In April 2018, the WHO and Strategic Advisory Group of Experts (SAGE) working group on Rabies published a series of updated recommendations on rabies prevention, based on the latest available, international evidence. Key changes include:
- A new, two-visit rabies pre-exposure prophylaxis (PrEP) regime of 2x 0.1ml ID or 1ml IM vaccination given on days 0 and 7 only, to replace the previous, three-visit schedule.
- A simplification of the post-exposure prophylaxis (PEP) assessment and management recommendations with reduction in the number of active vaccine doses from 5 to 4 doses (at 0, 3, 7 and 21 days) in unvaccinated people - in addition to immunoglobulin on Day 0.
The JCVI in the UK, however, has chosen not to implement all of the WHO/SAGE recommendations into its national guidelines for the time being... In particular, the traditional, ‘standard’ 0, 7 and 21-28 day PrEP schedule has been retained in this country for the next three years. [For more info, please see the updated Rabies chapter in The Green Book
At TrExMed Travel Clinic Edinburgh, we always try our best to fit in with national recommendations, while also offering our clients the benefit of the most up-to-date, international, evidence-based practice. We have therefore decided to stick with the three-dose schedule for most travellers, although we can also provide the new, ‘WHO’ accelerated schedule of two intra-dermal doses on days 0 and 7 for longer term travellers who are leaving at short notice.
[We do not, however, offer the UK’s proposed, new, accelerated 0, 3, 7 and 365 day PrEP schedule, which does not make much immunological sense, according to some respected, international rabies experts.]