School of Medicine, Faculty of Medicine, The University of Queensland, Herston, Australia.
Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, Australia.
Zoonoses Public Health. 2023 Sep;70(6):465-472. doi: 10.1111/zph.13048. Epub 2023 May 11.
Periodic vaccination against rabies is essential for individuals at continuing risk of rabies exposure. There is limited evidence on long-term immunogenicity after a 3-dose intramuscular (3IM) pre-exposure prophylaxis (PrEP) and single IM booster dose, thus current guideline recommendations differ in the interval for serology tests following PrEP and boosters. This study investigated post-PrEP and post-booster persistence of antibodies in Australian bat carers. Bat carers who received 3IM PrEP/booster doses and had post-PrEP/booster serology test results were included. The proportion of antibody-negative (<0.5 EU/mL) individuals after PrEP/booster dose were examined. Three hundred and five participants (65.6% females, median age at PrEP 43.1 years) were included. The proportion who were antibody-negative varied depending on the time between 3IM PrEP and the serology test: 8.0% <1 year, 29.8% 1-2 years, 21.2% 2-3 years and 7.7% >3 years. Ninety-one participants receiving booster doses were further assessed. Only one participant was antibody-negative at >3 years after receiving one IM booster dose. Our findings support that a serology test should be performed 1 year after 3IM PrEP, followed by first booster if required. Rabies antibodies persist for many years after receiving the booster doses. The interval between subsequent serology tests and the first booster dose should be no longer than 3 years. Future studies are required to provide more insight into the most appropriate timing of subsequent boosters.
定期接种狂犬病疫苗对于持续存在狂犬病暴露风险的个体至关重要。目前关于 3 剂肌内（3IM）暴露前预防（PrEP）和单次肌内加强剂量后的长期免疫原性的证据有限，因此，目前的指南建议在 PrEP 和加强剂后进行血清学检测的间隔时间有所不同。本研究调查了澳大利亚蝙蝠照顾者在 PrEP 和加强剂后的抗体持久性。纳入了接受 3IM PrEP/加强剂剂量且有 PrEP/加强剂后血清学检测结果的蝙蝠照顾者。检查了 PrEP/加强剂剂量后抗体阴性（<0.5 EU/mL）个体的比例。共有 305 名参与者（65.6%为女性，PrEP 时的中位年龄为 43.1 岁）被纳入研究。根据 3IM PrEP 和血清学检测之间的时间，抗体阴性的比例有所不同：1 年<8.0%、1-2 年 29.8%、2-3 年 21.2%和>3 年 7.7%。进一步评估了 91 名接受加强剂量的参与者。仅 1 名参与者在接受 1 次肌内加强剂量后>3 年时抗体阴性。我们的研究结果支持在 3IM PrEP 后 1 年进行血清学检测，如果需要，再进行第一次加强剂接种。接种加强剂后，狂犬病抗体可多年持续存在。随后的血清学检测和第一次加强剂接种之间的间隔时间不应超过 3 年。需要进一步的研究来提供更多关于后续加强剂接种的最佳时机的信息。
