Safety and efficacy of purified Vero cell rabies vaccine given intramuscularly and intradermally. (Results of a prospective randomized trial).

Objectives: To determine adverse reactions as a result of pre- and post-exposure rabies vaccination, using the conventional intramuscular, and reduced dose intradermal regimens and purified Vero cell rabies vaccine.

Design: A prospective and randomized study of patients exposed to rabies and of subjects in need of pre-exposure rabies vaccination.

Setting: A metropolitan rabies control center in a canine rabies endemic country.

Immune response to tissue culture rabies vaccine in subjects who had previous postexposure treatment with Semple or suckling mouse brain vaccine.

Nerve tissue derived Semple and suckling mouse brain rabies vaccines are still widely used. Patients who experience a new rabies exposure and who were given such vaccines decades earlier are not uncommon in rabies endemic countries. The World Health Organization recommends that persons who have had a previous course of a potent tissue or avian culture rabies vaccine and are reexposed, be given booster infections on days 0 and 3 without rabies immune globulin.

What is an acceptable delay in rabies immune globulin administration when vaccine alone had been given previously?

Rabies immune globulins (RIG) are not always available. Rabies-exposed patients often present to medical centers, particularly in canine rabies infested regions, after a vaccine series has been started without immune globulin administration. It is known that rabies immune globulin can result in suppression of the neutralizing antibody response which usually yields detectable antibodies by day 7.