single dose for rabies pre-immunization p. khawplod 1, h. wilde 2,t. kamolthum 3,visith sitprija 1....

Single dose for rabies Single dose for rabies pre-immunizationpre-immunization

P. Khawplod1 , H. Wilde2 ,T. Kamolthum3 ,Visith Sitprija1.

1Queen Saovabha Memorial Institute, The Thai Red Cross Society, Bangkok, Thailand.

2 Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand.

3 Provincial Public Health Office of Pitsanulok , Thailand.

The Ab response in incomplete PET casesThe Ab response in incomplete PET cases(1 - 3 injections)(1 - 3 injections)

SubjectsSubjects nn Day 0Day 0 Day 7Day 7 Day 14Day 14 Day 28Day 28

I. No previous I. No previous

rabies rabies

vaccinationvaccination1010 <0.03<0.03 0.060.06

(<0.03–0.2)(<0.03–0.2)

7.137.13(1.15-58.8)(1.15-58.8)

6.446.44(1.8-20.7)(1.8-20.7)

II. 1-3 II. 1-3

injections injections

previouslypreviously

20200.260.26

(<0.03-22.0)(<0.03-22.0)

6.736.73(1.1-80.5)(1.1-80.5)

38.9138.91(16.7-248.4)(16.7-248.4)

23.8623.86(6.7-175.6)(6.7-175.6)

All subjects received TRC-ID 2-2-2-0-1-1

(PVRV lot.no. L1012, potency 8.7

IU/0.5mL)

Pre-exposure vaccination

Shorten time & reduce cost

Objective :

To evaluate the immune memory of

two abbreviated pre-exposure rabies

vaccination schedules

Study 1 One week schedule

( 3 injections on day 0,3,7)

Study 2 One clinic visit (Single dose)

One week scheduleOne week schedule

Gr.A ID (2 sites) on day 0, 7 ,280, 7 ,28

Gr.B ID (2 sites) on day 0, 3, 70, 3, 7

Gr.C IM on day 0, 3, 70, 3, 7

PVRV potency 7.5 IU/0.5 mL

PVRV potency 7.5 IU/0.5 mL

Booster : ID (2 sites) on day 0,3 1 year later

One week scheduleOne week schedule

Blood collection : before booster (1 year) , 7 and 14 days

Group Day 360 Day 367 Day 374

A. IDx2 Age 18-35 GMT 0.96 29.14 49.39 day 0,7,28 M/F 5/11 Range 0.32-2.95 6.7-227.8 13.1-308.4

(n=16 ) >0.5 IU/ml 81% 100% 100%

B. IDx 2 Age 18-32 GMT 1.12 22.99 105.08 day 0,3,7 M/F 4/12 Range 0.30-4.76 5.9-295.4 26.1-496.7

(n=16 ) >0.5 IU/ml 94% 100% 100%

C. IM Age 18-40 GMT 0.97 35.16 125.0 day 0,3,7 M/F 8/12 Range 0.27-4.76 12.0-191.5 29.7-800.0

(n=20 ) >0.5 IU/ml 80% 100% 100%

Booster : ID(2 sites) on day 0,3 1 year later

Previous vaccination

regimen Times

(yrs)

day0 day7 day14 day28

PVRV ID 8 mths 0.08 16.0 25.0 19.3

PVRV ID 1 neg 1.1 18.2 6.7

PVRV ID 2 0.18 5.0 16.7 11.8

PVRV ID 3 1.14 36.4 34.9 20.8

unknown IM 4 neg 2.4 30.6 32.0

No previous vaccination

TRC-ID2-2-2-0-1-1

neg 0.06 5.56 5.84

One injection for 1- 4 years( at QSMI )

Conclusions:

3 injections on day 0,3,7 is as immunogenic as 3 injections on day 0,7,28

Provide at least 1 year of immune memory

Single dose for rabies pre-immunizationSingle dose for rabies pre-immunization( one clinic visit )( one clinic visit )

