A 1-week intradermal dose-sparing regimen for rabies post-exposure prophylaxis (RESIST-2): an observational cohort study
| Autor: | Yiksing Peng, Arnaud Tarantola, Chun Navy Taing, Chandara Phoeun, Sotheary In, Tineke Cantaert, Chanthy Hing, Rithy Choeung, Sivlin Ung, Channa Mey, Lauriane Kergoat, Manil Saman, Philippe Dussart, Sowath Ly, Laurence Borand, Chanthy Leng, Hervé Bourhy, Sivuth Ong |
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| Přispěvatelé: | Immunologie [Phnom Penh], Institut Pasteur du Cambodge, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Unité d'Épidémiologie et de Santé Publique [Phnom Penh], Centre collaborateur de l'OMS - Rage / World Health Organization Collaboration Centres - Rabies (CC-OMS / WHO-CC), Institut Pasteur [Paris]-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Unité de Virologie / Virology Unit [Phnom Penh], The study was done with support and funding from Institut Pasteur (for the serological analysis), Direction Internationale of Institut Pasteur (for the Rabies Elimination Support through Integrative Science and Therapy programme through an Action Concertées InterPasteuriennes grant), and Institut Pasteur du Cambodge., We thank all patients and participants for their involvement in the study. We thank Erik Karlsson for his help in determining the nutrition status of children., Institut Pasteur [Paris] (IP)-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO) |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Male Pediatrics medicine.medical_treatment MESH: Rabies virus / immunology medicine.disease_cause Antibodies Viral Cohort Studies MESH: Dogs MESH: Rabies / prevention & control 0302 clinical medicine [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases MESH: Child MESH: Immunization Schedule MESH: Post-Exposure Prophylaxis* / methods MESH: Animals 030212 general & internal medicine Young adult Child MESH: Rabies Vaccines / administration & dosage MESH: Cohort Studies 2. Zero hunger biology Vaccination MESH: Neutralization Tests Age Factors 3. Good health Infectious Diseases MESH: Young Adult Female Antibody Post-Exposure Prophylaxis Cohort study Adult medicine.medical_specialty Adolescent Injections Intradermal Rabies MESH: Antibodies Viral / immunology 03 medical and health sciences Young Adult Dogs Neutralization Tests medicine Animals Humans Post-exposure prophylaxis MESH: Antibodies Neutralizing / immunology Immunization Schedule MESH: Adolescent MESH: Age Factors MESH: Injections Intradermal MESH: Humans business.industry Rabies virus MESH: Adult MESH: Vaccination medicine.disease Antibodies Neutralizing MESH: Male Regimen 030104 developmental biology Rabies Vaccines biology.protein business MESH: Female |
| Zdroj: | The Lancet Infectious Diseases The Lancet Infectious Diseases, New York, NY : Elsevier Science ; The Lancet Pub. Group, 2001-, 2019, 19 (12), pp.1355-1362. ⟨10.1016/S1473-3099(19)30311-1⟩ The Lancet Infectious Diseases, 2019, 19 (12), pp.1355-1362. ⟨10.1016/S1473-3099(19)30311-1⟩ |
| ISSN: | 1473-3099 1474-4457 |
| DOI: | 10.1016/S1473-3099(19)30311-1⟩ |
| Popis: | Comment in : Improving human rabies post-exposure prophylaxis. / Blumberg L, Rupprecht CE. Lancet Infect Dis. 2019 Dec;19(12):1273-1274. doi: 10.1016/S1473-3099(19)30525-0. Epub 2019 Sep 27. PMID: 31570310; International audience; Background: The international health authorities are backing an effort to eliminate canine-mediated rabies in humans by 2030. This effort will require improving access to adequate and timely rabies post-exposure prophylaxis as compliance is low with WHO-recommended regimens (given in four to five visits over 1 month). Access could be substantially improved by an abridged regimen to reduce doses, direct and indirect costs, and improve vaccine equity by better sharing of available vaccine. We aimed to compare rabies virus neutralising antibody titres before and after the fourth visit to determine whether that session was needed or the current regimen could be abridged.Methods: In this observational cohort study, we measured rabies virus neutralising antibody titres using rapid fluorescent focus inhibition tests in 116 people bitten by dogs with laboratory-confirmed rabies and 20 control individuals. Percentages of circulating plasmablasts were determined by flow cytometry. All individuals had been referred to the rabies prevention clinic at Institut Pasteur in Cambodia and received two intradermal injections of post-exposure prophylaxis on days 0, 3, 7, and 28 (Thai Red Cross regimen) with or without equine rabies immunoglobulin, as per 2010 WHO recommendations.Findings: All individuals had rabies virus neutralising antibody titres considered protective (≥0·5 IU/mL) and plasmablast activation on day 28 before the last injection. The median rabies virus neutralising antibody concentration in the group of individuals bitten by rabies virus-positive dogs was 1·08 IU/mL (IQR 0·37-3·09) on day 7, 26·86 (22·68-49·50) on day 28, and 26·74 (11·78-49·06) on day 42. No significant differences were observed in titres between days 28 and 42, after titres reached a plateau. These titres were reached notwithstanding equine rabies immunoglobulin use, age, sex, nutrition status as indicated by upper-arm circumference in children or BMI in adults, or dog infection status. Titres or plasmablast percentages did not increase between the day of the last injection and 2 weeks later. All patients were alive 1 year after post-exposure prophylaxis.Interpretation: The fourth vaccine session on day 28 provides no additional benefit. Rabies post-exposure prophylaxis can be abridged to a two-dose, three-session, 1 week regimen to improve post-exposure prophylaxis coverage and equity at no risk to patients. |
| Databáze: | OpenAIRE |
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