Safety and immunogenicity of human rabies vaccine for the Chinese population after PEP: A systematic review and meta-analysis. Vaccine 2022:S0264-410X(22)00784-8. [PMID: 35750539 DOI: 10.1016/j.vaccine.2022.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/29/2022] [Accepted: 06/01/2022] [Indexed: 11/22/2022]
Abstract
AIM To evaluate the safety and immunogenicity of rabies vaccine for human use after post-exposure in China. METHODS A systematic search was performed from PubMed, EMBASE, CNKI and Cochrane Library database, supplemented by manual retrieval. According to the inclusion and exclusion criteria, a meta-analysis was performed using Stata 16.0 software after independent literature screening, data extraction and quality assessment by two evaluators. RESULTS A total of 32 studies were included. It was found that rabies vaccination after PEP could induce the body to produce sufficient RVNA. Both Essen and Zagreb regimens showed good immunogenicity, with no significant difference in systemic events and local events after PEP, but a relatively high incidence of local and systemic events after PEP under the Zagreb regimen. CONCLUSION For the Chinese population, rabies vaccination after PEP has shown relatively a good immune efficacy and acceptable safety for preventing human rabies. The survey also found that the Zagreb regimen was comparable to the Essen regimen in terms of rabies prophylaxis with an acceptable safety profile.
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Shen H, Wang Z, Yang B, Cai K, Jiang C, Xie R, Xiao H, Ren Q, Qi Z, Li J, Li Q, Ye J, Zhan F. Immunogenicity and safety of purified vero cell-cultured rabies vaccine under Zagreb 2-1-1 or 5-dose Essen regimen in the healthy Chinese subjects: a randomized, double-blind, positive controlled phase 3 clinical trial. Hum Vaccin Immunother 2020; 17:351-357. [PMID: 32783769 DOI: 10.1080/21645515.2020.1778408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Aim: The aims of the study were to evaluate the non-inferiority of the safety and immunogenicity of a new trial purified vero cell-cultured rabies vaccine (trial vaccine) in healthy subjects comparing with the control purified vero cell-cultured rabies vaccine (control vaccine) following Essen regimen and to evaluate the non-inferiority of the safety and immunogenicity of the trial vaccine following two intramuscular regimens, between Zagreb and Essen regimen. Methods: Serum samples were collected before vaccination and on d 7, 14, 35/42 post vaccination. Adverse events (AEs) were recorded for 30 d following each vaccination. This study was registered in the Chinese Clinical Trial Registry (ChiCTR-PPR-15007057). Results: There was no significant difference in the incidence of AEs, local and systemic reactions, among Zagreb group, Essen group, and control group. But the incidence of solicited AEs was a significant difference among the three groups (p = 0.0498). The incidence of solicited AEs was higher in Essen group than that in control group and Zagreb group (p = 0.0278, p = 0.0248). In the subjects whose antibodies were seronegative before vaccination, the seroconversion rates of antibodies among three groups were all 100.0% on d 14 and d 35/42. The Essen group was not inferior to the control group, and the Zagreb group was not inferior to the Essen group on d 14. On d 14 and d 35/42, the geometric mean concentration of the three groups was much higher than the immune protection level of 0.5 IU/ml. Conclusions: The trial vaccine had good safety and immunogenicity, and the trial vaccine is not inferior to the control vaccine. Abbreviations: PVRV: purified vero cell-cultured rabies vaccine; AE: adverse event; CI: confidence interval; GMC: geometric mean concentration; IM: intramuscular; NIFDC: National Institutes for Food and Drug Control; PPS: per-protocol set; SS: safety set; REFIT: Rapid Fluorescent Focus Inhibition Test; RVNA: rabies virus neutralizing antibody; WHO: World Health Organization.
