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Recommendation of the Immunization Practices Advisory Committee
Rabies Prevention: Supplementary Statement on the Preexposure Use
of Human Diploid Cell Rabies Vaccine by the Intradermal Route
The human diploid cell rabies vaccine (HDCV) produced by the
Merieux Institute has been used extensively for preexposure
immunization in a regimen of three 0.1-ml doses, one each on days
0,
7, and 21 or 28. The intradermal (ID) dose/route has previously
been
recommended by the ACIP as an alternative to the 1.0-ml
intramuscular
(IM) dose/route for rabies preexposure prophylaxis (1), but the
manufacturer had not met the packaging and labeling requirements
necessary to obtain approval by the U.S. Food and Drug
Administration
(FDA).
Merieux Institute has now developed a syringe containing a
single
dose of lyophilized HDCV (Imovax Rabies ID) that is reconstituted
in
the syringe just before administration. The syringe is designed to
reliably deliver 0.1 ml of HDCV and was approved by the FDA on May
30,
1986. Three 0.1-ml ID doses, given in the lateral aspect of the
upper
arm, on days 0, 7, and 21 or 28, are used for primary preexposure
prophylaxis. One 0.1-ml ID dose is used for booster vaccination
(based on previously outlined criteria (1)). Serologic testing is
not
necessary after preexposure prophylaxis with HDCV administered by
either the ID or IM route. The ID dose/route should not be used
for
postexposure prophylaxis.
Chloroquine phosphate (administered for malaria
chemoprophylaxis)
and unidentified factors (that may include multiple concurrent
vaccinations) may interfere with the antibody response to HDCV in
persons traveling to developing countries (2,3). The IM dose/route
of
preexposure prophylaxis provides a sufficient margin of safety in
this
setting (3). HDCV should not be administered by the ID dose/route
while a person is receiving chloroquine for malaria
chemoprophylaxis.
In persons receiving preexposure prophylaxis in preparation for
travel
to a rabies endemic area, the ID dose/route should be initiated
early
enough to allow the three-dose series to be completed 30 days or
more
before departure. If this is not possible, the IM dose/route
should
be used.
References
ACIP. Rabies prevention--United States, 1984. MMWR
1984;33:393-402, 407-8.
Bernard KW, Fishbein DB, Miller KD, et al. Pre-exposure rabies
immunization with human diploid cell rabies vaccine: decreased
antibody responses in persons immunized in developing
countries.
Am J Trop Med Hyg 1985;34:633-47.
Pappaioanou M, Fishbein DB, Dreesen DW, et al. Antibody
response
to preexposure human-diploid cell rabies vaccine given
concurrently with chloroquine. N Eng J Med 1986;314:280-4.
Disclaimer
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