Antibody Response to Preexposure Human Diploid-Cell Rabies Vaccine Given Concurrently with Chloroquine

Abstract

We conducted a randomized controlled trial to evaluate the antibody response of freshman veterinary students to intradermal human diploid-cell rabies vaccine administered concurrently with chloroquine, a drug frequently used for chemoprophylaxis against malaria. Fifty-one students who had not been vaccinated against rabies were enrolled: 26 received 300 mg of chloroquine base per week (the recommended dose for malaria prophylaxis); 25 did not receive chloroquine and served as controls. All subjects received 0.1 ml of rabies vaccine intradermally on days 0, 7, and 28. Chloroquine was administered weekly to the treatment group, beginning nine days before the first dose of vaccine and continuing until day 48. The mean rabies-neutralizing antibody titer for the chloroquine group was significantly lower than that for the control group on each day of testing--i.e., day 28 (P = 0.0094), day 49 (P = 0.0008), and day 105 (P = 0.0002)--although both groups had neutralizing antibody titers on days 49 and 105, according to the criteria of the Centers for Disease Control. The blood concentrations of chloroquine and desethylchloroquine (the major metabolite of chloroquine, which also has antimalarial properties) were negatively associated with log antibody titers. These results indicate that chloroquine taken in the dose recommended for malaria prophylaxis can reduce the antibody response to primary immunization with intradermal human diploid-cell rabies vaccine.

Intradermal vaccination for rabies prophylaxis: conceptualization, evolution, present status and future

“…Individuals taking chloroquine for malaria treatment or prophylaxis may have a reduced response to ID rabies vaccination and should receive the vaccine im. [1,49,88,89].…”

Cost Analysis of Post Exposure Prophylaxis of Rabies in A Tertiary Care Centre- A Cross Sectional Study

“…The safety of Pre exposure prophylaxis is firmly established. Only two documented cases of seroconversion failures have been observed among Pre exposure prophylaxis receivers especially in immuno-compromised persons (15,16 ).Chulasugandha P et al found that costs of both strategies, Pre exposure prophylaxis of children or PEP of exposed, become equal when the dog bite incidence is 2-30%; depending on which post-exposure treatment regimens (PEP) are used in study conducted in Thai children (17) The annual birth rate in Kerala is low (14.7 as per 2011 census) and the immunization coverage is high. Pre exposure prophylaxis may be implemented in a phased manner as the immunization schedule advised by WHO and IAP (18).It is also stated that the booster doses of rabies vaccines are not required for individuals living in or travelling to high risk areas who have received a complete series of pre-exposure prophylaxis with cell-culture based rabies vaccines (18,19).The Association of South East Asian Nation(ASEAN)countries adopted a call for action to prevent and control rabies with the goal of elimination by 2020.One of the ways to achieve this goal could be by pre exposure prophylaxis of all infants, children as well as on a voluntary basis.…”

Clinically Significant Drug Interaction Profiles of Chloroquine Analogues with Adverse Consequences and Risk Management

“…Similarly, the use of CQ with pyrimethamine and sulfadoxine do not affect the immune response to oral typhoid vaccine [52]. CQ significantly reduces intradermal human diploid-cell rabies vaccine [53] and CQ prophylaxis is associated with poor antibody response to this vaccine [54]. When vaccination against rabies with this vaccine is to be used, it is recommended that the vaccine should be given before starting CQ to avoid reducing the effectiveness of the vaccine.…”