Introduction to the Development of Immunization Program after Rabies Exposure

There are two kinds of rabies post-exposure immunization procedures approved for marketing in China, namely:

In the course of the development of the immunization program after rabies exposure, the "5-needle method" and "2-1-1" programs have been recommended by WHO and have gone through different development processes. The specific process can be seen in the following figure.

The 2010 Rabies Vaccine: WHO Position Paper recommends the "5-needle" and "2-1-1" procedures for post-exposure IM immunization.^[1]. The 2018 Rabies Vaccine: WHO Position Paper recommends a simple 4-needle and 2-1-1 method for post-exposure IM immunization.^[2]. As can be seen from the evolution of the recommended procedures, the WHO recommended procedures focus on the simplification of vaccination procedures and the improvement of cost-effectiveness while ensuring the effectiveness of immunization.

In the technical guidelines for rabies prevention and control (2016 edition), it is pointed out that the "2-1-1" procedure is only applicable to rabies vaccine products that have been approved to use the "2-1-1" procedure in China. The clinical research data of vaccines at home and abroad show that the vaccine is vaccinated according to the "5-needle method" or "2-1-1" after exposure, and most of them can appear neutralizing antibodies 7 days after vaccination, and 100 percent of the antibodies are positive in 14 days. Several serological studies showed that the "2-1-1" procedure had higher antibody positivity and serum antibody levels on day 7 than the 5-needle procedure, with no difference in antibody levels between day 14 and day 42. The current study also shows that there is no significant difference in the incidence of adverse reactions between the "2-1-1" procedure and the "5-needle method" procedure.^[3]。

The adult human rabies vaccine has two post-exposure immunization programs at the same time, which can provide patients with more choices.

References

1.WHO Publication. Rabies vaccines: WHO position paper-recommendations[J]. Vaccine,2010,28(44):7140–7142. DOI: 10.1016/j.vaccine.2010.08.082

2. World Health Organization. Rabies vaccines: WHO position paper, April 2018-Recommendations[J].Vaccine,2018,36(37):5500–5503. DOI: 10.1016/j.vaccine.2018.06.061

3. Chinese Center for Disease Control and Prevention. Technical guide for rabies prevention and control [M]. 2016.1.