Experience with preexposure rabies vaccination

Preexposure rabies vaccination, presently limited to high-risk target populations, is facilitated by cell culture vaccines. Officially recommended programs comprise either two doses administered on days 0 and 28 or three doses given on days 0, 7, and 21 or 28. A first booster 1 year later ensures a good duration of immunity; follow-up studies now cover 5-8 years. These results were obtained by the intramuscular and subcutaneous injection routes; intradermal programs have been explored with the aim of reducing costs. Preexposure immunization is well tolerated, despite some systemic allergic reactions. Efficacy has been observed universally, but certain factors may affect results. Several lines of evidence favor an extension of preexposure vaccination. In Scandinavian countries, the majority of vaccine doses are used preexposure, while about 40%, 15%, and 10% are so used in the United Kingdom, the United States, and France, respectively. However, preventive immunization is rare in developing countries, where the risk of infection is maximal and permanent. The more economical new vaccines, such as purified Vero rabies vaccine, permit a reevaluation of preventive vaccination. Vaccine combinations including rabies may prove economical.