Improving human rabies post-exposure prophylaxis

Abstract

In The Lancet Infectious Diseases, Tineke Cantaert and colleagues 1 Cantaert T Borand L Kergoat L et al. A 1-week intradermal dose-sparing regimen for rabies post-exposure prophylaxis (RESIST-2): an observational cohort study. Lancet Infect Dis. 2019; (published online Sept 27)https://doi.org/10.1016/S1473-3099(19)30311-1 PubMed Scopus (12) Google Scholar illustrate a strong commitment in Cambodia to preventing human rabies by rapid intradermal delivery of post-exposure prophylaxis. The investigators included 116 people bitten by rabies virus-positive dogs and 20 people bitten by rabies virus-negative dogs who attended Institut Pasteur du Cambodge, Phnom Penh, Cambodia, between April 20, 2016, and Feb 9, 2018. Patients received intradermal vaccination on days 0, 3, 7, and 28, and serum samples were obtained for detection of rabies virus neutralising antibodies on days 0, 7, 28, and 42. This well designed cohort study showed that exposed people had rabies virus neutralising antibody titres after three rabies vaccine sessions (of two intradermal doses each) that were similar to titres observed immediately before a fourth vaccine session on day 28. The authors concluded that rabies post-exposure prophylaxis could be abridged to a 1-week (three sessions of two doses on days 0, 3, and 7) intradermal regimen. Recognising the possibility of long incubation periods, the investigators contacted all patients after 1 year and found that all were still alive. These compelling data help identify the best use of human rabies post-exposure prophylaxis in developing countries, which should be used in combination with mass vaccination of dogs. A 1-week intradermal dose-sparing regimen for rabies post-exposure prophylaxis (RESIST-2): an observational cohort studyThe fourth vaccine session on day 28 provides no additional benefit. Rabies post-exposure prophylaxis can be abridged to a two-dose, three-session, 1 week regimen to improve post-exposure prophylaxis coverage and equity at no risk to patients. Full-Text PDF