Pre-exposure rabies booster vaccinations: a literature review

In Europe, more attention is turning towards human infection with European bat lyssaviruses (EBLVs). Following the death of a bat conservationist from EBLV in Scotland, in 2002, the Department of Health in the United Kingdom (UK) recommended that all bat workers receive prophylactic rabies vaccination. This systematic literature review aims to review the evidence base for current UK policy on rabies booster vaccination. Ten papers met the inclusion criteria and were reviewed. Most of the papers were prospective cohort studies with follow-up ending after the first booster vaccination. One year after a three dose intramuscular primary rabies vaccination course, 87.9-100 % of participants had a rabies antibody level > or = 0.5 IU/ml, before the first booster. It may, therefore, be prudent for the UK to reduce its current recommended interval, primary course to first booster, from two years to one year. More research, with longer follow-up, is required to enable recommendations on subsequent boosters to be made.