Heterogeneity of Rabies Vaccination Recommendations across Asia

Abstract

Asian countries bear the greatest burden of the disease, with a majority (59%) of rabies-related deaths occurring in Asia. In order to promote best practices, we summarized national human vaccination guidelines across this region, to highlight differences and similarities and to discuss the aspects that would benefit from updates. National management guidelines for rabies were retrieved from various sources to extract information on rabies pre- and post-exposure prophylaxis (PrEP, and PEP), booster vaccination, and route of administration. Rabies guidelines recommendations for wound management and PrEP across Asia are broadly aligned to the World Health Organization (WHO) guidelines. For PEP, the 5-dose Essen, and the 4-dose Zagreb are the regimens of choice for intramuscular (IM), and the Thai Red Cross regimen for intradermal (ID), administration. Several national guidelines have yet to endorse ID vaccine administration. Most guidelines recommend rabies immunoglobulin in category III exposures. Booster recommendations are not included in all guidelines, with limited clarity on booster requirement across the spectrum of risk of rabies exposure. In conclusion, national recommendations across Asian countries differ and while some guidelines are closely aligned to the WHO recommendations, resource-saving ID administration and use of rational abbreviated schedules have yet to be endorsed.

Purified Vero Cell Rabies Vaccine (PVRV, Verorab®): A Systematic Review of Intradermal Use Between 1985 and 2019

“…Although the WHO has provided recommendations for PrEP and PEP regimens, national guidelines differ between countries that have contributed to the assessment of numerous regimens over the years [54]. In this regard, it is reassuring that the immunogenicity of ID PVRV has been extensively assessed using numerous PrEP, PEP, and simulated PEP regimens.…”

Circumstances of human conflicts with bears and patterns of bear maul injuries in Bhutan: Review of records 2015–2019

“…All patients in our study had received anti-rabies vaccination and/or rabies immunoglobulin. Though 59% of 59,000 annual global deaths related to human rabies occur in Asia, the majority are transmitted by rabid dogs [23]. While rabies infection is documented among bears in North America, the seroprevalence of rabies antibody among sixty-three black bears in North America was 5.5% [24] and there is a lack of literature on human transmission of rabies from a rabid bear.…”

“…While rabies infection is documented among bears in North America, the seroprevalence of rabies antibody among sixty-three black bears in North America was 5.5% [24] and there is a lack of literature on human transmission of rabies from a rabid bear. However, the majority of rabies guidelines across Asia including the National Guideline for Management of Rabies 2014, Bhutan recommend post-exposure prophylaxis with anti-rabies vaccine and rabies immunoglobulin [23,25].…”

Knowledge, attitude, and practice of a local community towards the prevention and control of rabies in Gaibandha, Bangladesh

“…However, it is entirely remediable if victims treat with World Health Organization guided post-exposure prophylaxis (PEP), entailing vigorous washing of wound, instant rabies vaccination after probable exposure, and finally, in exceptional situation, rabies immunoglobulin [ 2 , 3 ]. In the developing countries, deprived portions of the society may not get this life-sparing treatment either because PEP treatment is exorbitant or because individuals can’t visit the clinic for remady due to lack of awareness about rabies [ 4 , 5 ].…”