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Affiliation(s)
- Heng Shen
- Hubei Center for Disease Prevention and Control , Wuhan, China
| | - Zhao Wang
- Hubei Center for Disease Prevention and Control , Wuhan, China
| | - Beifang Yang
- Hubei Center for Disease Prevention and Control , Wuhan, China
| | - Kun Cai
- Hubei Center for Disease Prevention and Control , Wuhan, China
| | - Changjun Jiang
- Dangyang Center for Disease Prevention and Control , Dangyang, China
| | - Ronghua Xie
- Tuanfeng Center for Disease Prevention and Control , Huanggang, China
| | - Haitao Xiao
- Dangyang Center for Disease Prevention and Control , Dangyang, China
| | - Qunhui Ren
- Dangyang Center for Disease Prevention and Control , Dangyang, China
| | - Zhengxu Qi
- Tuanfeng Center for Disease Prevention and Control , Huanggang, China
| | - Jinghui Li
- Xianshengweike Biopharmaceutical Co., Ltd , Jiangsu, China
| | - Qiong Li
- Hubei Center for Disease Prevention and Control , Wuhan, China
| | - Jianjun Ye
- Hubei Center for Disease Prevention and Control , Wuhan, China
| | - Faxian Zhan
- Hubei Center for Disease Prevention and Control , Wuhan, China
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Gholami A, Shirzadi MR, Asouri M, Farahtaj F, Mostafavi E, Gharibzadeh S, Pourmozafari J, Nabavi M, Nazari F, Bahrami F. Seroconversion after three doses of intramuscular rabies vaccine as a post-exposure treatment. Virus Res 2020; 278:197883. [PMID: 31981771 DOI: 10.1016/j.virusres.2020.197883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/24/2019] [Accepted: 01/21/2020] [Indexed: 12/25/2022]
Abstract
Rabies is still threatening half of the world's population with the global burden of canine rabies being estimated as 59,000 human deaths, annually. With no cure existing for clinical rabies, post-exposure prophylaxis (PEP) is the only certain means to save lives of the exposed people. In Iran, bite incidences exceed 180,000 per year, where all victims receive 5 vaccine doses for PEP, conforming to the Essen regimen. More than two-thirds of the exposed individuals stop receiving treatments after day 7, for the reason of being exposed to a non-rabid dog or cat. According to the national standard protocols, these individuals should re-start a complete 5-dose PEP course upon the re-exposure. New WHO recommendations based on scientific data is encouraging revisions to the existing prophylaxis programs. In order to know if an incomplete Essen regimen can provide adequate immunity, in the present study, 5 groups of individuals who had only received 3 first doses of the Essen regimen within the previous 1, 3, 6, 12 and 24 months were examined for immunity against rabies. Our results indicated sufficient anti-rabies neutralizing antibody in all individuals, before and after receiving two standard booster doses (i.e. days 0 and 3). This might also suggest the adequacy of the 3 first doses of vaccination, as a one-week long post-exposure vaccination program.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wang J, Luo F, Feng Z, Li L, Bai Y, Ai X, Ma J, Zhang Z, Shi N. Immunogenicity and safety of purified vero cell rabies vaccine (PVRV) produced by Liaoning Cheng Da Co. under Zagreb 2-1-1 or 5-dose Essen regimen in Chinese adults aged 50 and above. Hum Vaccin Immunother 2017; 13:144-150. [PMID: 28045585 DOI: 10.1080/21645515.2016.1230260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Two kinds of regimens (2-1-1 and 1-1-1-1-1) can be selected after Zagreb regimen(2-1-1)of PVRV was officially approved in Beijing in January 2015. Up to now, the subjects for most studies about the comparison between Zagreb and Essen regimen are under 50 y old, rarely at and above. Aging of the immune system may result in decreasing efficacy of vaccination, especially for adults aged above 65-70 y. This study compared the safety and immunogenicity of the Zagreb and Essen regimen in Chinese adults aged 50 and above with the goal to provide a supplemental data for this age group. METHODS A total of 114 cases were divided into 2 groups randomly, received PVRV under the Zagreb and Essen regimens respectively. Serum samples were collected at D0, D7, D14, D42, D180 and D365 to determine the rabies serum neutralizing antibody by rapid fluorescent focus inhibition test (RFFIT). Safety analyses were made by comparing the AEs in day-3, day-7, and day-(7 + 21) in Zagreb or day-(7 + 28) in Essen by gender and age cohorts. RESULTS 617 blood samples were obtained. Two groups showed similar immunogenicity, the neutralizing antibody titer of all subjects at D14 and D42 showed >0.5 IU/ml. Under the same regimen, Subjects ≥65 y had lower GMC than those who <65 years from D7 to D365 within 2 groups. This difference was significantly shown on D7, D14, D180 in Zagreb group, and on D180 in Essen group (t = 2.38, p = 0.02; t = 3.78, p < 0.001; t = 2.30, p = 0.03; t = 4.42, p < 0.001). Subjects<65 years had higher seroconversion rate compared to ≥65 y on D7, D180 and D365 in both 2 groups, this difference was also significantly shown on D180, D365 in Zagreb group and on D180 in Essen group (χ2 = 20.66, p < 0.001; χ2 = 6.56, p = 0.02; χ2 = 10.96, p = 0.002). Two regimens all showed favorable performances with mildly or common adverse events (AEs). The incidence of local AEs after 3 d in Essen group was higher than Zagreb group (χ2 = 9.69, p = 0.002). The most common local AE was pain, the incidences (8.8%) in Zagreb group was higher than Essen group (8.4%, χ2 = 5.12, p = 0.02). All AEs for Zagreb group and 52.3% of AEs for Essen group occurred during the first 72 hours. During the first 72 hours, subjects aged <65 in Zagreb group (16.26%) had higher incidences of AEs than Essen group (8.57%, χ2 = 4.54, p = 0.03), males in Zagreb group (16.05%) had higher incidence of AEs than Essen group (5.71%, χ2 = 5.34, p = 0.02). The incidences of AEs close in during the first 7 d. CONCLUSION The Zagreb and Essen regimens demonstrated the similar safety and efficacy of PVRV in Chinese adults aged 50 and above. People ≥65 y showed reduced immune response to both regimens. More AEs for the Zagreb regimen were observed within the first 72 hours, especially for male and people < 65 y.
