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Pre-exposure rabies prophylaxis: a systematic review.

Jocelyn A Kessels1, Sergio Recuenco2, Ana Maria Navarro-Vela3

  • 1School of Veterinary Science, University of Queensland Gatton Campus, Via Warrego Highway, Gatton, Queensland 4343, Australia .

Bulletin of the World Health Organization
|March 3, 2017
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Summary

Pre-exposure rabies prophylaxis is safe and effective for all ages, with flexible dosing schedules. It is recommended in areas with limited access to post-exposure treatment or high rabies risk.

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Area of Science:

  • Public Health
  • Infectious Disease Epidemiology
  • Vaccinology

Background:

  • Rabies remains a significant public health concern globally, particularly in regions with limited access to post-exposure prophylaxis (PEP).
  • Pre-exposure prophylaxis (PrEP) offers a proactive approach to rabies prevention, but its optimal use, including schedules and cost-effectiveness, requires ongoing evaluation.

Purpose of the Study:

  • To review the safety, immunogenicity, cost-effectiveness, and recommended use of rabies pre-exposure prophylaxis (PrEP).
  • To assess the impact of accelerated schedules, co-administration with other vaccines, and booster dose intervals on PrEP efficacy.
  • To provide guidance on PrEP implementation, especially in high-risk settings and resource-limited areas.

Main Methods:

  • A comprehensive literature search of PubMed, CABI, Cochrane Library, and Web of Science databases (2007-2016).
  • Inclusion of field data from PrEP campaigns in Peru and the Philippines.
  • Review of studies on safety, immunogenicity, cost-effectiveness, and dosing strategies for rabies PrEP.

Main Results:

  • Rabies PrEP demonstrated safety and immunogenicity in both children and adults, including when co-administered with routine childhood vaccines and Japanese encephalitis vaccine.
  • Shorter regimens and fewer doses were found to be safe and immunogenic, with potential for extended booster intervals up to 10 years.
  • Current cost-effectiveness analyses suggest PrEP campaigns are not cost-effective in most settings, though future accelerated regimens and novel vaccines may improve affordability.

Conclusions:

  • Rabies PrEP is a safe and immunogenic option recommended when access to PEP is limited or delayed, or in situations with high, unrecognized exposure risk.
  • PrEP should be considered in areas where controlling the animal rabies reservoir is challenging.
  • PrEP implementation should complement, not replace, canine vaccination, timely PEP provision, and community rabies awareness education.