Predictive factors for the neutralizing antibody response following pre-exposure rabies immunization: validation of a new booster dose strategy.
A prospective cohort of 312 subjects who received pre-exposure rabies immunization and who were monitored serologically with a 10-year follow-up was assessed using multivariate analysis. The aim was to propose a new booster dose strategy by identifying predictive factors for the durability of the neutralizing antibody response. Evaluation bore on several factors relating to: (1) demographic characteristics: age, gender; (2) vaccines: type of vaccine (HDCV or PVRV), injection regimen (D0-D28-D365 or D0-D7-D28-D365) and vaccine lots' antigenic potency; and (3) resulting antibody titers. Logistic regression analysis enabled the authors to establish a predictive model for immunized subjects' serological status at ten years' follow-up expressed as a P probability for seroreversion (antibody titer <0.5 IU/ml). Highly significant factors were the immunization regimen, the type of vaccine used and the antibody titer at D379. A P value <0.4 identified subjects as "good" responders who were sure to be have satisfactory antibody titers at 10 years and who required a single booster dose every 10 years. A P value >/=0.4 identified subjects as "poor" responders in whom a specific follow-up and booster dose strategy is proposed. This new immunization strategy could at least be applied to subjects with a frequent risk of exposure, as defined by institutional recommendations. This new immunization strategy should nevertheless undergo an external validation and a cost-effectiveness evaluation.
Strady
C
C
Centre antirabique, Centre Hospitalier Universitaire de Reims, Hôpital Robert Debré, avenue du Général Koenig, 51092, Reims Cedex, France. astrady@chu-reims.fr
Jaussaud
R
R
Béguinot
I
I
Lienard
M
M
Strady
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000096:biosynthesis; D002648:Child; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007117:Immunization, Secondary; D008875:Middle Aged; D018448:Models, Immunological; D015999:Multivariate Analysis; D009500:Neutralization Tests; D011819:Rabies Vaccines / Q000276:immunology*
D000914:Antibodies, Viral; D011819:Rabies Vaccines