Pre-immunization

ID 0.1 ml (2 sites) on day 0

Single dose for rabies pre-immunizationSingle dose for rabies pre-immunization

Booster ( 1 year later )

ID 0.1 ml ( 2 sites ) on day 0, 3

PVRV lot no 0525 potency 7.5 IU/0.5mL

Primary vaccinationPrimary vaccination Day 360( Before booster )

Day 367( 7 days)

Day 374( 14 days )

I. ID 0.1 ml (2sites) on day 0 I. ID 0.1 ml (2sites) on day 0 booster ID 0.1ml (2 sites )booster ID 0.1ml (2 sites )

day0,3day0,3 >0.5 IU/ml

0.41(0.06–3.7)

5/13

38%

9.15(3.36-22.6)

10/10

100%

51.96(13.6-141.4)

9/9

100%

Single dose rabies pre-immunizationSingle dose rabies pre-immunization

Primary vaccinationPrimary vaccination Day 360 (Before booster)

Day 367( 7 days)

Day 374( 14 days)

I. ID 0.1 ml (2sites) on day 0I. ID 0.1 ml (2sites) on day 0

0.41(0.06–3.7)

5/13

38%

9.15(3.36-22.6)

10/10

100%

51.96(13.6-141.4)

9/9

100%

II.TRC-ID 2-2-2-0-1-1 (PVRV)II.TRC-ID 2-2-2-0-1-1 (PVRV)

No previous rabies vaccinationNo previous rabies vaccination<0.03<0.03

0.060.06(0.03 –0.15)(0.03 –0.15)

0%0%

5.565.56(1.15 - 53.8)(1.15 - 53.8)

100%100%

III.TRC-ID 2-2-2-0-1-1 (PCEC)III.TRC-ID 2-2-2-0-1-1 (PCEC)

No previous rabies vaccinationNo previous rabies vaccination<0.03<0.03

0.060.06(<0.03– 0.3)(<0.03– 0.3)

0%0%

8.548.54(1.56 – 27.3)(1.56 – 27.3)

100%100%

Single dose injection Single dose injection Single dose rabies pre-immunizationSingle dose rabies pre-immunization

Conclusion:

One clinic visit

( ID 0.1 ml (2 sites) one time)

provide at least 1 year of immune memory

Pre-immunization vaccination

ID 0.1 ml (1 site) on day 0

Booster ( 1 or 3 years later )

ID 0.1 ml ( 1 site ) on day 0, 3

PCEC Lot no 725 potency 7.25 IU/mL

Single dose for rabies pre-immunizationSingle dose for rabies pre-immunization

in Petchaboonin Petchaboon provinceprovince

BoosterBooster : ID 0.1ml (1 site) on day 0,3 1 year later

Subject no. Day 360 Day 367 Day 374

01032 0.07 3.69 6.59

01042 0.1 2.29 6.04

01049 0.06 18.74 21.51

01070 0.18 2.62 22.15

01098 neg 5.00 9.72

Subject no. Day 360 Day 367 Day 374

03022 0.27 2.09 20.57

03027 0.71 3.08 5.73

03050 0.13 4.18 4.42

03051 0.15 1.04 3.56

03059 0.46 1.68 5.98

03066 0.09 2.13 7.76

03082 0.07 1.00 19.28

03093 0.2 1.04 14.23

BoosterBooster : ID 0.1ml (1 site) on day 0,3 3 years later

• 3 injections on day 0,3 and 7

• One clinic visit ID 0.1 ml ( 2 sites) one time

Provide immune memory at least 1 year or more

Conclusions:

• reliable booster vaccination

• long lasting

• ????

NEED FURTHER STUDIES

Application for rabies pre-immunization

Thank you for your attention

Bite Prevention

PET = 100%

Preventions

Exposed

Pre-exposure vaccination

Animal controlAnimal control