Safety and Immunogenicity of purified chick embryo cell rabies vaccine (VaxiRab N) administered intradermally as post exposure prophylaxis

Post-exposure prophylaxis (PEP) for rabies with purified chick embryo cell vaccine: a systematic literature review and meta-analysis

“…Across the studies identified for this review, there were 54 reports of immune responses to vaccination including healthy volunteers, or individuals at risk such as those occupationally exposed to rabies cases, and bite cases. Our analysis showed that in almost all individuals, 14 days after starting the vaccine regime, PCECV elicited RVNA titers above the WHO recommended serological threshold for an adequate immune response to vaccination (≥0.5 IU/mL serum) [7]. The studies reviewed showed that if administered promptly within a PEP protocol, PCECV with potency ≥2.5 IU per dose by the IM route or the ID route should be entirely effective in preventing rabies.…”

“…The majority of intervention studies were conducted in Asia (China, India, Philippines, Thailand) [7,9,10, and eight studies in Europe (Austria, Croatia, Czech Republic, Germany, Lithuania, Serbia) [8,[41][42][43][44][45][46][47]. All the observational studies were conducted in Asian countries [19,[48][49][50][51][52][53][54][55][56][57][58][59][60][61]].…”

“…The rabies PEP protocol involves careful and adapted management of the wound such as thoroughly washing, applying antiseptics, avoiding sutures, and the use of antibiotics, as well as a complete course of human rabies vaccine for category II exposures (nibbling of uncovered skin, minor scratches, or abrasions without bleeding); a complete course of human rabies vaccine plus the concomitant administration of rabies immunoglobulin (RIG) is recommended for category III exposures (transdermal bites or scratches, contamination of mucous membrane with saliva from licks, licks on broken skin, and exposures to bats) [7].…”

“…Protocols for ID administration were established to reduce the direct costs of vaccine since the volume of vaccine dose needed by the ID route (0.1 mL) is lower than that needed by the IM route (0.5 or 1.0 mL, depending on the vaccine used) [8][9][10][11]. However, although ID administration is recommended by the WHO, the technique requires training and is not approved in all countries [7]. Indeed, ID administration requires highly trained medical staff and medical supervision meaning that it is not appropriate everywhere, that is, adoption of ID administration in local rabies strategies depends upon factors such as the burden of rabies, population distribution, clinical infrastructure, and funding [12].…”

“…Dose potency and immune response to vaccination have been assessed in meta-analyses of rabies vaccines with potency ranging from <2.5 IU to ≥5 IU per dose. Results demonstrated that a minimum potency of 2.5 IU per dose was needed to elicit an adequate immune response to vaccination by both the IM and ID routes [7,14].…”