Rabies Post-exposure Prophylaxis Research Articles

Isolation and characterization of rabies monoclonal antibody charge variants.

Current postexposure prophylaxis of rabies includes vaccines, human rabies immunoglobulin (RIG), equine RIG, and recombinant monoclonal antibodies (mAb). In the manufacturing of rabies recombinant mAb, charge variants are the most common source of heterogeneity. Charge variants of rabies mAb were isolated by salt gradient cation exchange chromatography (CEX) to separate acidic and basic and main charge variants. Separated variants were further extensively characterized using orthogonal analytical techniques, which include secondary and tertiary structure determination by far and near ultraviolet circular dichroism spectroscopy. Charge and size heterogeneity were evaluated using CEX, isoelectric focusing (IEF), capillary-IEF, size exclusion chromatography, sodium dodecyl sulfate polyacrylamide gel electrophoresis, and western blotting. Antigen binding affinity was assessed by enzyme linked immuno-sorbent assay and rapid florescence foci inhibition test. Results from structural and physicochemical characterizations concluded that charge variants are formed due to posttranslational modification demonstrating that the charge heterogeneity, these charge variants did neither show any considerable physicochemical change nor affect its biological function. This study shows that charge variants are effective components of mAb and there is no need of deliberate removal, until biological functions of rabies mAb will get affected.

The first confirmed human case of rabies, Timor-Leste, 2024.

In March 2024, the first ever human case of rabies, following a dog bite, was detected in Timor-Leste. This paper briefly discusses the circumstances of transmission, clinical presentation, palliative care of the case and public health measures taken. Timor-Leste was previously considered rabies-free. Any person who is bitten or scratched by an animal that could potentially transmit rabies virus (especially dogs, bats, monkeys or cats) in Timor-Leste should be assessed for consideration of provision of rabies post-exposure prophylaxis.

The epidemiology and clinical features of post-exposure prophylaxis for rabies: A retrospective study of 9772 cases

BackgroundIn December 2015, the World Health Organization, the World Animal Health Organization, and the Food and Agriculture Organization of the United Nations convened the International Congress on the elimination of rabies in Geneva. How to use epidemiological factors of post-exposure prophylaxis to prevent rabies has become the focus of attention. ObjectiveTo analyze the epidemiological characteristics of 9772 patients with rabies in a four-year period in one hospital, to clarify the outbreak law of rabies and to explore the corresponding prevention and control strategies. MethodsThe epidemiological data of rabies patients were collected from the infectious disease reporting information management system of the hospital from July 2018 to June 2022. The distributional characteristics of 13 influencing factors were analyzed using the chi-square test and linear regression. ResultsThere was a significant correlation between the number of wounds and age, and the numbers of female and male patients were close. People over the age of 44 were more likely to get bites or scratches on their lower extremity (P<0.0001). There was a greater possibility for elderly people to be bitten by dogs (P<0.0001). Dogs preferred to bite or scratch lower limbs (P<0.0001), while cats upper limbs (P<0.0001). Upper limbs were more possibly attacked by animals at home (P<0.0001). There were significant correlations among exposure grade, wound treatment and number of wounds. Conclusions: Lower extremity protection is needed for the elderly and when encountering dogs, and more attention needs to be paid to the upper extremities when encountering cats and household pets, as well as pets that are cute but need to be protected from bites or scratches.

IJCM_306A: Patient compliance towards Post exposure Prophylaxis with Anti Rabies Vaccine - Hospital based study

