Circulating Antibody's Role During Post-Exposure Prophylaxis, and Beyond for Rabies: A Review.

Area of Science:

• Immunology
• Public Health
• Infectious Diseases

Background:

• Rabies remains a significant global health concern, with over 150 countries affected.
• Despite widespread use of rabies vaccines and post-exposure prophylaxis (PEP), documented failures continue to occur worldwide.
• Occasional PEP failures have been reported in China, highlighting ongoing challenges.

Purpose of the Study:

• To review recommended PEP procedures from ACIP and WHO.
• To analyze factors contributing to PEP failure and introduce the concept of circulating antibodies.
• To discuss the role of antibodies in PEP and summarize guidelines for clinical trials and new antibody therapies.

Main Methods:

• Literature review of PEP guidelines and reported failures.
• Analysis of contributing factors to PEP failure.
• Summary of clinical trial design guidelines (FDA, CDE) and advancements in monoclonal antibody therapies.

Main Results:

• Adherence to wound cleansing, immunoglobulin infiltration, and vaccination is critical for PEP success.
• For high-risk or immunocompromised individuals, high-dose human rabies immune globulin (HRIG) or monoclonal antibodies (mAbs) are vital to prevent PEP failure.
• Early establishment of high-concentration circulating antibodies is crucial.

Conclusions:

• Early and sufficient circulating antibodies are essential for preventing rabies PEP failure.
• A collective, societal effort is required to address rabies as a neglected disease.
• Achieving the WHO's "zero by 30" goal necessitates comprehensive global collaboration.