Systematic Booster after Rabies Pre-Exposure Prophylaxis to Alleviate Rabies Antibody Monitoring in Individuals at Risk of Occupational Exposure.

Perrine Parize,Laura Schaeffer,Johann Cailhol,Agnès Durand,Florence Ribadeau-Dumas,Marie-Laurence Mousel,Anne-Sophie Le Guern,Julia Goesch,Laurent Dacheux,Hervé Bourhy,Sheherazade Benabdelkader,Jérémie Sommé,Beata Francuz,Paul-Henri Consigny,Arnaud Tarantola,Arnaud Fontanet,Lauriane Kergoat

doi:10.3390/vaccines9040309

Perrine Parize, Laura Schaeffer + Show 15 more

Open Access

https://doi.org/10.3390/vaccines9040309

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Abstract

Pre-exposure rabies prophylaxis (PrEP) is recommended for people at frequent or increased risk of professional exposure to lyssavirus (including rabies virus). PrEP provides protection against unrecognized exposure. After the primary vaccination, one’s immune response against rabies may decline over time. We aimed to evaluate the immune response to rabies in individuals immunized for occupational reasons before and after a booster dose of the rabies vaccine. With this aim, we retrospectively documented factors associated with an inadequate response in individuals vaccinated for occupational purposes. Our findings analyzed data from 498 vaccinated individuals and found that 17.2% of participants had an inadequate antibody titration documented after their primary vaccination without the booster, while inadequate response after an additional booster of the vaccine was evidenced in 0.5% of tested participants. This study showed that a single booster dose of vaccine after PrEP conferred a high and long-term immune response in nearly all individuals except for rare, low responders. A systematic rabies booster after primary vaccination may result in alleviating the monitoring strategy of post-PrEP antibody titers among exposed professionals.

Highlights

We reported our experience related to rabies pre-exposure prophylaxis and antibody titer monitoring among 498 individuals vaccinated for occupational purposes
Our findings indicated that 28.8% of tested individuals exhibited inadequate postvaccination titers when assessed between 6 and 12 months following Pre-exposure rabies prophylaxis (PrEP)
A time-lapse greater than six months between PrEP and antibody titration, and simultaneous nonrabies vaccination were independently associated with titers considered nonprotective on the first post-PrEP assessment

Summary

Introduction

Rabies is a viral zoonosis responsible for approximately 59,000 human deaths each year, affecting mainly poor and rural populations of Asia and Africa [1]. The disease in humans is mainly transmitted by dogs through bites, scratches, contamination of the mucous membrane, or broken skin with saliva [2]. Rabies is 100% preventable after exposure to a rabid animal by the timely and adequate administration of postexposure prophylaxis (PEP) which consists of rabies vaccines and immunoglobulin in severe exposures [3]. In the absence of PEP, an infection can occur, and rabies acute encephalitis or meningoencephalitis can develop. The outcome of these complications is almost invariably fatal [4]

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