New WHO/SAGE recommendations for rabies vaccination

OCT 05, 2018

New WHO/SAGE recommendations for rabies vaccination

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:

  1. 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.
  2. 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.]

Intra-dermal technique for rabies vaccination and tuberculin testing

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