Updates on the development of vaccines and therapeutic options against rabies

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Roshan Arjun Ananda ◽  
Hooi-Leng Ser ◽  
Vengadesh Letchumanan
Keyword(s):  
Animal Health ◽  
Viral Disease ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Therapeutic Approaches ◽  
The Public ◽  
Health Authorities ◽  
Initial Stage ◽  
Potential Development ◽  
Exposure Prophylaxis

Even though rabies has been claiming more than 50,000 deaths annually worldwide, it is considered as a vaccine-preventable viral disease. More than 95 % of the total human rabies cases are caused by dogs. During the initial stage of infection, affected individuals usually show weakess at the bitten extremities and the virus can ultimately travel to the brain causing neurological signs. In attenuated (inactivated) form, the currently in use vaccines have been recommended by WHO for the prevention (i.e. pre-exposure prophylaxis, PrEP) and treatment (i.e. post-exposure prophylaxis, PEP) regime againstthe rabies virus (RABV). However, given that they normally require refrigeration and are costly, there have been discussions revolving around potential development of newer, safer and cheaper alternative that can perform better and more convenient than the ones that are currently in use. The current review aims to explore general characteristics of RABV before looking into potential candidates of vaccines that have been studied. Further studies on the pathogenic mechanism of RABV and therapeutic approaches are still required to prevent the deathly infection following clinical manifestation. In sum, integrated interventional strategy emphasizing human health and animal health is essential and requires collaboration between health authorities and the public.

scholarly journals Current Rabies Vaccines Do Not Confer Protective Immunity against Divergent Lyssaviruses Circulating in Europe

Viruses ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 892 ◽  
Author(s):  
Juan E. Echevarría ◽  
Ashley C. Banyard ◽  
Lorraine M. McElhinney ◽  
Anthony R. Fooks
Keyword(s):  
Protective Immunity ◽  
Rabies Vaccine ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Efficient Tool ◽  
Imported Case ◽  
Health Authorities ◽  
European Health ◽  
Preventive Vaccination ◽  
Exposure Prophylaxis

The use of the rabies vaccine for post-exposure prophylaxis started as early as 1885, revealing a safe and efficient tool to prevent human rabies cases. Preventive vaccination is the basis for the control of canine-mediated rabies, which has already been eliminated from extensive parts of the world, including Europe. Plans to eliminate canine-mediated human rabies by 2030 have been agreed upon by international organisations. However, rabies vaccines are not efficacious against some divergent lyssaviruses. The presence in European indigenous bats of recently described lyssaviruses, which are not neutralised by antibody responses to existing vaccines, as well as the declaration of an imported case of an African lyssavirus, which also escapes vaccine-derived protection, leaves the European health authorities unable to provide efficacious protective vaccines to some potential situations of human exposure. All these circumstances highlight the need for a universal pan-lyssavirus rabies vaccine, able to prevent human rabies in all circumstances.

scholarly journals Findings from the initial Stepwise Approach to Rabies Elimination (SARE) Assessment in China, 2019

2021 ◽  
Vol 15 (3) ◽  
pp. e0009274
Author(s):  
Qiulan Chen ◽  
Xiaoyue Ma ◽  
Jeanette J. Rainey ◽  
Yu Li ◽  
Di Mu ◽  
...  
Keyword(s):  
Disease Control ◽  
Vaccination Coverage ◽  
Assessment Tool ◽  
Animal Health ◽  
The United States ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Stepwise Approach ◽  
Control And Prevention ◽  
Exposure Prophylaxis

