title: Pre-exposure rabies vaccination: strategies and cost-minimization study.
abstract: An alternative strategy for pre-exposure rabies vaccination to the institutional recommendations of the World Health Organization and the Centers for Disease Control and Prevention is proposed based on recent long-term follow-up of post-vaccinal seroconversion rates. The alternative strategy uses the same primary series (i.e. vaccination in the deltoid area on D0, D7, and D28), but is completed by a scheduled booster vaccination at D365. The frequency of recommended subsequent booster injections depends on the serological test results obtained by a RFFIT on D379 and 3 years later. The objective of this study was to compare the efficiency of the two pre-exposure strategies. A cost-minimization analysis was carried out to compare the two rabies pre-exposure vaccination and serological test strategies based on the data from two published studies on the long-term evolution of the immunity achieved using the different recommendations. For a theoretically equivalent immunogenicity, the cost of the alternative strategy ranged from 1.7 to 5.2 times lower than that of the institutional recommendations. A sensitivity analysis confirmed the robustness of the results. The alternative strategy should be validated externally under field conditions. This approach would compare its real efficiency to the institutional recommendations.
authors.affiliation: Centre Antirabique, Hôpital Robert Debré, Avenue du Général Koenig, 51092, Reims Cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Strady
authors.forename: V
authors.initials: V
authors.lastname: Hung Nguyen
authors.forename: R
authors.initials: R
authors.lastname: Jaussaud
authors.forename: J
authors.initials: J
authors.lastname: Lang
authors.forename: M
authors.initials: M
authors.lastname: Lienard
authors.forename: A
authors.initials: A
authors.lastname: Strady
mesh_terms: D000914:Antibodies, Viral / Q000096:biosynthesis; D003363:Cost Control; D003663:Decision Trees; D006801:Humans; D007115:Immunization Schedule; D007117:Immunization, Secondary; D011818:Rabies / Q000276:immunology / Q000517:prevention & control; D011819:Rabies Vaccines / Q000008:administration & dosage* / Q000191:economics*; D011820:Rabies virus / Q000276:immunology
chemical_list: D000914:Antibodies, Viral; D011819:Rabies Vaccines