Real-world evidence of rabies post-exposure prophylaxis in Serbia: Nation-wide observational study (2017–2019)

Background: Rabies remains a deadly zoonotic disease, primarily prevalent in Eastern European countries, with a significant global burden in Asia and Africa. Post-exposure prophylaxis (PEP) is critical to prevent clinical rabies. Serbia, a country with a relatively low animal rabies incidence, has b...

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Bibliographic Details
Published in:Travel Medicine and Infectious Disease
Main Authors: Pavle Banović, Dragana Mijatović, Verica Simin, Nenad Vranješ, Eleftherios Meletis, Polychronis Kostoulas, Dasiel Obregon, Alejandro Cabezas-Cruz
Format: Article in Journal/Newspaper
Language:English
Published: Elsevier 2024
Subjects:
Rabies
Post-exposure prophylaxis
Essen regimen
Seroconversion
Rabies virus-neutralizing antibodies
Arctic medicine. Tropical medicine
RC955-962
Infectious and parasitic diseases
RC109-216
Arctic
Online Access:https://doi.org/10.1016/j.tmaid.2024.102697
https://doaj.org/article/3b039e1c47674eadb503797cb511559a
Description
Summary:Background: Rabies remains a deadly zoonotic disease, primarily prevalent in Eastern European countries, with a significant global burden in Asia and Africa. Post-exposure prophylaxis (PEP) is critical to prevent clinical rabies. Serbia, a country with a relatively low animal rabies incidence, has been implementing a 4-dose Essen PEP regimen for 13 years. This real-world study aimed to assess the effectiveness of the 4-dose Essen regimen, considering demographic and clinical factors, after WHO Category III exposure. Method: The study included 601 patients who received the 4-dose Essen PEP and 79 who received an additional 5th dose. Results: Age emerged as a critical factor influencing seroconversion rates after the 4-dose regimen, with older individuals exhibiting lower RVNA titers. Logistic regression indicated a 3.18% decrease in seroconversion odds for each added year of age. The Cox proportional hazards mixed model highlighted age-related risks, with age groups 45–60 and 75–92 at the highest risk of non-seroconversion. Human Rabies Immune Globulin (HRIG) administration was associated with lower RVNA values after the 4-dose regimen, suggesting interference with vaccine immunogenicity among people who received larger doses of HRIG. Conclusions: This study provides valuable real-world evidence for rabies PEP in a non-homogeneous population with potential comorbidities. The results underscore the importance of optimizing PEP strategies, particularly in older individuals, and reconsidering HRIG dosing to improve seroconversion rates.

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