Postexposure Rabies Prophylaxis Completed in 1 Week: Preliminary Study

• Published in: Clinical infectious diseases Vol. 50; no. 1; pp. 56 - 60
• Main Authors: Shantavasinkul, Prapimporn, Tantawichien, Thanphet, Wilde, Henry, Sawangvaree, Artikaya, Kumchat, Apinya, Ruksaket, Natthasri, Lohsoonthorn, Vitool, Khawplod, Pakamatz, Tantawichien, Terapong
• Format: Journal Article
• Language: English
• Published: Oxford The University of Chicago Press 01.01.2010; University of Chicago Press; Oxford University Press
• Subjects: Adult; Analysis of Variance; Animals; Antibodies; Antibodies, Neutralizing - blood; Antibodies, Viral - blood; ARTICLES AND COMMENTARIES; Biological and medical sciences; Cercopithecus aethiops; Clinical medicine; Disease prevention; Female; Geometric mean; Horses; Human viral diseases; Humans; Immune system; Immunization, Passive - methods; Immunoglobulins; Immunoglobulins - administration & dosage; Infectious diseases; Injections, Intradermal; Male; Medical research; Medical sciences; Middle Aged; Neutralizing antibodies; Nonprofit organizations; Post exposure prophylaxis; Post-Exposure Prophylaxis - methods; Prospective Studies; Rabies; Rabies - immunology; Rabies - prevention & control; Rabies vaccines; Rabies Vaccines - administration & dosage; Rabies Vaccines - adverse effects; Rabies Vaccines - immunology; Vaccination; Vaccines; Vero Cells; Viral diseases; Viral diseases of the nervous system; Infection; Prevention; Nervous system diseases; Chemoprophylaxis; Viral disease; Rabies
• DOI: 10.1086/649211
• ISSN: 1058-4838; 1537-6591

Background Patients exposed to a rabid animal often travel long distances to receive postexposure prophylaxis (PEP), which requires 4 or 5 visits. Reducing the number of clinic visits would not only reduce costs for the patient but may also help increase compliance to receive complete PEP. We made an effort to develop PEP completed in 1 week. Methods We administered the 4-site intradermal injections of 0.1 mL of purified Vero cell rabies vaccine to the deltoids and thighs on days 0, 3, and 7, with and without equine rabies immunoglobulin (40 IU/kg). A control group received the World Health Organization-approved and widely used Thai Red Cross regimen (2-site intradermal injections on days 0, 3, and 7 and 1 injection on days 28 and 90) with equine rabies immunoglobulin. We then determined rabies neutralizing antibody (NAb) up to day 360. Results Geometric mean titers for subjects receiving the 4-site intradermal regimen, with or without equine rabies immunoglobulin, had significantly higher NAb values than did the control group on day 14 and 28 (P <.001). All subjects in all groups had a NAb value ⩾0.5 IU/mL on days 14 and 28. The percentages of subjects who had a NAb value ⩾0.5 IU/mL from days 0 through 360 were not significantly different among the 3 groups. Conclusions After any PEP regimen, World Health Organization recommendations require a NAb value ⩾0.5 IU/mL on days 14 and 28. The 1-week PEP regimen, therefore, appears promising. It increased immunogenicity over the 2-site intradermal schedule, and it is convenient and can be used in small clinics, because it consumes almost the entire supplied vaccine ampoule volume.