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Affiliation(s)
- Jing Wang
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
| | - FengJi Luo
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
| | - ZiJian Feng
- b China Center for Disease Prevention and Control ; Beijing , China
| | - Li Li
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
| | - YunHua Bai
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
| | - Xing Ai
- c National Institutes for Food and Drug Control , Beijing , China
| | - JianXin Ma
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
| | - Zheng Zhang
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
| | - NianMin Shi
- a ChaoYang Center for Disease Prevention and Control , Beijing , China
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Liu SQ, Tao XY, Yu PC, Jin CQ, Yu HJ, Chen MS, Zhu WY. The Adverse Effect of the 2-1-1 Regimen for Rabies PEP in Preschool Children. Biomed Environ Sci 2017; 30:373-375. [PMID: 28549493 DOI: 10.3967/bes2017.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/25/2017] [Indexed: 06/07/2023]
Abstract
Post-exposure prophylaxis (PEP) has proved to be the most important measure for rabies prevention and control. There is little information regarding adverse reactions to the Essen and 2-1-1 regimens in preschool children (aged 0-6). We reexamined the outcomes of 1,109 preschool children who were vaccinated using SPEEDA under the Essen regimen between January 2011 and December 2012 and 1,267 preschool children under the 2-1-1 regimen between January 2013 and December 2014. We find that, in preschool children, the febrile reaction after the first 2-dose injection in the 2-1-1 regimen was significantly higher than that induced by the first 1-dose in the Essen procedure. Thus, we recommend that the Essen regimen should still be used for rabies PEP in preschool children.
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Affiliation(s)
- Shu Qing Liu
- Key Laboratory of Medical Virology, Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Xiao Yan Tao
- Key Laboratory of Medical Virology, Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Peng Cheng Yu
- Key Laboratory of Medical Virology, Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Chun Qiu Jin
- Wenling Center for Disease Control and Prevention, Wenling 317500, Zhejiang, China
| | - Hong Jie Yu
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Mei Shun Chen
- Wenling Center for Disease Control and Prevention, Wenling 317500, Zhejiang, China
| | - Wu Yang Zhu
- Key Laboratory of Medical Virology, Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
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Li R, Li Y, Wen S, Wen H, Nong Y, Mo Z, Xie F, Pellegrini M. Immunogenicity and safety of purified chick-embryo cell rabies vaccine under Zagreb 2-1-1 or 5-dose Essen regimen in Chinese children 6 to 17 years old and adults over 50 years: a randomized open-label study. Hum Vaccin Immunother 2015; 11:435-42. [PMID: 25692350 PMCID: PMC4514244 DOI: 10.4161/21645515.2014.994460] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/03/2014] [Accepted: 10/12/2014] [Indexed: 11/19/2022] Open
Abstract
The aim of this Phase IIIb, open-label, randomized study was to demonstrate the non-inferiority of immune responses and to assess the safety of a purified chick-embryo cell rabies vaccine (PCECV) in healthy Chinese children (6 to 17 years) and older adults (≥51 years) following 2 alternative intramuscular (IM) simulated post-exposure prophylaxis (PEP) regimens: 4-dose Zagreb or 5-dose Essen regimen. Serum samples were collected prior to vaccination on Days 1 and 15 and on day 43 to assess immune response by rabies virus neutralizing antibody (RVNA) concentrations. Solicited adverse events (AEs) were recorded for up to 7 days following each vaccine dose, and unsolicited AEs throughout the entire study period. PCECV vaccination induced a strong immune response at Day 15, and the non-inferiority in immune response of the Zagreb vs. the Essen regimen was demonstrated in children and older adults. At Day 15,100% of children (N = 224), and 99% of subjects ≥51 years of age (N = 376) developed adequate RVNA concentrations (≥0.5 IU/mL); at Day 43 all subjects achieved RVNA concentrations ≥0.5 IU/mL, for both PEP regimens. The well-known tolerability and safety profile of the PCECV was again observed in this study following either Zagreb or Essen regimens. Rabies PEP vaccination with PCECV following a Zagreb regimen induced immune responses non-inferior to those of the Essen regimen, and had a similar safety and tolerability profile to the Essen regimen in Chinese children, adolescents, and adults over 51 years. ClinicalTrials.gov identifier: NCT01680016.
