WHO's New Rabies Recommendations

Implications for High Incidence Countries

Amrita Pattanaik; Reeta S. Mani

Disclosures

Curr Opin Infect Dis. 2019;32(5):401-406. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Rabies is virtually always fatal; however, it is nearly 100% preventable with timely and appropriate prophylactic immunization. This review summarizes the recently revised WHO guidelines for rabies prophylaxis published in 2018, following a scientific review by a strategic advisory group of experts on immunization. The scientific basis for the major changes and its implications for countries with high disease burden are also discussed.

Recent findings: The key changes in the updated WHO 2018 guidelines for rabies prophylaxis include abbreviated vaccination regimens for pre and postexposure prophylaxis. These cost and dose-sparing regimens allow equitable sharing of vaccines, necessitate fewer clinic visits and thus can enhance patient compliance. The recommendations on rabies immunoglobulin administration permit prioritization and optimal use of this life-saving biologic, especially in areas with scarcity. However, there is a need for additional evidence to support the abridgment of some regimens and need for data on the safety and immunogenicity of these regimens in special groups such as infants and the immunocompromised.

Summary: National health authorities in high incidence countries need to develop consensus for effective implementation of simplified, cost-effective, and logistically feasible regimens for rabies prophylaxis, on the basis of the revised WHO guidelines.

Introduction

Rabies, one of the most dreaded neglected tropical diseases is caused by the rabies virus, the archetypal virus of the Rhabdoviridae family in the genus Lyssavirus. About 59 000 cases are being reported worldwide every year, most of which are from Asia and Africa, acquired frequently through exposure to rabid dogs. Human rabies is almost always fatal; however, it can be prevented by avoiding exposure and by prophylactic immunization. Preexposure prophylaxis (PrEP) is highly effective for those at risk of exposure like laboratory workers, veterinarians, and travelers visiting rabies endemic areas. After an exposure, prompt and correct administration of postexposure prophylaxis (PEP) that consists of wound care, infiltration of rabies immune globulin (RIG) as indicated, and administration of rabies vaccine virtually ensure survival.[1,2] Owing to competing public health priorities, rabies continues to be a neglected disease and most high incidence countries have weak rabies control programs and poor surveillance systems in place.[3] The WHO has been reviewing, updating, and putting forth recommendations for rabies PrEP and PEP regimens periodically, keeping in mind the availability and affordability of the vaccines without compromising on the quality and efficacy. These are based on clinical data that have been critically analyzed and reviewed by a group of experts in the field.[4,5] The updated recent WHO guidelines are published and are accessible online.[1,2] This review provides a brief outline of the recent WHO guidelines, scientific rationale for the changes and the implications for countries with high burden of human rabies.

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