Background: Rabies is a deadly viral disease that affects the nervous system. The components of rabies post-exposure prophylaxis involve wound treatment, Rabies Immune Globulin, and the anti-rabies vaccine. Proper compliance with the rabies vaccination schedule is crucial to prevent development of Rabies Objectives: 1) To assess prevalence of non-compliance and delayed compliance towards post-exposure prophylaxis of the anti-rabiess vaccine of GMC, Jammu 2) To study factors associated with and reasons of delayed compliance and non-compliance towards post-exposure prophylaxis of the anti-rabies vaccine of GMC, Jammu Methodology: A cross- sectional study was carried out from September 2022 to July 2023 on 594 animal bite victims presenting to OPD of the anti-rabies clinic of GMC, Jammu for the first time, with category 2 and 3 bites were included Results: Males were about 76.9%, and females, 23.1%. Graduates were 29.3%. Animal bites were mainly from stray dogs (58.2%), with category three wounds (93.8%). Wound washing practices were done by 540 (90.9%), about 58 (9.8%) had used only water and about 482 (81.1%) had used only soap and water for wound washing. 71.7% completed the full course of Anti-Rabies Vaccine (ARV), 24.6% showed delayed compliance, and 3.7% were non-compliant or dropouts. Delayed compliance was observed on the second (35%), third (42.4%), and fourth doses (22.6%). Reasons for delayed compliance included distant residence, loss of wages, and forgetfulness. Non-compliance reasons included negligence and health issues. No socio- demographic factors showed an association with compliance with ARV. Conclusion: The urgent need to increase awareness and counseling for individuals bitten by animals. Special attention is crucial for promptly administering Anti-Rabies Immunoglobulin in severe cases (category 3 bites) to prevent rabies

Real-world evidence of rabies post-exposure prophylaxis in Serbia: Nation-wide observational study (2017–2019)

BackgroundRabies remains a deadly zoonotic disease, primarily prevalent in Eastern European countries, with a significant global burden in Asia and Africa. Post-exposure prophylaxis (PEP) is critical to prevent clinical rabies. Serbia, a country with a relatively low animal rabies incidence, has been implementing a 4-dose Essen PEP regimen for 13 years. This real-world study aimed to assess the effectiveness of the 4-dose Essen regimen, considering demographic and clinical factors, after WHO Category III exposure. MethodThe study included 601 patients who received the 4-dose Essen PEP and 79 who received an additional 5th dose. ResultsAge emerged as a critical factor influencing seroconversion rates after the 4-dose regimen, with older individuals exhibiting lower RVNA titers. Logistic regression indicated a 3.18% decrease in seroconversion odds for each added year of age. The Cox proportional hazards mixed model highlighted age-related risks, with age groups 45–60 and 75–92 at the highest risk of non-seroconversion. Human Rabies Immune Globulin (HRIG) administration was associated with lower RVNA values after the 4-dose regimen, suggesting interference with vaccine immunogenicity among people who received larger doses of HRIG. ConclusionsThis study provides valuable real-world evidence for rabies PEP in a non-homogeneous population with potential comorbidities. The results underscore the importance of optimizing PEP strategies, particularly in older individuals, and reconsidering HRIG dosing to improve seroconversion rates.

Rabies postexposure prophylaxis protocol option for unvaccinated domestic animals, Texas: 2010-2019.

To assess data on rabies postexposure prophylaxis (PEP) in domestic animals following Texas' protocol and to describe preexposure and postexposure vaccination failures from 2010 through 2019. 1,218 unvaccinated animals that received PEP, 925 unvaccinated animals that were euthanatized instead of receiving PEP, and 3 preexposure vaccinated dogs that developed rabies. Zoonotic incident reports from 2010 through 2019 were reviewed for information regarding animals with no known rabies vaccination that received PEP or were euthanatized in accordance with state protocol after exposure to a laboratory-confirmed rabid animal; reports were also reviewed for any preexposure and postexposure vaccination failures. The state-required PEP protocol was to immediately vaccinate the animal against rabies, confine the animal for 90 days, and administer booster vaccines during the third and eighth weeks of the confinement period. From 2010 through 2019, 1,218 exposed animals received PEP; 99.8% did not develop rabies. Three failures were recorded, all in animals < 12 weeks of age when PEP was initiated. Additionally, 925 exposed animals were euthanatized instead of receiving PEP. One true preexposure vaccination failure was recorded. The Texas PEP protocol was used during the 10-year period. Results indicated that this protocol is a viable option for unvaccinated domestic animals exposed to rabies. Alternative protocols warrant additional consideration.

Prevalence of delayed initiation of rabies postexposure prophylaxis and factors influencing it among animal bite victims from Eastern Uttar Pradesh, India.

