WHO's new rabies recommendations: implications for high incidence countries

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.