New WHO/SAGE recommendations for rabies vaccination
JUL 23, 2020
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In April 2018, the World Health Organization (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 treatment (PET) recommendations with reduction in the number of active vaccine doses from 5 to 3 ID doses (on days 0, 3 and 7) or 4 IM doses (at 0, 3, 7 and 21-28 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, 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 offer the best, evidence-based practice to our patients. The current evidence shows that the new 'WHO' intra-dermal schedule of two ID doses on days 0 and 7 is the most effective in terms of generating a long-term, boostable immune response. It also happens to work out much cheaper and less painful than the traditional, 3-dose IM one, and to be more convenient for 'last minute' travellers.
We do always try and fit in with national recommendations wherever possible, and for this reason will continue to offer the traditional, 3-dose PrEP schedule (ID or IM if not in short supply), to clients who have e.g. started their courses elsewhere.
[We do not, however, endorse the UK’s proposed new, 'accelerated' 0, 3, 7 day PrEP schedule, nor a routine 4th dose after a year, neither of which makes much immunological sense, according to most respected, international rabies experts.]
