Prospective Immunogenicity Study of Multiple Intradermal Injections of Rabies Vaccine in an Effort to Obtain an Early Immune Response without the Use of Immunoglobulin

Khawplod, Pakamatz; Wilde, Henry; Tepsumethanon, Saovaluk; Limusanno, Sukunya; Tantawichien, Thanphet; Chomchey, Pranee; Ayuthaya, Ampai Bungjiongkasaena Na; Wangroonsarb, Yongyuth

doi:10.1086/344954

Cited by 37 publications

(11 citation statements)

References 6 publications

(9 reference statements)

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“…Nevertheless, the 4-site 1-week regimen does not eliminate the use of RIG. It, like the 8-site (Oxford) intradermal regimen, results in higher antibody levels by day 14, but there is no significant earlier antibody response to protect the patient during the early "window period" [13].…”

Section: Discussionmentioning

confidence: 99%

“…He also found that there is then an earlier cellular antibody response than with the intramuscular schedules [12]. Later experiments suggested that doubling the number of intradermal injections during the first few days of treatment resulted in higher initial (but not earlier) antibody titers [13]. This encouraged us to perform this study of the longevity of antibody responses to a 1-week PEP schedule…”

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confidence: 99%

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Postexposure Rabies Prophylaxis Completed in 1 Week: Preliminary Study

et al. 2010

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Postexposure Rabies Prophylaxis Completed in 1 Week: Preliminary Study

et al. 2010

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“…Other studies of 8-site PVRV have used 0.1 ml per ID site [29], as recommended by WHO [5], which almost doubles the amount of vaccine used. The results for the 2-site regimen we report here apply to PVRV, the equivalent dose for PCECV would be 0.2 ml per site.…”

Section: Discussionmentioning

confidence: 99%

A Simplified 4-Site Economical Intradermal Post-Exposure Rabies Vaccine Regimen: A Randomised Controlled Comparison with Standard Methods

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Riddell

et al. 2008

PLoS Negl Trop Dis

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BackgroundThe need for economical rabies post-exposure prophylaxis (PEP) is increasing in developing countries. Implementation of the two currently approved economical intradermal (ID) vaccine regimens is restricted due to confusion over different vaccines, regimens and dosages, lack of confidence in intradermal technique, and pharmaceutical regulations. We therefore compared a simplified 4-site economical PEP regimen with standard methods.MethodsTwo hundred and fifty-four volunteers were randomly allocated to a single blind controlled trial. Each received purified vero cell rabies vaccine by one of four PEP regimens: the currently accepted 2-site ID; the 8-site regimen using 0.05 ml per ID site; a new 4-site ID regimen (on day 0, approximately 0.1 ml at 4 ID sites, using the whole 0.5 ml ampoule of vaccine; on day 7, 0.1 ml ID at 2 sites and at one site on days 28 and 90); or the standard 5-dose intramuscular regimen. All ID regimens required the same total amount of vaccine, 60% less than the intramuscular method. Neutralising antibody responses were measured five times over a year in 229 people, for whom complete data were available.FindingsAll ID regimens showed similar immunogenicity. The intramuscular regimen gave the lowest geometric mean antibody titres. Using the rapid fluorescent focus inhibition test, some sera had unexpectedly high antibody levels that were not attributable to previous vaccination. The results were confirmed using the fluorescent antibody virus neutralisation method.ConclusionsThis 4-site PEP regimen proved as immunogenic as current regimens, and has the advantages of requiring fewer clinic visits, being more practicable, and having a wider margin of safety, especially in inexperienced hands, than the 2-site regimen. It is more convenient than the 8-site method, and can be used economically with vaccines formulated in 1.0 or 0.5 ml ampoules. The 4-site regimen now meets all requirements of immunogenicity for PEP and can be introduced without further studies.Trial RegistrationControlled-Trials.com ISRCTN 30087513

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“…12 This had encouraged the authors of the previous study to assess the immunogenicity of a new "one week PEP" schedule using PVRV (Verorab). As the results were encouraging, WHO in improving the compliance of the patients to rabies prophylaxis and also reduces the overall expenditure of rabies PEP, thus helping to reduce the burden of rabies in endemic countries of Asia and Africa.…”

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confidence: 99%