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Key Words
- AE, adverse event
- CI, confidence interval
- Essen regimen
- GMC, geometric mean concentration
- IM, intramuscular
- NIFDC, National Institutes for Food and Drug Control
- PCECV, purified chick-embryo cell rabies vaccine
- PEP, post-exposure prophylaxis
- PPS, per-protocol set
- RFFIT, Rapid Fluorescent Focus Inhibition Test
- RVNA, rabies virus neutralizing antibody
- Zagreb regimen
- immunogenicity
- intramuscular post-exposure prophylaxis; purified chick-embryo cell rabies vaccine
- rabies
- rabies virus neutralizing antibody
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Affiliation(s)
- RongCheng Li
- Guangxi Center for Disease Prevention and Control; Guangxi, China
| | - YanPing Li
- Guangxi Center for Disease Prevention and Control; Guangxi, China
| | - ShuQing Wen
- Mengshan Center for Disease Prevention and Control; Mengshan, Guangxi, China
| | - HuiChun Wen
- Mengshan Center for Disease Prevention and Control; Mengshan, Guangxi, China
| | - Yi Nong
- Guangxi Center for Disease Prevention and Control; Guangxi, China
| | - Zhaojun Mo
- Guangxi Center for Disease Prevention and Control; Guangxi, China
| | - Fang Xie
- Novartis Vaccines & Diagnostics Inc.; Cambridge, MA USA
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10
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Hu Q, Liu MQ, Zhu ZG, Zhu ZR, Lu S. Comparison of safety and immunogenicity of purified chick embryo cell vaccine using Zagreb and Essen regimens in patients with category II exposure in China. Hum Vaccin Immunother 2014; 10:1645-9. [PMID: 24632727 DOI: 10.4161/hv.28420] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The aim was to compare the safety and immunogenicity of purified chick embryo cell vaccine (PCECV) with Zagreb 2-1-1 and Essen 1-1-1-1-1 regimens in patients with WHO category II exposure in China. Side effects including systemic and local symptoms were recorded for all patients during vaccination with purified chick embryo cell vaccine (PCECV) under Zagreb 2-1-1 or Essen 1-1-1-1-1 regimens, and the rabies neutralization antibody titers in patients' serum at days 0, 7, 14, 45, 365 post-immunization were measured to determine the immunogenicity. Fever and pain were the most common events for systemic and local symptoms respectively, and most side effects (86.78%, 105/121) occurred after the first dose of vaccination. Safety analysis showed differences in side effects in<5-year-old patients between Zagreb and Essen regimens, especially after the first dose of vaccination (P = 0.043). Immunogenicity analysis indicated that Zagreb can achieve higher neutralization antibody titers and a greater seroconversion rate in a shorter time but had less persistence than Essen. When compared with the Essen regimen, the Zagreb regimen had a different immunogenicity in all study subjects, and different safety profile in young children, and a further study with a larger population and longer surveillance is warranted.
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Affiliation(s)
- Quan Hu
- Wuhan Centers for Disease Prevention and Control; Wuhan, PR China
| | - Man-Qing Liu
- Wuhan Centers for Disease Prevention and Control; Wuhan, PR China
| | - Zheng-Gang Zhu
- Wuhan Centers for Disease Prevention and Control; Wuhan, PR China
| | - Ze-Rong Zhu
- Wuhan Centers for Disease Prevention and Control; Wuhan, PR China
| | - Sha Lu
- Wuhan Centers for Disease Prevention and Control; Wuhan, PR China
| |
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