Postexposure rabies prophylaxis completed in 1 week: preliminary study.
BACKGROUND
Patients exposed to a rabid animal often travel long distances to receive postexposure prophylaxis (PEP), which requires 4 or 5 visits. Reducing the number of clinic visits would not only reduce costs for the patient but may also help increase compliance to receive complete PEP. We made an effort to develop PEP completed in 1 week.


METHODS
We administered the 4-site intradermal injections of 0.1 mL of purified Vero cell rabies vaccine to the deltoids and thighs on days 0, 3, and 7, with and without equine rabies immunoglobulin (40 IU/kg). A control group received the World Health Organization-approved and widely used Thai Red Cross regimen (2-site intradermal injections on days 0, 3, and 7 and 1 injection on days 28 and 90) with equine rabies immunoglobulin. We then determined rabies neutralizing antibody (NAb) up to day 360.


RESULTS
Geometric mean titers for subjects receiving the 4-site intradermal regimen, with or without equine rabies immunoglobulin, had significantly higher NAb values than did the control group on day 14 and 28 (P<.001). All subjects in all groups had a NAb value > or =0.5 IU/mL on days 14 and 28. The percentages of subjects who had a NAb value > or =0.5 IU/mL from days 0 through 360 were not significantly different among the 3 groups.


CONCLUSIONS
After any PEP regimen, World Health Organization recommendations require a NAb value > or =0.5 IU/mL on days 14 and 28. The 1-week PEP regimen, therefore, appears promising. It increased immunogenicity over the 2-site intradermal schedule, and it is convenient and can be used in small clinics, because it consumes almost the entire supplied vaccine ampoule volume.
Shantavasinkul
Prapimporn
P
Queen Saovabha Memorial Institute, The Thai Red Cross Society (World Health Organization Collaborating Center for Research on Rabies Pathogenesis and Prevention), Bangkok, Thailand. sprapimporn@gmail.com
Tantawichien
Thanphet
T
Wilde
Henry
H
Sawangvaree
Artikaya
A
Kumchat
Apinya
A
Ruksaket
Natthasri
N
Lohsoonthorn
Vitool
V
Khawplod
Pakamatz
P
Tantawichien
Terapong
T
D000328:Adult; D000704:Analysis of Variance; D000818:Animals; D057134:Antibodies, Neutralizing / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D002522:Chlorocebus aethiops; D005260:Female; D006736:Horses; D006801:Humans; D007116:Immunization, Passive / Q000379:methods; D007136:Immunoglobulins / Q000008:administration & dosage; D007271:Injections, Intradermal; D008297:Male; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D011446:Prospective Studies; D011818:Rabies / Q000276:immunology / Q000517:prevention & control*; D011819:Rabies Vaccines / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D014709:Vero Cells
D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral; D007136:Immunoglobulins; D011819:Rabies Vaccines