Post-exposure prophylaxis (PEP) for rabies with purified chick embryo cell vaccine: a systematic literature review and meta-analysis

<p><b>Introduction</b>: Fifteen million people each year receive post-exposure prophylaxis (PEP) to prevent rabies, yet the disease remains neglected and highly under-reported.</p> <p><b>Areas covered</b>: In this systematic literature review, we assessed the immunogenicity, efficacy, and safety of a purified chick embryo cell-culture rabies vaccine (PCECV) for PEP against rabies by intramuscular (IM) or intradermal (ID) administration. We performed meta-analyses to compare immunogenicity according to the route of vaccine administration, study population, and PEP regimen, such as number of doses, and concomitant rabies immunoglobulin.</p> <p><b>Expert commentary</b>: There were 54 estimates of immune responses to vaccination, which showed that in the overall population, after starting PEP with PCECV by the IM or ID route (≥2.5 IU per dose), almost all individuals had rabies virus neutralizing antibody (RVNA) titers above the World Health Organization (WHO) recommended serological threshold for an adequate immune response to vaccination (RVNA ≥0.5 IU/ml by day 14). In the overall population, PCECV had an acceptable safety profile. However, given that there are 59,000 human rabies deaths reported annually, the challenge is to improve access to PCECV for PEP against human rabies.</p

Place of exposure and place of diagnosis (arrows) of GeoSentinel Zika patients from Africa (green dot), Asia (red dots), and the Pacific (blue dots)—Circular arrows indicate cases in international travelers who contracted Zika while abroad and were diagnosed in the country of exposure while traveling.

<p>Linear arrows indicate cases in international travelers who contracted Zika while abroad and had their diagnosis confirmed on returning to their home country.—Base map is available free of charge from <a href="http://www.histgeo.ac-aix-marseille.fr/ancien_site/carto/" target="_blank">http://www.histgeo.ac-aix-marseille.fr/ancien_site/carto/</a>.</p

Temporal association of endemic and exported cases with travel notices by international authorities for selected countries in Africa.

<p>Temporal association of endemic and exported cases with travel notices by international authorities for selected countries in Africa.</p

Demographic, itinerary, and laboratory characteristics of GeoSentinel Zika patients from Africa, Asia, and the Pacific.

<p>Demographic, itinerary, and laboratory characteristics of GeoSentinel Zika patients from Africa, Asia, and the Pacific.</p

Risk categorization by major international bodies.

<p>Risk categorization by major international bodies.</p