[Immunoprophylaxis of rabies: current recommendations]

Area of Science:

• Immunology
• Vaccinology
• Public Health

Context:

• Rabies remains a significant global public health concern, necessitating effective prevention and post-exposure protocols.
• High-risk populations, including those with occupational exposure or travel to endemic areas, require specific vaccination strategies.
• Access to timely and appropriate post-exposure prophylaxis (PEP) can be challenging in certain regions.

Purpose:

• To outline recommended pre-exposure rabies vaccination schedules and indications.
• To detail post-exposure rabies treatment protocols, including variations for previously vaccinated individuals.
• To specify immunoglobulin dosages and administration techniques for rabies prevention.

Summary:

• Pre-exposure rabies vaccination comprises 3 intramuscular injections (days 0, 7, 28), with boosters at 1 year and every 5 years thereafter.
• Post-exposure treatment typically involves 5 injections (days 0, 3, 7, 14, 28) and rabies immunoglobulin on day 0 for penetrating wounds.
• For individuals with documented, up-to-date vaccination, PEP may be simplified to 2 injections (days 0, 3).
• Rabies immunoglobulin is administered at 20 IU/kg (human) or 40 IU/kg (equine), infiltrated around wounds and intramuscularly.
• Seroconversion, monitored via neutralizing antibody assays (≥0.5 IU/ml by RFFIT), is crucial for assessing vaccine efficacy in regularly exposed populations.

Impact:

• Ensures adequate rabies immunity in at-risk populations, reducing the incidence of this fatal disease.
• Provides clear guidelines for healthcare professionals managing potential rabies exposures.
• Facilitates appropriate and potentially simplified post-exposure treatment, improving patient compliance and outcomes.