Rabies vaccine

Rabies vaccine
Vaccine description
Target disease Rabies
Type Killed/Inactivated
Clinical data
Trade names Imovax Rabies, RabAvert, others
AHFS/Drugs.com Monograph
MedlinePlus a607023
Routes of
administration		 Intramuscular injection
ATC code
Identifiers
ChemSpider
  • none
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Rabies vaccine is a vaccine used to prevent rabies.[1] There are a number of vaccines available that are both safe and effective.[1] They can be used to prevent rabies before and for a period of time after exposure to the virus such as by a dog or bat bite.[1] The immunity that develops is long lasting after a full course.[1] Doses are usually given by injection into the skin or muscle.[1] After exposure vaccination is typically used along with rabies immunoglobulin.[1] It is recommended that those who are at high risk of exposure be vaccinated before potential exposure.[1] Vaccines are effective in humans and other animals.[1] Vaccinating dogs is very effective in preventing the spread of rabies to humans.[1]

Rabies vaccines may be safely used in all age groups.[1] About 35 to 45 percent of people develop a brief period of redness and pain at the injection site.[1] About 5 to 15 percent of people may have fever, headaches, or nausea.[1] After exposure to rabies there is no contraindication to its use.[1] Most vaccines do not contain thimerosal.[1] Vaccines made from nerve tissue are used in a few countries, mainly in Asia and Latin America, but are less effective and have greater side effects.[1] Their use is thus not recommended by the World Health Organization.[1]

The first rabies vaccine was introduced in 1885, and was followed by an improved version in 1908.[2] Millions of people globally have been vaccinated and it is estimated that this saves more than 250,000 people a year.[1] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[3] The wholesale cost in the developing world is between 44 and 78 USD for a course of treatment as of 2014.[4] In the United States a course of rabies vaccine is more than 750 USD.[5]

Medical uses

The World Health Organization recommends vaccinating in those who are at high risk of the disease including children who live in areas where it is common.[1] Three doses are given over a one-month period.[1]

Additional doses

Immunity following a course of doses is typically long lasting.[1] Additional doses are not typically needed except in those at very high risk.[1] Following administration of a booster dose, one study found 97% of immuno-competent individuals demonstrate protective levels of neutralizing antibodies at 10 years.[6]

Types

The human diploid cell rabies vaccine (H.D.C.V.) was started in 1967. Human diploid cell rabies vaccines are inactivated vaccines made using the attenuated Pitman-Moore L503 strain of the virus.[7] Human diploid cell rabies vaccines have been given to more than 1.5 million people as of 2006.

In addition to these developments, newer and less expensive purified chicken embryo cell vaccine, and purified Vero cell rabies vaccine are now available. The purified Vero cell rabies vaccine uses the attenuated Wistar strain of the rabies virus, and uses the Vero cell line as its host.

History

Virtually all infections with rabies resulted in death until two French scientists, Louis Pasteur and Émile Roux, developed the first rabies vaccination in 1885. This vaccine was first used on a human on July 6, 1885, on nine-year-old Joseph Meister (1876–1940), who had been mauled by a rabid dog.[8]

Their vaccine consisted of a sample of the virus harvested from infected (and necessarily dead) rabbits that was weakened by allowing it to dry for 5 to 10 days. Similar nerve tissue-derived vaccines are still used now in some countries, and while they are much cheaper than modern cell culture vaccines, they are not as effective.[9] Neural tissue vaccines also carry a certain risk of neurological complications.[10]

Veterinary use

Baits with vaccine for oral vaccination
Machine for distribution of baits from airplane

Pre-exposure immunization has been used on domesticated and wild populations. In many jurisdictions, domestic dogs, cats, ferrets, and rabbits are required to be vaccinated.

Dogs

Aside from vaccinating humans, another approach was also developed by vaccinating dogs to prevent the spread of the virus. In 1979 the Van Houweling Research Laboratory of the Silliman University Medical Center in Dumaguete in the Philippines,[11] developed and produced a dog vaccine that gave a three-year immunity from rabies. The development of the vaccine resulted in the elimination of rabies in many parts of the Visayas and Mindanao Islands. The successful program in the Philippines was later used as a model by other countries, such as Ecuador and the Yucatan State of Mexico, in their fight against rabies conducted in collaboration with the World Health Organization.[12]

In Tunisia a rabies control program was initiated to give dog owners free vaccination to promote mass vaccination which was sponsored by their government. The vaccine is known as Rabisin (Mérial), which is a cell based rabies vaccine only used countrywide. Vaccinations are often administered when owners take in their dogs for check-ups and visits at the vet.[13]