In 2015, China and other member states of the United Nations adopted the goal of eliminating dog-mediated rabies by 2030. China has made substantial progress in reducing dog-mediated human rabies since peaking with more than 3,300 reported cases in 2007. To further improve coordination and planning, the Chinese Center for Disease Control and Prevention, in collaboration with the United States Centers for Disease Control and Prevention, conducted a Stepwise Approach towards Rabies Elimination (SARE) assessment in March 2019. Assessment goals included outlining progress and identifying activities critical for eliminating dog-mediated rabies. Participants representing national, provincial and local human and animal health sectors in China used the SARE assessment tool to answer 115 questions about the current dog-mediated rabies control and prevention programs in China. The established surveillance system for human rabies cases and availability of post-exposure prophylaxis were identified as strengths. Low dog vaccination coverage and limited laboratory confirmation of rabid dogs were identified gaps, resulting in an overall score of 1.5 on a scale of 0 to 5. Participants outlined steps to increase cross-sectoral information sharing, improve surveillance for dog rabies, increase dog vaccination coverage, and increase laboratory capacity to diagnose rabies at the provincial level. All assessment participants committed to strengthening cross-sector collaboration using a One Health approach to achieve dog-mediated human rabies elimination by 2030.

Imported Rabies Cases and Preparedness for Rabies in Japan

2009 ◽  
Vol 4 (5) ◽  
pp. 346-351 ◽  
Author(s):  
Kinjiro Morimoto ◽  
◽  
Masayuki Saijo ◽  
Keyword(s):  
Developing Countries ◽  
Developed Countries ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Wild Animals ◽  
The Public ◽  
Fatal Infection ◽  
Imported Cases ◽  
Exposure Prophylaxis ◽  
Supply Systems

Rabies has been causing some 55,000 annual deaths worldwide, mostly in the developing countries in Asia and Africa. At present, safe and effective post-exposure prophylaxis (PEP) has been established and applied to more than 10 million persons each year. Nevertheless, fatal infection of human rabies imported or from wild animals has not been eradicated even in developed countries. In Japan, two imported cases occurred in 2006, the first such cases in 36 years. It is necessary to inform the public about rabies, in particular for overseas tourists, to establish the prompt and appropriate PEP systems, and to improve vaccine supply systems in order to prevent the recurrence of rabies cases in Japan.

scholarly journals Benefit–Risk Assessment of the French Surveillance Protocol of Apparently Healthy Biting Dogs and Cats for Human Rabies Prevention

2021 ◽  
Vol 8 (7) ◽  
pp. 132
Author(s):  
Guillaume Crozet ◽  
Tiffany Charmet ◽  
Florence Cliquet ◽  
Emmanuelle Robardet ◽  
Barbara Dufour ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Traffic Accidents ◽  
Scenario Tree ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Policy Makers ◽  
Benefit Risk Assessment ◽  
Surveillance Protocol ◽  
Exposure Prophylaxis ◽  
Apparently Healthy

In France, apparently healthy dogs and cats that bite humans must undergo an observation period of 15 days with three veterinary visits to ascertain that they remain healthy, indicating that no zoonotic transmission of rabies virus occurred via salivary presymptomatic excretion. This surveillance protocol is mandatory for all pets that have bitten humans, despite France’s rabies-free status in non-flying mammals (i.e., a very low rabies risk). In this context, we aimed to perform a benefit–risk assessment of the existing regulatory surveillance protocol of apparently healthy biting animals, as well as alternative surveillance protocols. A scenario-tree modelling approach was used to consider the possible successions of events between a dog or cat bite and a human death attributed to either rabies or to lethal harm associated with the surveillance protocol (e.g., lethal traffic accidents when traveling to veterinary clinics or anti-rabies centers). The results demonstrated that the current French surveillance protocol was not beneficial, as more deaths were generated (traffic accidents) than avoided (by prompt post-exposure prophylaxis administration). We showed here that less stringent risk-based surveillance could prove more appropriate in a French context. The results in this study could allow policy-makers to update and optimize rabies management legislation.

scholarly journals Post-exposure prophylaxis vaccination rate and risk factors of human rabies in mainland China: a meta-analysis

2018 ◽  
Vol 147 ◽  
Author(s):  
D. L. Wang ◽  
X. F. Zhang ◽  
H. Jin ◽  
X. Q. Cheng ◽  
C. X. Duan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Meta Analysis ◽  
Mainland China ◽  
Vaccination Rate ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Eastern Region ◽  
Post Exposure ◽  
Exposure Prophylaxis

