Background
The first live attenuated injectable rabies vaccine was developed by Louis Pasteur and Emile Roux in 1885. This original vaccine was developed from rabbit nerve tissues. While effective, severe adverse reactions were commonly attributed to the vaccine. In 1984, the nerve tissue vaccine was discontinued in lieu of safer more immunogenic cell culture rabies vaccines.
Concentrated, purified call culture and embryonated egg-based vaccines (CCEEVs) have proved to be safe and effective. A list of vaccines that have been pre-qualified by WHO is maintained on the WHO website resources.
💡Intradermal (ID) regimens are a cost- and dose- sparing alternative to intramuscular administration which produce the same level of protection against rabies. Specific regimens have been developed for ID vaccine administration.
Why is vaccination important?
Rabies is responsible for an estimated 59,000 human deaths globally. While almost always fatal once symptoms start, appropriate post-exposure prophylaxis (PEP) is almost 100% effective in preventing death. In 2015, global health organizations such as the World Health Organisation (WHO), the World Organisation for Animal Diseases (WOAH) and the Food and Agriculture Organisation of the United Nations (FAO) set a goal to reach zero dog-mediated human rabies deaths by 2030. Part of achieving this goal is appropriate Pre-Exposure Prophylaxis (PrEP) and PEP for rabies-exposed persons to prevent the onset of disease.
Duration of immunity
Data supports that the immunogenic effect of PrEP or PEP may last for the lifetime of the individual. This may not apply where individuals are immunocompromised, and periodic boosters may be advised for this group and as a precaution for anyone with a continual risk of exposure (those who work with animals in rabies endemic areas). The WHO recommends regimens of PEP for anyone subsequently exposed to rabies even if they have previously received PrEP.
Side effects of immunisation
Adverse events are rare; generally modern rabies vaccines (CCEEVs) are very well tolerated. 35-45% of vaccinated people may experience minor localised, transient swelling and tenderness at the administration site. Mild systemic effects may occur in 5-15% or people vaccinated and include fever, headache, dizziness and gastrointestinal upset.
💡 There are no contraindications to PEP. It can be given to children, pregnant and/or lactating women, immunocompromised individuals (including those with HIV/AIDs).
Rabies Immunoglobulin (RIG)
Rabies Immunoglobulin (RIG) is an additional part of PEP. Administration of RIG is recommended for those who have not received at least two doses of PrEP or PEP and have experienced a category III exposure.
📚 Read more about RIG here.