Rabies Vaccine – How many doses before a trip

How many doses of rabies vaccine do you need before a trip

6/9/23

Although there is one body of knowledge in the world, different medical groups  assess that information differently.

They also take variable amounts of time to update their guidelines

Timing for Guidelines

WHO made their guidelines in April 2018

https://www.who.int/publications/i/item/who-wer9316

The CDC updated their guidelines  May 2022

https://www.cdc.gov/mmwr/volumes/71/wr/mm7118a2.htm

The Australian Guidelines were last updated June 2018

https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/rabies-and-other-lyssaviruses#page-history

Guidelines take a while to get updated so the Australian guidelines were from before the WHO guidelines

Differences in Guidelines

There are  differences in the current guidelines  for PRE exposure prophylaxis.

For PRE exposure Rabies vaccination

Australia: three doses of IM  rabies vaccine are recommended

 CDC ( Centre US Centres for Disease Control ( CDC) : recommends two doses

WHO ( World Health Organisation), recommends two doses.

For Boosters

Australia – just recommends 3 doses unless working with potentially infected animals so no other boosters

CDC says check serology or give a booster within three years.

(For those having intradermal rabies vaccine with a serology check, this fulfils the guidelines of CDC)

WHO does not specify the need for a booster after 2 doses

Everyone specifies you need 2 boosters if you are bitten licked or scratched by a potentially infected animal of course.

Recommendation from Dr Deb

For travellers, I recommend 2 doses of rabies vaccine before a trip, and then a booster before the next trip.

This spreads the cost across two trips and give great protection.

It also makes for better antibodies from a theoretical point of view as we know the immune system works better if it has more time between doses of vaccine to process the antigen through the immune system.

If there is no time for two doses before departure?

For people leaving at short notice, it IS worth having at least one dose of rabies vaccine, to give your immune system a head start on the virus. This is especially important because OFTEN after a bite in an under-resourced part of the world,    one is supposed to get RIG (Rabies Immune Globulin ) but RIG is  just not readily available.

More info on our BORS trial of one dose last minute traveller research

 https://www.thetraveldoctor.com.au/borsinfo/