In a rabies-endemic country like India, every animal bite is potentially taken as rabid exposure and timely and appropriate postexposure prophylaxis (PEP) is crucial as rabies is an almost 100% fatal disease. A retrospective record-based study was conducted at an anti-rabies clinic (ARC) in Eastern Uttar Pradesh, India. Data of the animal bite victims attending the ARC for PEP from January to December 2022 were extracted from the records. A semistructured questionnaire was used for collecting information regarding the interval between exposure and the initiation of anti-rabies PEP, age, gender, residence, the bite site on the body, category of exposure and other risk factors associated with the delay in PEP. Most of the victims were male (67.6%), from an urban background (61.3%) and aged up to 20 y (43.9%). Out of the 222 victims, 62 (27.9%) had delayed initiation of PEP (>48 h after exposure). Factors found to be significantly associated with delayed initiation of PEP were residence (p=0.01), age (p=0.04) and the type of biting animal (p=0.002). Delayed initiation of PEP is common among animal bite victims in this region of India, although PEP is affordable. Educational programmes and awareness-raising campaigns for timely administration of PEP should be a priority, especially targeting rural residents, those aged<18 y and those bitten by animals other than dogs.

Rabies post-exposure prophylaxis in the emergency department

Study objectivesRabies is a zoonotic single-stranded RNA lyssavirus that can cause acute infections of the central nervous system (CNS) including encephalomyelitis, encephalitis, and meningoencephalitis that is progressively fatal. Rabies is more common in developing countries, but approximately 23,000 people in the United States (US) are estimated to have been exposed or to have received post exposure prophylaxis (PEP) yearly. Nebraska Medicine follows the Advisory Committee on Immunization Practices (ACIP) guidelines for the vaccination series, as well as the 20 units/kg administration of immunoglobulin (RIG).Nebraska Medicine Medical Center (NMC) and Bellevue Medical Center (BMC) treat the scheduling of the complete rabies vaccine series differently. At both campuses, patients receive their immunoglobulin and first vaccine in the Emergency Department (ED). At NMC, patients are scheduled to receive the remainder of their vaccination series at the outpatient infusion center by the ED pharmacist. At BMC, the subsequent vaccinations are given as “Nurse Only” return visits to the ED. The objective of this study was to compare patient compliance of two different processes for follow-up rabies vaccine series completion. This project's primary aim was to determine the rate of patient compliance for follow up rabies vaccine doses. The secondary aims of this project were to determine if there was a difference in patient follow-up compliance between the two campuses, patient specific factors that impact compliance, and potential cost savings if a dose rounding protocol for RIG was utilized. MethodsThis retrospective chart review was completed as a quality improvement project. Data from patients who had received either rabies immunoglobulin and/or a rabies vaccine, were >18 years of age, and were not admitted were collected for a 3-year period from July 1, 2019, to June 30, 2022. Data were abstracted from the patient's EMR (electronic medical records) using a SQL (Structured query language) query of pre-identified data elements. When unable to abstract with SQL query, data elements were manually abstracted. All data abstracted was collated and descriptive analysis performed. ResultsA total of 723 individual encounters were identified during the study period. After combining rabies series for each individual patient, 173 unique patients remained. After exclusions were applied, 143 patients were included: 104 patients from NMC, and 39 from BMC. For the primary outcome, appropriate completion between the two campuses was 78.3%. When comparing the two campuses, completion rates were higher at NMC (82% vs. 69%), although not statistically significant (p = 0.12). Appropriate completion of vaccine series was statistically significant for both payor and exposure type. Application of a dose rounding policy with those >45 kg, rounding to the nearest vial, as well as rounding down if at the midpoint interval, 56 fewer vials would have been used between the two campuses. This would have resulted in a potential cost savings of $57,928.64 over the study period.

Fatal cases in pediatric patients after post-exposure prophylaxis for rabies: A report of two cases

Rationale: Rabies is a zoonotic disease with a high mortality, primarily transmitted through the bite of infected mammals, particularly dogs and cats. Despite being a well-known disease since ancient times, it continues to cause a significant number of human deaths worldwide, with approximately 65 000 fatalities reported annually. Patient concerns: We present two fatal cases of rabies in a 12-year- old immigrant boy and a 7-year-old boy. The first case was subject to a 24-hour delay in receiving appropriate medical attention and rabies preventive measures due to the lack of awareness among emergency hospital staff, leading to the administration of wound dressing only. The second case received timely rabies immunoglobulin administration; however, there was a 4-day delay in administering the fourth dose of the rabies vaccine, despite presenting evident symptoms of rabies. Diagnosis: Postmortem examination of brain samples from both patients confirmed the presence of rabies virus. Interventions: Post-exposure prophylaxis for rabies. Outcomes: Both patients were admitted to the hospital after the manifestation of rabies-related symptoms, with the 12-year-old child seeking medical care 47 days after the animal bite and the 7-year-old child seeking medical care 58 days after the exposure. Finally, the first patient died after 27 days and the second patient died after 40 days of hospitalization. Lessons: There is an urgent need for heightened awareness and education among both healthcare professionals and the public regarding the urgency of seeking immediate medical attention after potential rabies exposure. Timely recognition and initiation of post-exposure prophylaxis are pivotal in preventing the progression of the disease. Strengthening surveillance and reporting systems, coupled with continuous training for healthcare professionals, can contribute to early detection and management of rabies cases.