AbstractRabies is one of the major public health problems in China, and the mortality rate of rabies remains the highest among all notifiable infectious diseases. A meta-analysis was conducted to investigate the post-exposure prophylaxis (PEP) vaccination rate and risk factors for human rabies in mainland China. The PubMed, Web of Science, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical and Wanfang databases were searched for articles on rabies vaccination status (published between 2007 and 2017). In total, 10 174 human rabies cases from 136 studies were included in this meta-analysis. Approximately 97.2% (95% confidence interval (CI) 95.1–98.7%) of rabies cases occurred in rural areas and 72.6% (95% CI 70.0–75.1%) occurred in farmers. Overall, the vaccination rate in the reported human rabies cases was 15.4% (95% CI 13.7–17.4%). However, among vaccinated individuals, 85.5% (95% CI 79.8%–83.4%) did not complete the vaccination regimen. In a subgroup analysis, the PEP vaccination rate in the eastern region (18.8%, 95% CI 15.9–22.1%) was higher than that in the western region (13.3%, 95% CI 11.1–15.8%) and this rate decreased after 2007. Approximately 68.9% (95% CI 63.6–73.8%) of rabies cases experienced category-III exposures, but their PEP vaccination rate was 27.0% (95% CI 14.4–44.9%) and only 6.1% (95% CI 4.4–8.4%) received rabies immunoglobulin. Together, these results suggested that the PEP vaccination rate among human rabies cases was low in mainland China. Therefore, standardised treatment and vaccination programs of dog bites need to be further strengthened, particularly in rural areas.

scholarly journals Human rabies post-exposure prophylaxis relative to the disease epidemiological status

2019 ◽  
Vol 24 (1) ◽  
pp. 315-322 ◽  
Author(s):  
Bruno Fonseca Martins da Costa Andrade ◽  
Taísa Santos de Melo Andrade ◽  
Luzia Helena Queiroz
Keyword(s):  
Rabies Vaccine ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Paulo State ◽  
Technical Manual ◽  
Prophylactic Measures ◽  
Exposure Prophylaxis ◽  
Main City ◽  
Technical Recommendations

Abstract This study evaluated the prophylactic measures adopted after attacks by dogs and cats in the main city of Northwester São Paulo State, based on the technical manual for post-exposure treatment, considering the not controlled (1990-1996) and controlled (1997-2010) rabies status. A retrospective analysis was done using the data from the SINAN records (W64-CID10) between 1990 and 2010. In most cases, the accidents were mild (76.9%), and biting animals were healthy (75.4%); therefore, no treatment was needed in 53.3% of the cases. In 64.6% of cases, the prescribed PEP treatment was inappropriate. The most indicated PEP treatments consisted of vaccine and RIG (43.4%), and either three doses of mouse brain vaccine or two doses of cell culture vaccine (76.5%), during the not controlled and controlled rabies periods, respectively. The treatment was more appropriate and followed the technical recommendations during controlled rabies periods compared to not controlled (p < 0.0001) periods. However, excessive application of RIG and rabies vaccine was observed in both periods.

scholarly journals Human rabies post exposure prophylaxis at the Pasteur Institute of Dakar, Senegal: trends and risk factors

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mamadou Korka Diallo ◽  
Alpha Oumar Diallo ◽  
Anta Dicko ◽  
Vincent Richard ◽  
Emmanuelle Espié
Keyword(s):  
Risk Factors ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Pasteur Institute ◽  
Post Exposure ◽  
Exposure Prophylaxis

Recurrent Temporary Paralysis Reported After Human Rabies Post-Exposure Prophylaxis

2014 ◽  
Vol 62 (3) ◽  
pp. 222-227 ◽  
Author(s):  
V. M. Dato ◽  
E. R. Campagnolo ◽  
D. U. Shah ◽  
M. J. Bellush ◽  
C. E. Rupprecht
Keyword(s):  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Exposure Prophylaxis

