Pre-exposure rabies vaccination using purified chick embryo cell rabies vaccine intradermally is immunogenic and safe.
ABSTRACT To demonstrate the safety and immunogenicity of intradermal rabies pre-exposure prophylaxis with purified chick embryo cell vaccine (PCECV) in schoolchildren age 5 to 8 years in Thailand.
In a randomized, open-label, phase II clinical trial, 2 or 3 intradermal doses of 0.1 mL PCECV (Rabipur) were administered to 703 schoolchildren on days 0 and 28 or on days 0, 7, and 28. In 206 children, 2 simulated post-exposure booster doses were given 1 year after the primary vaccination series. Rabies virus- neutralizing antibody (RVNA) titers were determined by the rapid fluorescent focus inhibition test.
In school-age children in Thailand, a pre-exposure immunization regimen of 3 intradermal doses of PCECV produced adequate immune responses. After primary vaccination, all subjects developed RVNA titers > or =0.5 IU/mL and demonstrated a rapid increase in RVNA titer after 2 simulated post-exposure booster immunizations 1 year after the primary vaccination series. No serious adverse drug reactions occurred.
Rabies pre-exposure immunization with PCECV is safe and immunogenic, and its implementation could save the lives of many children in rabies-endemic areas.
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ABSTRACT: A five-year project to prevent human deaths from rabies in Phetchabun Province, Thailand involved increasing accessibility of post-exposure treatment with the Thai Red Cross intradermal (2-2-2-0-1-1) regimen for humans exposed to potentially and confirmed rabid animals; intensifying documentation of post-exposure treatment; increasing educational awareness through advocacy in provincial schools, television programmes, and newspapers; reducing canine rabies by monitoring the dog population and implementing vaccination and sterilization programmes; increasing the cooperation between the Ministries of Public Health, Agriculture, and Education on a provincial level; and assessing the impact of the programme through intensified follow-up of patients exposed to suspected and laboratory-confirmed rabid animals. Between 1996 and 2001, 10350 patients received post-exposure treatment; 7227 of these received the Thai Red Cross intradermal regimen. Fewer than 3% of exposed patients received rabies immunoglobulin. Seventy-three percent of all patients presented with WHO category III exposures. In a retrospective study, 188 patients exposed to laboratory-confirmed rabid animals were followed to determine their health status. Of these patients, 20 received the intramuscular Essen regimen and 168 the Thai Red Cross intradermal regimen (148 received 0.1 ml purified chick embryo cell rabies vaccine, 10 received 0.1 ml purified vero cell rabies vaccine, and 10 received 0.2 ml purified duck embryo cell rabies vaccine). All patients were alive one year after exposure. Two human deaths occurred in the first two years of the programme - neither patient had received vaccine or rabies immunoglobulin after exposure. No deaths occurred during the last three years of the programme, which indicated that the programme was successful.Bulletin of the World Health Organisation 02/2003; 81(5):375-81. · 5.25 Impact Factor
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ABSTRACT: The equivalence and interchangeability of Purified Chick Embryo Cell Culture Rabies Vaccine (PCECV) to Human Diploid Cell Culture Rabies Vaccine (HDCV) and the immunogenicity of a reduced post-exposure regimen with PCECV was investigated. Statistical analyses revealed no difference (P</=0.05) between the geometric mean titers (GMT) on day 49 of subjects that received PCECV or HDCV. In Year 2, subjects were boosted with one or two dose(s) of PCECV. No significant difference (P</=0.05) was detected between the GMT of the two groups on days 7 and 365 post-booster. Subjects that received HDCV initially developed an adequate anamnestic response to PCECV. On day 21 post-booster, the GMT of subjects that received two boosters was higher (151.6 IU/ml) than those that received one booster (120.9 IU/ml). However, this difference may not be clinically significant.Vaccine 01/2001; 19(9-10):1055-60. · 3.49 Impact Factor
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ABSTRACT: Background. The use of intradermal (id) injections of purified Vero cell rabies vaccine (PVRV) for preexposure prophylaxis has not been well-established. We studied the safety and immunogenicity of id and intramuscular (im) PVRV injections for primary and booster preexposure immunizations. Methods. One of two rabies preexposure PVRV regimens comprising three doses of either 0.1 ml id or 0.5 ml im administered during 28 days was assigned at random to 190 school children. One booster dose was given 1 year later either id or im, according to their initial randomization group. Serologic results were available from 155 (82%) children at 1 year after primary immunization and 118 (62%) children at 2 years after booster. Results. Although children vaccinated id had significantly lower rabies-neutralizing antibody titers after primary immunization as well as after booster than children vaccinated im (P < 0.001 for all time points), there were no significant differences in the percentages of children with adequate titers (≥0.15 IU/ml) between the id and im groups after both primary and booster immunizations. Mild local reactions were more frequent after id vaccination. Mild or moderate systemic reactions were infrequent and similar after id and im vaccinations. Fever and headache were reported by ≤6%. The reactions after booster were not different from those of post-primary immunization. Conclusions. Purified Vero cell rabies vaccine appears to be safe and immunogenic for primary and booster preexposure immunizations. An id PVRV preexposure regimen should be useful especially for rabies-endemic countries with low per capita income.The Pediatric Infectious Disease Journal 10/1998; 17(11):1001-1007. · 3.57 Impact Factor