Risk Reduction Strategies for Rabies Exposures and Prophylaxis in Children

Annually, 59,000 people die of rabies, the world’s oldest known infectious disease, globally. In the United States, canine rabies has been virtually eliminated but the risk of rabies due to wildlife, especially raccoons, skunks, and bats, has required post exposure prophylaxis (PEP) be administered to more than 60,000 patients annually1. In 2021, 5 people in the United States2 died of rabies mostly due to misinformation or improper treatment. Rabies post exposure prophylaxis consists of three steps, wound washing, administration of human rabies immune globulin (HRIG) and a full course of vaccine3. In 2022, Whitehouse4 published that there were 122 breakthrough rabies infections when PEP was given due to four factors: 1) deviations from core practice 2) delays in seeking health care 3) errors in administration of HRIG 4) comorbidities or immunosuppression. It is estimated that over 40% of PEP administration is given inappropriately. The publication,” Safety, and efficacy of rabies immunoglobulin in pediatric patients with suspected exposure”, Human Vaccines &amp; Immunotherapeutics, 17:7, 2090–20965, was the first study that prospectively reviewed the use of human rabies immune globulin 150 IU/ml in 30 pediatric patients ages 0.5–14.9 years old. Globally, 40% of people bitten by animals suspected of being infected with the rabies virus are children under the age of 15.6 This paper will look at risk reduction strategies that will include: Proper Identification of major rabies vectors Special risks associated with bat exposures in children Administration of human rabies immune globulin with volume considerations in children Special administration consideration for rabies vaccines “Just -in- time “Education for health care providers Illustrative cases will be used to demonstrate each of these strategies of risk as well as the strategies for risk reduction.

A novel mRNA rabies vaccine as a promising candidate for rabies post-exposure prophylaxis protects animals from different rabies viruses

Rabies, caused by the rabies virus (RABV), is the most fatal zoonotic disease. It is a neglected tropical disease which remains a major public health problem, causing approximately 59,000 deaths worldwide annually. Despite the existence of effective vaccines, the high incidence of human rabies is mainly linked to tedious vaccine immunisation procedures and the overall high cost of post-exposure prophylaxis. Therefore, it is necessary to develop an effective vaccine that has a simple procedure and is affordable to prevent rabies infection in humans. RABV belongs to the genus Lyssavirus and family Rhabdoviridae. Previous phylogenetic analyses have identified seven major clades of RABV in China (China I–VII), confirmed by analysing nucleotide sequences from both the G and N proteins.This study evaluated the immunogenicity and protective capacity of SYS6008, an mRNA rabies vaccine expressing rabies virus glycoprotein, in mice and cynomolgus macaques.We demonstrated that SYS6008 induced sufficient levels of rabies neutralising antibody (RVNA) in mice. In addition, SYS6008 elicited strong and durable RVNA responses in vaccinated cynomolgus macaques. In the pre-exposure prophylaxis murine model, one or two injections of SYS6008 at 1/10 or 1/30 of dosage provided protection against a challenge with a 30-fold LD50 of rabies virus (China I and II clades). We also demonstrated that in the post-exposure prophylaxis murine model, which was exposed to lethal rabies virus (China I–VII clades) before vaccination, one or two injections of SYS6008 at both 1/10 and 1/30 dosages provided better protection against rabies virus challenge than the immunization by five injections of commercial vaccines at the same dosage. In addition, we proved that SYS6008-induced RVNAs could neutralise RABV from the China I–VII clades. Finally, 1/10 of the dosage of SYS6008 was able to stimulate significant RABV-G specificity in the T cell response. Furthermore, we found that SYS6008 induced high cellular immunity, including RABV-G-specific T cell responses and memory B cells.Our results imply that the SYS6008 rabies vaccine, with a much simpler vaccination procedure, better immunogenicity, and enhanced protective capacity, could be a candidate vaccine for post-exposure prophylaxis of rabies infections.

