Introduction of intradermal rabies vaccination - A paradigm shift in improving post-exposure prophylaxis in Asia

The cost of cell culture vaccines for intramuscular administration limits their widespread use in many areas where rabies is present. The innovation of cost-effective multi-site intradermal (ID) vaccination technique was an impetus for high burden countries to phase out production and use of rabies vaccine of nerve tissue origin in public hospitals in subsequent years. The WHO Expert Committee in 1991 recommended intradermal application of modern rabies vaccines for post-exposure prophylaxis. There are many challenges in promotion of ID schedule. Poor patient compliance due to the need for several clinic visits is one of the drawbacks of the presently recommended ID rabies vaccination regimens. A series of clinical trial and field observations in past 3 decade have generated enough evidence-based information to recommend one week ID schedule. Off label use of commercially available human rabies vaccine for ID administration is an issue. The national authority should consider revision of ID vaccination schedule in line with new WHO guidelines.