Human diploid cell rabies vaccine. Effectiveness of immunization with small intradermal or subcutaneous doses

Abstract

To determine antibody responses to small doses of human diploid cell rabies vaccine (HDCV), we determined rabies antibody titers in 124 volunteers who had been vaccinated with one of five primary preexposure regimens. In a sixth group of 47 persons previously vaccinated with duck embryo rabies vaccine (DEV), we evaluated the booster responses after a 0.1-mL dose of intradermal (ID) HDCV. Persons in all five groups undergoing primary immunization received three doses of vaccine, one each on days 0, 7, and 28. The dose and route of vaccination for the five groups included 1 mL intramuscular (IM), 0.1 mL ID (two subgroups), 0.1 mL subcutaneous (SC), and 0.25 mL SC. Adequate titers developed in all persons, irrespective of the route or quantity of vaccine. The geometric mean titers (IU/mL) on day 49 in those receiving primary regimens were 12.87 (1.0 mL IM), 7.44 (0.1 mL ID by syringe), 3.05 (0.1 mL by jet injector), 3.17 (0.1 mL SC), and 6.47 (0.25 mL SC). Titers on day 90, while lower, were still acceptable. Adequate antibody titers developed in all persons previously vaccinated with DEV after a single 0.1-mL ID dose of HDCV; however, higher titers developed at day 7 in those who had shown an adequate response to DEV in the past. Results of this study suggest that HDCV may be used ID or SC for primary preexposure rabies prophylaxis and ID for booster immunization.

Delivery Systems for Intradermal Vaccination

“…Both post-exposure prophylaxis and pre-exposure prophylaxis ID regimens induce protective titers, and WHO has recommended ID delivery of reduced doses of rabies vaccines since 1991 (WHO 2005;. Given equivalent doses of antigen, delivery to the dermis appears to be either superior or equivalent to IM/SC (Bernard et al 1982;Bernard et al 1987;Fishbein et al 1987;Phanuphak et al 1990). A detailed review on ID rabies vaccination can be found elsewhere in this special volume on ID immunization (Warrell 2011).…”

“…MUNJI devices provided millions of ID smallpox doses during the implementation of the smallpox eradication program (Millar and Foege 1969;Weniger and Papania 2008). Jet injectors have also been utilized historically for ID vaccination of rabies (Bernard et al 1982;Bernard et al 1987), hepatitis A (Williams et al 2000), BCG (Paul et al 1978;Parker 1984), DTP combination vaccine (Stanfield et al 1972), measles (Burland 1969;Kok et al 1983), and influenza vaccine (Weniger and Papania 2008).…”

Subcutaneous diphtheria and tetanus vaccines in children with haemophilia: A pilot study and review of the literature

“…[20][21][22][23][24][25][26][27] A compilation of comparative vaccine studies conducted within the bleeding disorder population and the general population are reviewed in Table 1 [14][15][16][17][18][19][20][21][22][23][24][25][26][27]36 and Table S1 respectively. 12,28,29,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] 29,58 There were no reports of sterile abscesses in our patients. A larger prospective study would be needed to assess for significant differences in local reactions and complications between SQ and IM administered vaccines.…”

Technologies to Improve Immunization

“…Although the latter was typically delivered intramuscularly, research found that reduced doses of rabies vaccines delivered via ID are similarly effective for both postexposure and preexposure prophylaxis regimens. [325][326][327][328][329][330][331][332][333] Because of the high cost of cell-culture rabies vaccines, the WHO has recommended ID delivery for resourceconstrained settings since 1991, and this route is widely used in the developing world, particularly in Asia. 333a,334-336 In the Mantoux technique, a short-bevel, fine-gauge needle, usually 27 gauge, is inserted, bevel up, at a 5-to 15-degree angle into slightly stretched skin, often the volar surface of the forearm.…”