Dog-mediated rabies, an increasing threat to families in Kenema district: A call for action

On 5th December 2022, a stray dog attacked and bit five children, aged between 6 to 10 years in the same community in Kenema District. The children suffered multiple wounds on their bodies and were rushed to the hospital for treatment. The dog was killed, head decapitated and submitted to the Central Veterinary Laboratory/Teko, in Makeni, Bombali District, for confirmation of rabies. The sample was confirmed positive using a direct fluorescent antibody test. The victims of the dog attack were rushed to the Kenema Regional Hospital for treatment. Due to the high cost of the rabies post-exposure prophylaxis (PEP) vaccine (rabies vaccine freeze-dried from Liaoning Cheng Da Biotechnology Company Limited (SPEEDA®)), the families could not afford the whole cost of treatment. The victims were only able to receive the first dose of post-exposure vaccination which cost Le 400 per dose (US$ 20.5 equivalent). Upon the intervention of the Ministry of Agriculture and Food Security, the children received the complete dose. This is just one among many unreported cases of exposure to dog-mediated rabies within the country.

RABIES IN RODENTS AND LAGOMORPHS IN THE USA, 2011-20.

Rabies is an acute progressive encephalitis caused by infection with rabies viruses, with reservoirs among bats and mesocarnivores, but all mammals are susceptible. Despite its distribution and abundance, cases of rabies are much less common in rodents and lagomorphs. Familiarity with current rabies prevalence data is important for informed decisions on human postexposure prophylaxis after rodent and lagomorph bites. This study is an update of rabies cases reported in rodents and lagomorphs in the US from 2011 to 2020. Rabies reports were collected passively from laboratory testing agencies in the US and Puerto Rico from 2011 to 2020. Descriptive analysis was conducted to determine the percent positivity of rabies cases by species. A total of 401 cases of rabies in rodents and lagomorphs were reported from 2011 to 2020. Most reported cases were in groundhogs (Marmota monax), representing >90% of cases, and the trend closely aligned with rabies in raccoons (Procyon lotor). In any given year, the percent positivity of rabies in rodents and lagomorphs was <2.5%, and the trend of percent positivity from 2011 to 2020 was stable. Groundhog and North American beaver (Castor canadensis) percent positivity was significantly higher than the rest of the rodents and lagomorphs. Most rabies cases occurred during the months of May-September. Documented cases of rabies in rodents and lagomorphs are generally rare, but with variation between species. Groundhogs and North American beavers had rabies percent positivity similar to high-risk species, such as bats and raccoons, and constituted 97% of all rodent and lagomorph positive cases. Since 1993, the trend in rabies cases in groundhogs has significantly declined. These results can be used to help inform public health officials on rodent and lagomorph prevention and control efforts, as well as rabies postexposure prophylaxis.

Electromagnetic radiation as antiviral treatment with a focus on Rabies post-exposure prophylaxis

Shortwave and microwave diathermy devices are commonly used in physical therapy as heating treatment. The rise in temperature occurs due to the flow of electric current in the treated area. Ions are evenly distributed in a predicted pattern from skin to deeper tissues. We hypothesise that the diathermy physiotherapy devices (DPDs) can be repurposed as a means of neutralisation of the Rabies virus (RABV) by exploiting the generated electric charges. In order to minimise the ohmic heating of the tissue, the pulsed output of the diathermy devices is preferred where the ‘on’ time of active energy emission is considerably shorter than the ‘off’ time. RABV proteins mediating cell invasion, cytoplasmic replication and budding, contain polar components that can be adversely affected by non-thermal electric phenomena. Repurposed DPDs can replace the Rabies immunoglobulin (RIG) by targeting the site of inoculation i.e. the area of the animal bite, provided that the delivered electric charges can reduce pathogenicity by altering key viral proteins. The modality is advantageous compared to conventional RIG since it can theoretically neutralise all Lyssavirus species, is not limited by the compartment syndrome, can intercept RABV even after it gains access to the peripheral neural network where conventional post-exposure prophylaxis is ineffective and is cost-effective in the long term. The principle of physical alteration of vulnerable proteins by electricity delivered by electromagnetic radiation is not limited to RABV, but may be applied to a spectrum of viral pathogens.

