Abstract
Although vaccines are available, rabies still claims more than 55,000 human lives each year. In most cases, rabies vaccines are given to humans after their exposure to a rabid animal; pre-exposure vaccination is largely reserved for humans at high risk for contacts with the virus. Most cases of human rabies are transmitted by dogs. Dog rabies control by mass canine vaccination campaigns combined with intensive surveillance programs has led to a decline of human rabies in many countries but has been unsuccessful in others. Animal vaccination programs are also not suited to control human rabies caused by bat transmission, which is common in some Central American countries. Alternatively, or in addition, more widespread pre-exposure vaccination, especially in highly endemic remote areas, could be implemented. With the multiple dose regimens of current vaccines, pre-exposure vaccination is not cost effective for most countries and this warrants the development of new rabies vaccines, which are as safe as current vaccines, but achieve protective immunity after a single dose, and most importantly, are less costly. This chapter discusses novel rabies vaccines that are in late stage pre-clinical testing or have undergone clinical testing and their potential for replacing current vaccines.
Highlights
Rabies continues to claim upwards of 55,00 human lives each year [1]
In most cases the vaccines are given after exposure to a suspected rabid animal, and depending on the severity of the exposure, post-exposure prophylaxis (PEP) must be combined with a rabies immunoglobulin (RIG) preparation of human or equine origin that is infiltrated into the wound
Numerous studies have shown that protection against rabies virus infection is mediated by virus neutralizing antibodies (VNAs) against the viral glycoprotein [8,9,10] that is expressed as trimers on the surface of the virion
Summary
Rabies continues to claim upwards of 55,00 human lives each year [1]. Most deaths occur in less developed countries in Asia and Africa, and disproportionally affect children below the age of. Rabies vaccines are costly and have to be given several times, which becomes very burdensome for those living in remote areas. New human vaccines could be developed that achieve protective immunity after a single immunization, reduce the need for RIG if given after severe exposure and/or are cost effective if used for pre-exposure prophylaxis (PrEP) in highly endemic areas. PrEP would be especially useful for children living in remote areas with limited access to health care. This was demonstrated in Peru, a country that upon experiencing several human rabies outbreaks caused by vampire bats in Amazonia [5,6], implemented PrEP and thereby stopped further human deaths due to rabies [7]
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