Wild animals

There is also vaccination in pellet form which can be left out for wild animals to produce a herd immunity effect.[14] Oral rabies vaccination (ORV) is a preventive measure to eradicate rabies in wild animal vectors of disease, mainly foxes, raccoons, raccoon dogs, coyotes and jackals, but also can be used for dogs in developing countries.[15] Baits are distributed by airplanes in rural areas and by hand in urban and suburban areas. The idea of wildlife vaccination was conceived during the 1960s, and modified-live rabies viruses were used for the experimental oral vaccination of carnivores by the 1970s. The development of safe and effective rabies virus vaccines applied in attractive baits resulted in the first field trials in Switzerland in 1978 to immunize red foxes.[16] ORV programs have seen success in preventing the westward spread of raccoon variant rabies in the United States and even eradicating rabies in red foxes in Switzerland.[17][18]

Imrab is an example of a veterinary rabies vaccine containing the Pasteur strain of killed rabies virus. Several different types of Imrab exist, including Imrab, Imrab 3, and Imrab Large Animal. Imrab 3 has been approved for ferrets and, in some areas, pet skunks.[19][20]

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 "Rabies vaccines: WHO position paper" (PDF). Weekly epidemiological record. 32 (85): 309–320. Aug 6, 2010. Archived (PDF) from the original on 2015-02-27.
  2. ↑ Nunnally, Brian (2014). Vaccine Analysis: Strategies, Principles, and Control. Springer. p. 63. ISBN 9783662450246. Archived from the original on 2016-03-05.
  3. ↑ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
  4. ↑ "Vaccine, Rabies". International Drug Price Indicator Guide. Retrieved 6 December 2015.
  5. ↑ Shlim, David (June 30, 2015). "Perspectives: Intradermal Rabies Preexposure Immunization". Archived from the original on 2 October 2015. Retrieved 6 December 2015.
  6. ↑ STATEMENT ON TRAVELLERS AND RABIES VACCINE
  7. ↑ "Rabies - Human Vaccines". World Health Organization. Archived from the original on 3 November 2012. Retrieved 1 October 2012.
  8. ↑ Geison GL (1978). "Pasteur's work on rabies: Reexamining the ethical issues diagnosis for developing countries". Hastings Center Report. The Hastings Center. 8 (April): 26–. doi:10.2307/3560403. JSTOR 3560403. PMID 348641.
  9. ↑ Plotkin, Stanley A. (1980). "Rabies Vaccine Prepared in Human Cell Cultures: Progress and Perspectives". Reviews of Infectious Diseases. 2 (3): 433–448. doi:10.1093/clinids/2.3.433.
  10. ↑ Srivastava AK, Sardana V, Prasad K, Behari M; Sardana; Prasad; Behari (March 2004). "Diagnostic dilemma in flaccid paralysis following anti-rabies vaccine". Neurol India. 52 (1): 132–3. PMID 15069272. Archived from the original on 2009-08-02.
  11. ↑ "Dr. George W. Beran's Biography" Archived April 15, 2010, at the Wayback Machine.. World Rabies Day. Retrieved 2010-04-23.
  12. ↑ "One World, One Health Rabies" Archived 2011-07-24 at the Wayback Machine..OneHealthInitiative.com. Retrieved 2010-04-23.
  13. ↑ Touihri; Zaouia, I.; Elhili, K.; Dellagi, K.; Bahloul, C. (23 Dec 2009). "Evaluation of Mass Vaccination Campaign Coverage Against Rabies in Dogs in Tunisia". Zoonoses and Public Health. Institut Pasteur de Tunis and Blackwell Verlag GmbH. 58 (2): 110–8. doi:10.1111/j.1863-2378.2009.01306.x. PMID 20042063.
  14. ↑ "CDC - Signs and Symptoms - Rabies". www.cdc.gov. Archived from the original on 2015-11-09. Retrieved 2015-11-09.
  15. ↑ "Archived copy". Archived from the original on January 7, 2014. Retrieved February 21, 2014.
  16. ↑ Rupprecht CE, Hanlon CA, Slate D. "Oral vaccination of wildlife against rabies: opportunities and challenges in prevention and control". Dev Biol (Basel). 119: 173–84. PMID 15742629.
  17. ↑ "Oral Rabies Vaccine Project – Environmental Epidemiology". www.vdh.virginia.gov. Archived from the original on 2017-08-18. Retrieved 2017-07-23.
  18. ↑ "Switzerland's Kind of Gross, Incredibly Effective Anti-Rabies Weapon | Now I Know". nowiknow.com. Archived from the original on 2016-02-12. Retrieved 2017-07-23.
  19. ↑ Merial Archived April 9, 2005, at the Wayback Machine.
  20. ↑ Aspen Skunk Rabies Research, Inc. Archived May 25, 2011, at the Wayback Machine.
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