Boostability after single-visit pre-exposure prophylaxis with rabies vaccine: a randomised controlled non-inferiority trial

After rabies pre-exposure prophylaxis (PrEP) vaccination, scarcely available rabies immunoglobulins are not required for post-exposure prophylaxis (PEP). However, PrEP is not sufficiently accessible as it is cost-intensive and time-intensive. This study investigates whether rabies PrEP schedules can be shortened to one visit, removing some of these barriers. In a block-randomised (2:2:2:1) controlled, multicentre non-inferiority trial, healthy adult travellers (aged 18-50 years and >50 years) were randomly assigned to (A) single-visit intramuscular (1·0 mL); (B) single-visit intradermal (0·2 mL); (C) standard two-visit intramuscular (1·0 mL; day 0 and 7) PrEP; or (D) no rabies vaccination. 6 months later, participants received simulated intramuscular rabies PEP (1·0 mL; day 0 and 3). Rabies virus neutralising antibody (RVNA) concentrations were measured repeatedly. The primary outcome was the fold increase in geometric mean RVNA concentrations between day 0 and 7 after simulated PEP for all participants. The two main comparisons of this primary outcome are between the standard two-visit schedule and the one-visit intramuscular schedule, and between the standard two-visit schedule and the one-visit intradermal schedule. The non-inferiority margin was 0·67. This study is registered with EudraCT, 2017-000089-31. Between May 16, 2018, and March 26, 2020, 288 healthy adult travellers were randomly assigned and 214 participants were evaluated for the primary outcome. Single-visit intramuscular rabies PrEP induced an anamnestic antibody response non-inferior compared with the two-visit intramuscular schedule; single-visit intradermal PrEP did not. The fold increases in the single-visit intramuscular and the single-visit intradermal schedule were 2·32 (95% CI [1·43-3·77]) and 1·11 (0·66-1·87) times as high as the fold increase in the standard schedule, respectively. No vaccine-related serious adverse events were observed. Adverse events related to vaccination were mostly mild. Single intramuscular rabies vaccination can effectively prime travellers (aged 18-50 years), and potentially other populations, and could replace current standard two-visit rabies vaccination as PrEP. ZonMW. For the Dutch translation of the abstract see Supplementary Materials section.

Potential option for rabies post-exposure prophylaxis: New vaccine with PIKA adjuvant against diverse Chinese rabies strains

Rabies is a fatal zoonotic disease caused by the rabies virus. Despite existing vaccines, failures still persist. Complete protection relies on improving vaccination for delayed antibody response and weak cellular immunity. A more effective and secure vaccine is necessary for rabies prevention. For this purpose, we employed the use of PIKA adjuvant, a stabilized double-stranded RNA that interacts with TLR3, as an enhancer for the rabies immunization. Testing on mice infected with seven rabies strains prevalent in China showed over 80% protective efficacy without immunoglobulin. In contrast, the PIKA rabies vaccine exhibited a more significant enhancement in neutralizing antibody levels just 5 days post-vaccination, surpassing the immune response induced by licensed rabies vaccines. Furthermore, the administration of the PIKA rabies vaccine resulted in a significant augmentation in the population of T cells that produce IFN-γ in response to the antigen. Additionally, elevated levels of IL-1β, IL-6, CCL-2, and TNF-α were observed at the injection site. Furthermore, an increase in the levels of chemotactic proteins and pro-inflammatory molecules in the serum was observed following administration of the PIKA rabies vaccine. Confirmation of the mechanism of action of PIKA was further established by testing it on TLR3-knockout mice, proving that its adjuvant function is dependent on the TLR3 pathway. Taken together, these results indicate that the PIKA vaccine for rabies shows potential as a highly efficacious approach, resulting in a significant enhancement of the efficacy of rabies vaccines.

