title: Pre-exposure rabies prophylaxis: a systematic review.
abstract: OBJECTIVE
  To review the safety and immunogenicity of pre-exposure rabies prophylaxis (including accelerated schedules, co-administration with other vaccines and booster doses), its cost-effectiveness and recommendations for use, particularly in high-risk settings.
  
  
  METHODS
  We searched the PubMed, Centre for Agriculture and Biosciences International, Cochrane Library and Web of Science databases for papers on pre-exposure rabies prophylaxis published between 2007 and 29 January 2016. We reviewed field data from pre-exposure prophylaxis campaigns in Peru and the Philippines.
  
  
  RESULTS
  Pre-exposure rabies prophylaxis was safe and immunogenic in children and adults, also when co-administered with routine childhood vaccinations and the Japanese encephalitis vaccine. The evidence available indicates that shorter regimens and regimens involving fewer doses are safe and immunogenic and that booster intervals could be extended up to 10 years. The few studies on cost suggest that, at current vaccine and delivery costs, pre-exposure prophylaxis campaigns would not be cost-effective in most situations. Although pre-exposure prophylaxis has been advocated for high-risk populations, only Peru and the Philippines have implemented appropriate national programmes. In the future, accelerated regimens and novel vaccines could simplify delivery and increase affordability.
  
  
  CONCLUSIONS
  Pre-exposure rabies prophylaxis is safe and immunogenic and should be considered: (i) where access to postexposure prophylaxis is limited or delayed; (ii) where the risk of exposure is high and may go unrecognized; and (iii) where controlling rabies in the animal reservoir is difficult. Pre-exposure prophylaxis should not distract from canine vaccination efforts, provision of postexposure prophylaxis or education to increase rabies awareness in local communities.
authors.affiliation: School of Veterinary Science, University of Queensland Gatton Campus, Via Warrego Highway, Gatton, Queensland 4343, Australia .
authors.forename: Jocelyn A
authors.initials: JA
authors.lastname: Kessels
authors.affiliation: National Centre for Public Health, Instituto Nacional de Salud, Lima, Peru .
authors.forename: Sergio
authors.initials: S
authors.lastname: Recuenco
authors.affiliation: Directorate General of Strategic Interventions in Public Health, Ministry of Health, Lima, Peru .
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Navarro-Vela
authors.affiliation: Diseases Prevention and Control Bureau, Department of Health, Manilla, Philippines .
authors.forename: Raffy
authors.initials: R
authors.lastname: Deray
authors.affiliation: Veterinary Public Health Unit, Pan American Health Organisation-World Health Organisation, Rio de Janeiro, Brazil .
authors.forename: Marco
authors.initials: M
authors.lastname: Vigilato
authors.affiliation: Wistar Institute Vaccine Center, Philadelphia, United States of America (USA).
authors.forename: Hildegund
authors.initials: H
authors.lastname: Ertl
authors.affiliation: Hunter Medical Research Institution, University of Newcastle, Newcastle, Australia .
authors.forename: David
authors.initials: D
authors.lastname: Durrheim
authors.affiliation: Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa .
authors.forename: Helen
authors.initials: H
authors.lastname: Rees
authors.affiliation: Department of Microbiology and Plant Pathology, University of Pretoria, Pretoria, South Africa .
authors.forename: Louis H
authors.initials: LH
authors.lastname: Nel
authors.affiliation: Neglected Zoonotic Diseases, World Health Organization, Geneva, Switzerland .
authors.forename: Bernadette
authors.initials: B
authors.lastname: Abela-Ridder
authors.affiliation: College of Veterinary Medicine, Kansas State University, Manhattan, USA .
authors.forename: Deborah
authors.initials: D
authors.lastname: Briggs
mesh_terms: D000367:Age Factors; D000818:Animals; D001733:Bites and Stings / Q000821:virology; D002685:Chiroptera; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D004285:Dogs; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D017589:Immunization Programs; D007115:Immunization Schedule; D017059:Models, Econometric; D010568:Peru; D010679:Philippines; D011819:Rabies Vaccines / Q000008:administration & dosage* / Q000191:economics*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D011819:Rabies Vaccines