Abstract
.A 2-visit multiple-site intradermal (ID) vaccine protocol would be the most economical, immunogenic, and practicable regimen for postexposure rabies prophylaxis (PEP) in clinics seeing few patients a month. This regimen with an additional day 28 dose is now recommended by the WHO. The difficulties surrounding ID rabies vaccination have hindered progress in provision of prophylaxis, especially in rural Asia and Africa. Although the latest WHO recommendations include 1-week ID postexposure vaccine regimens, these are unlikely to prove economical where rabies vaccination is presently unavailable. The new protocol uses a whole vial of vaccine divided between 4-sites ID on the first day and half a vial at 2-sites ID on day 7. Gavi has recently approved support for rabies PEP. This 2-visit 4-site ID regimen, with or without a day 28 dose, should be considered for implementation in this remarkable new initiative.
Highlights
Rabies encephalitis following a rabid dog bite is always fatal in unvaccinated patients, yet correct preventive vaccination has proved 100% effective
The WHO has recently recommended the new IPC (Institut Pasteur du Cambodge) postexposure vaccine regimen consisting of 0.1 mL ID injection at 2 sites on days 0, 3, and 7.3 This is the same as the method recommended for 20 years, the Thai Red Cross (TRC) 2-site ID regimen, but without the day 28 dose (Table 1)
The WHO decision to accept this regimen was based on preliminary serological data from some of the patients in a clinical trial.[4] (The study used vaccine containing 0.5 mL/vial.) The full data remain unavailable a year later.[2]
Summary
Rabies encephalitis following a rabid dog bite is always fatal in unvaccinated patients, yet correct preventive vaccination has proved 100% effective. Attempts to use the TRC regimen in rural clinics where only a few dog bite patients are treated each month have failed, mainly because of vaccine wastage. If injecting 0.2 mL ID is difficult, the needle can be withdrawn and the remaining dose is given at an adjacent site In this regimen, the amount of vaccine antigen remains constant, unlike in the 2-site regimens, which use an ID dose of 0.1 mL with any vaccine, thereby halving the dose with 1 mL/vial vaccines.[2] Because the dosage and timing of these 8-site and 4-site ID methods are identical, the proven efficacy of the 8-site regimen in postexposure trials and in the field over many years applies to the 4-site version.[5,11].
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