Rabies post-exposure prophylaxis delivery to ensure treatment efficacy and increase compliance

ObjectivesSince rabies is lethal once symptoms appear, its prevention including community awareness, mass dog vaccination and post-exposure prophylaxis (PEP) is crucial. Although safe and potent rabies vaccines have long been available, the global rabies burden is still high and access to adequately-delivered PEP remains challenging. Here we offer healthcare providers up-to-date, simple, exhaustive, visual guidance on how to perform PEP steps correctly. ProtocolPEP consists of 1) washing the wound with water and soap for 15 min, 2) assessing the need for rabies biologicals based on specific criteria; 3) administering, if required, rabies immunoglobulin or monoclonal antibodies deep in and around all wounds; 4) starting, if necessary, the WHO-recommended intradermal 1-week vaccination regimen; 5) informing patients adequately throughout the PEP process to increase compliance and avoid dangerous misconceptions about animal bite treatment and rabies risk. DiscussionThe intradermal 1-week vaccination regimen recommended by WHO is as safe as other regimens but carries important cost-, dose- and time-sparing benefits. As fundamental as the correct administration of rabies biologicals is clear doctor-patient communication and sharing of up-to-date knowledge among healthcare professionals. ConclusionsThis resource will help ensuring that no life is lost to rabies, an incurable yet preventable disease.

Challenges in Accessing Comprehensive Rabies Post-Exposure Prophylaxis: A Case Study Following a Street Dog Attack and Subsequent Kitten Bite

Challenges in Accessing Comprehensive Rabies Post-Exposure Prophylaxis: A Case Study Following a Street Dog Attack and Subsequent Kitten Bite

Evaluation of Various Analytical Methods for Quantification of Rabies Antigen

Background: Rabies is a zoonotic viral disease caused by rabies virus. Rabies virus has special inclination towards central nervous system (CNS) where it causes life threatening acute encephalitis. Perhaps being extremely fatal, rabies can be 100% prevented by early, effective and complete post exposure prophylaxis (PEP). PEP for rabies include immediate toileting of bite wound, administration of rabies immunoglobulins (severe exposures), and a full course of anti-rabies vaccination (ARV). As ensuring the absence of any variations in the primary nucleotide sequence of the viral backbone after successive propagation in human cell lines is crucial to ensure that the expression vector does not produce variants of the antigen during production of vaccine, the present study was conducted with an aim to evaluate various analytical methods for quantification of rabies antigen. Method: Various analytical methods the Western Blot technique, the Sodium Dodecyl Sulphate Agarose Gel Electrophoresis(SDS-PAGE), ELLA method, the Enzyme-linked immunosorbent assay (ELISA) and extinction coefficient were used for quantification of rabies antigen. Results: When results of these tests were analyzed, it was observed that these analytical methods are easy, cost effective, accurate and most importantly rapid for quantification of rabies antigen. Conclusion: On the basis of observations noted in this study, Western Blot technique, the Sodium Dodecyl Sulphate Agarose Gel Electrophoresis(SDS-PAGE), ELLA method, the Enzyme-linked immunosorbent assay (ELISA) and extinction coefficient can be reliably recommended as analytical methods for quantification of rabies antigen..

Efficiency Comparative Approach of Plant-Produced Monoclonal Antibodies against Rabies Virus Infection.

Rabies encephalitis is a fatal zoonotic viral disease caused by the neurotropic rabies virus. It remains a major public health concern as it causes almost 100% fatality and has no effective medication after the onset of the disease. However, this illness is preventable with the timely administration of effective post-exposure prophylaxis (PEP) consisting of the rabies vaccine and passive immune globulins (HRIG and ERIG). Recently, conventional PEP has been shown to have many limitations, resulting in little support for these expensive and heterologous globulins. Monoclonal antibody (mAb) production via recombinant technology in animal and human cell cultures, as well as a plant-based platform, was introduced to overcome the costly and high-tech constraints of former preparations. We used transient expression technology to produce two mAbs against the rabies virus in Nicotiana benthamiana and compared their viral neutralizing activity in vitro and in vivo. The expression levels of selective mAbs E559 and 62-71-3 in plants were estimated to be 17.3 mg/kg and 28.6 mg/kg in fresh weight, respectively. The plant-produced mAbs effectively neutralized the challenge virus CVS-11 strain in a cell-based RFFIT. In addition, the combination of these two mAbs in a cocktail protected hamsters from rabies virus infection more effectively than standard HRIG and ERIG. This study suggests that the plant-produced rabies antibody cocktail has promising potential as an alternative biological to polyclonal RIG in rabies PEP.