Pre-exposure rabies prophylaxis: a systematic review

Kessels, Jocelyn A., Recuenco, Sergio, Navarro-Vela, Ana Maria, Deray, Raffy, Vigilato, Marco, Ertl, Hildegund, Durrheim, David, Rees, Helen, Nel, Louis H., Abela-Ridder, Bernadette and Briggs, Deborah (2017) Pre-exposure rabies prophylaxis: a systematic review. Bulletin of the World Health Organization, 95 3: 210-219. doi:10.2471/BLT.16.173039


Author Kessels, Jocelyn A.
Recuenco, Sergio
Navarro-Vela, Ana Maria
Deray, Raffy
Vigilato, Marco
Ertl, Hildegund
Durrheim, David
Rees, Helen
Nel, Louis H.
Abela-Ridder, Bernadette
Briggs, Deborah
Title Pre-exposure rabies prophylaxis: a systematic review
Journal name Bulletin of the World Health Organization   Check publisher's open access policy
ISSN 1564-0604
0042-9686
Publication date 2017-03-01
Year available 2016
Sub-type Critical review of research, literature review, critical commentary
DOI 10.2471/BLT.16.173039
Open Access Status Not yet assessed
Volume 95
Issue 3
Start page 210
End page 219
Total pages 10
Place of publication Geneva, Switzerland
Publisher World Health Organization
Collection year 2018
Language eng
Formatted abstract
Objective: To review the safety and immunogenicity of pre-exposure rabies prophylaxis (including accelerated schedules, co-administration with other vaccines and booster doses), its cost–effectiveness and recommendations for use, particularly in high-risk settings.

Methods: We searched the PubMed, Centre for Agriculture and Biosciences International, Cochrane Library and Web of Science databases for papers on pre-exposure rabies prophylaxis published between 2007 and 29 January 2016. We reviewed field data from pre-exposure prophylaxis campaigns in Peru and the Philippines.

Findings: Pre-exposure rabies prophylaxis was safe and immunogenic in children and adults, also when co-administered with routine childhood vaccinations and the Japanese encephalitis vaccine. The evidence available indicates that shorter regimens and regimens involving fewer doses are safe and immunogenic and that booster intervals could be extended up to 10 years. The few studies on cost suggest that, at current vaccine and delivery costs, pre-exposure prophylaxis campaigns would not be cost-effective in most situations. Although preexposure prophylaxis has been advocated for high-risk populations, only Peru and the Philippines have implemented appropriate national programmes. In the future, accelerated regimens and novel vaccines could simplify delivery and increase affordability.

Conclusion: Pre-exposure rabies prophylaxis is safe and immunogenic and should be considered: (i) where access to postexposure prophylaxis is limited or delayed; (ii) where the risk of exposure is high and may go unrecognized; and (iii) where controlling rabies in the animal reservoir is difficult. Pre-exposure prophylaxis should not distract from canine vaccination efforts, provision of postexposure prophylaxis or education to increase rabies awareness in local communities.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: HERDC Pre-Audit
School of Veterinary Science Publications
 
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