Problems in human rabies post-exposure prophylaxis management

2007 ◽  
Vol 5 (3) ◽  
pp. 189-193 ◽  
Author(s):  
Saowaluck Tepsumethanon ◽  
Veera Tepsumethanon ◽  
Thanphet Tantawichien ◽  
Kanitta Suwansrinon ◽  
Henry Wilde
Keyword(s):  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Exposure Prophylaxis

scholarly journals How geographic access to care shapes disease burden: the current impact of post-exposure prophylaxis and potential for expanded access to prevent human rabies deaths in Madagascar

2020 ◽  
Author(s):  
Malavika Rajeev ◽  
Hélène Guis ◽  
Glenn Edosoa ◽  
Chantal Hanitriniaina ◽  
Anjasoa Randrianarijaona ◽  
...  
Keyword(s):  
Rabies Vaccine ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Travel Times ◽  
Middle Income ◽  
Geographic Access ◽  
Post Exposure ◽  
Canine Rabies ◽  
Middle Income Countries ◽  
Exposure Prophylaxis

AbstractBackgroundPost-exposure prophylaxis (PEP) is highly effective at preventing human rabies deaths, however access to PEP is limited in many rabies endemic countries. The 2018 decision by Gavi to add human rabies vaccine to its investment portfolio should expand PEP availability and reduce rabies deaths. We explore how geographic access to PEP impacts the rabies burden in Madagascar and the potential benefits of improved provisioning.Methodology & Principal FindingsWe use travel times to the closest clinic providing PEP (N=31) as a proxy for access. We find that travel times strongly predict reported bite incidence across the country. Using resulting estimates in an adapted decision tree framework we extrapolate rabies deaths and reporting and find that geographic access to PEP shapes burden sub-nationally. We estimate 960 human rabies deaths annually (95% Prediction Intervals (PI):790 - 1120), with PEP averting an additional 800 deaths (95% PI: 800 (95% PI: 640 - 970) each year. Under these assumptions, we find that expanding PEP to one clinic per district could reduce deaths by 19%, but even with all major health centers provisioning PEP (1733 additional clinics), we still expect substantial rabies mortality. Our quantitative estimates are most sensitive to assumptions of underlying rabies exposure incidence, but qualitative patterns of the impacts of travel times and expanded PEP access are robust.Conclusions & SignificancePEP is effective at preventing rabies deaths, and in the absence of strong surveillance, targeting underserved populations may be the most equitable way to provision PEP. Our framework could be used to guide PEP expansion and improve targeting of interventions in similar endemic settings where PEP access is geographically restricted. While better PEP access should save many lives, improved outreach and surveillance is needed and if rolled out with Gavi investment could catalyze progress towards achieving zero rabies deaths.Author SummaryCanine rabies causes an estimated 60,000 deaths each year across the world, primarily in low- and middle-income countries where people have limited access to both human vaccines (post-exposure prophylaxis or PEP) and dog rabies vaccines. Given that we have the tools to prevent rabies deaths, a global target has been set to eliminate deaths due to canine rabies by 2030, and recently, Gavi, a multilateral organization that aims to improve access to vaccines in the poorest countries, added human rabies vaccine to it’s portfolio. In this study, we estimated reported bite incidence in relation to travel times to clinics provisioning PEP, and extrapolate human rabies deaths in Madagascar. We find that PEP currently averts around 800 deaths each year, but that the burden remains high (1000 deaths/ year), particularly in remote, hard-to-reach areas. We show that expanding PEP availability to more clinics could significantly reduce rabies deaths in Madagascar, but our results suggest that expansion alone will not eliminate deaths. Combining PEP expansion with outreach, surveillance, and mass dog vaccination programs will be necessary to move Madagascar, and other Low- and Middle-Income countries, forward on the path to rabies elimination.

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