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. 2023 Dec:1:100006.
doi: 10.1016/j.ijidoh.2023.100006.

Rabies post-exposure prophylaxis delivery to ensure treatment efficacy and increase compliance

Deborah Nadal  1   2 , Katrin Bote  2 , Ramesh Masthi  3 , Ashwath Narayana  3 , Yasmeen Ross  4 , Ryan Wallace  4 , Bernadette Abela  2
Affiliations

Rabies post-exposure prophylaxis delivery to ensure treatment efficacy and increase compliance

Deborah Nadal et al. IJID One Health. 2023 Dec.

Abstract

Objectives: Since rabies is lethal once symptoms appear, its prevention including community awareness, mass dog vaccination and post-exposure prophylaxis (PEP) is crucial. Although safe and potent rabies vaccines have long been available, the global rabies burden is still high and access to adequately-delivered PEP remains challenging. Here we offer healthcare providers up-to-date, simple, exhaustive, visual guidance on how to perform PEP steps correctly.

Protocol: PEP consists of 1) washing the wound with water and soap for 15 min, 2) assessing the need for rabies biologicals based on specific criteria; 3) administering, if required, rabies immunoglobulin or monoclonal antibodies deep in and around all wounds; 4) starting, if necessary, the WHO-recommended intradermal 1-week vaccination regimen; 5) informing patients adequately throughout the PEP process to increase compliance and avoid dangerous misconceptions about animal bite treatment and rabies risk.

Discussion: The intradermal 1-week vaccination regimen recommended by WHO is as safe as other regimens but carries important cost-, dose- and time-sparing benefits. As fundamental as the correct administration of rabies biologicals is clear doctor-patient communication and sharing of up-to-date knowledge among healthcare professionals.

Conclusions: This resource will help ensuring that no life is lost to rabies, an incurable yet preventable disease.

Keywords: Intradermal vaccination; Rabies immunoglobulin; Rabies post-exposure prophylaxis; Rabies vaccine; Risk assessment; Wound treatment.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

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Graphical abstract
Fig. 1
Figure 1
Post-exposure prophylaxis decision tree 1: wound risk assessment. This decision tree compiles all needed information on the assessment of the patient’s wound to guide healthcare providers on the appropriate, WHO-recommended PEP delivery.
Fig. 2
Figure 2
Post-exposure prophylaxis decision tree 2: PEP risk assessment. This decision tree compiles all needed information on the assessment of the animal exposure to guide healthcare providers on the appropriate, WHO-recommended PEP delivery.
Fig. 3
Figure 3
WHO-recommended 1-week intradermal post-exposure prophylaxis vaccination schedule. For exposed individuals who have not been previously immunized, WHO recommends a 1-week vaccination schedule on days 0, 3 and 7, with a 2-site intradermal injection on each day.
Fig. 4
Figure 4
Confirmation of correct intradermal rabies vaccine administration. When the rabies vaccine is correctly injected into the upper skin area (over the deltoid muscle in adults or the lateral thigh area of infants), a distinctive bleb with an ‘orange peel’ appearance is visible.
See this image and copyright information in PMC

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