Circulating Antibody’s Role During Post-Exposure Prophylaxis, and Beyond for Rabies: A Review
<b>Background:</b> Since the introduction of Pasteur’s rabies vaccine in 1885, rabies prophylaxis and post-exposure prophylaxis (PEP) have been widely administered globally under the recommendation of the World Health Organization (WHO). However, 124 documented cases of PEP failure had b...
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2025-07-01
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| author | Qingjun Chen Li Cai Xinjun Lv Si Liu Cheng Liu Jiayang Liu Xiaoqiang Liu Wenwu Yin Chuanlin Wang Zhenggang Zhu |
| author_facet | Qingjun Chen Li Cai Xinjun Lv Si Liu Cheng Liu Jiayang Liu Xiaoqiang Liu Wenwu Yin Chuanlin Wang Zhenggang Zhu |
| author_sort | Qingjun Chen |
| collection | DOAJ |
| description | <b>Background:</b> Since the introduction of Pasteur’s rabies vaccine in 1885, rabies prophylaxis and post-exposure prophylaxis (PEP) have been widely administered globally under the recommendation of the World Health Organization (WHO). However, 124 documented cases of PEP failure had been reported worldwide between 1980 and 2023. Additionally, sporadic media reports from China showed occasional PEP failures between 2017 and 2024. Rabies remains a serious public health problem in over 150 countries and regions. <b>Methods:</b> In this review, we summarize PEP procedures recommended by the Advisory Committee on Immunization Practices (ACIP) and the WHO. We also analyze potential contributing factors to PEP failure, propose a concept of circulating antibodies, and discuss their roles in PEP. Furthermore, we summarize key guidelines for clinical trial design from the U.S. Food and Drug Administration (FDA) and China’s Center for Drug Evaluation (CDE), as well as the latest developments in monoclonal antibody (cocktail) therapies. <b>Results:</b> Adherence to core PEP practices, such as wound cleansing, infiltration of wounds with immunoglobulin (mAbs), and administration of vaccines, and broader societal involvement are crucial for preventing rabies infection in most cases. For high-risk exposures or immunocompromised individuals, the provision of circulating antibodies through high-dose human rabies immune globulin (HRIG) or mAbs is of utmost importance for preventing PEP failure. <b>Conclusions:</b> Early, high-concentration circulating antibodies are important for preventing PEP failure. Addressing the global issue of rabies requires involvement of the entire society. Only through collective efforts can we tackle this neglected disease and achieve WHO’s goal of “zero by 30”. |
| format | Article |
| id | doaj-art-dfba2dd4f6f44fc194cb85a08d1aa716 |
| institution | Matheson Library |
| issn | 2076-393X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Vaccines |
| spelling | doaj-art-dfba2dd4f6f44fc194cb85a08d1aa7162025-07-25T13:38:30ZengMDPI AGVaccines2076-393X2025-07-0113777510.3390/vaccines13070775Circulating Antibody’s Role During Post-Exposure Prophylaxis, and Beyond for Rabies: A ReviewQingjun Chen0Li Cai1Xinjun Lv2Si Liu3Cheng Liu4Jiayang Liu5Xiaoqiang Liu6Wenwu Yin7Chuanlin Wang8Zhenggang Zhu9Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100024, ChinaImmunization Program, Wuhan Center for Disease Prevention and Control, Wuhan 430024, ChinaNational Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100052, ChinaEmergency Department, Peking University First Hospital, Beijing 100034, ChinaEmergency Department, Peking University First Hospital, Beijing 100034, ChinaEmergency Department and Trauma Center, Peking University People’s Hospital, Beijing 100044, ChinaCenter of Vaccine Clinical Research, Yunnan Center for Disease Control and Prevention, Kunming 650022, ChinaInfectious Disease Management Department, Chinese Center for Disease Control and Prevention, Beijing 100052, ChinaEmergency Department and Trauma Center, Peking University People’s Hospital, Beijing 100044, ChinaImmunization Program, Wuhan Center for Disease Prevention and Control, Wuhan 430024, China<b>Background:</b> Since the introduction of Pasteur’s rabies vaccine in 1885, rabies prophylaxis and post-exposure prophylaxis (PEP) have been widely administered globally under the recommendation of the World Health Organization (WHO). However, 124 documented cases of PEP failure had been reported worldwide between 1980 and 2023. Additionally, sporadic media reports from China showed occasional PEP failures between 2017 and 2024. Rabies remains a serious public health problem in over 150 countries and regions. <b>Methods:</b> In this review, we summarize PEP procedures recommended by the Advisory Committee on Immunization Practices (ACIP) and the WHO. We also analyze potential contributing factors to PEP failure, propose a concept of circulating antibodies, and discuss their roles in PEP. Furthermore, we summarize key guidelines for clinical trial design from the U.S. Food and Drug Administration (FDA) and China’s Center for Drug Evaluation (CDE), as well as the latest developments in monoclonal antibody (cocktail) therapies. <b>Results:</b> Adherence to core PEP practices, such as wound cleansing, infiltration of wounds with immunoglobulin (mAbs), and administration of vaccines, and broader societal involvement are crucial for preventing rabies infection in most cases. For high-risk exposures or immunocompromised individuals, the provision of circulating antibodies through high-dose human rabies immune globulin (HRIG) or mAbs is of utmost importance for preventing PEP failure. <b>Conclusions:</b> Early, high-concentration circulating antibodies are important for preventing PEP failure. Addressing the global issue of rabies requires involvement of the entire society. Only through collective efforts can we tackle this neglected disease and achieve WHO’s goal of “zero by 30”.https://www.mdpi.com/2076-393X/13/7/775rabiescirculating antibodyPEP failuremonoclonal antibodies |
| spellingShingle | Qingjun Chen Li Cai Xinjun Lv Si Liu Cheng Liu Jiayang Liu Xiaoqiang Liu Wenwu Yin Chuanlin Wang Zhenggang Zhu Circulating Antibody’s Role During Post-Exposure Prophylaxis, and Beyond for Rabies: A Review Vaccines rabies circulating antibody PEP failure monoclonal antibodies |
| title | Circulating Antibody’s Role During Post-Exposure Prophylaxis, and Beyond for Rabies: A Review |
| title_full | Circulating Antibody’s Role During Post-Exposure Prophylaxis, and Beyond for Rabies: A Review |
| title_fullStr | Circulating Antibody’s Role During Post-Exposure Prophylaxis, and Beyond for Rabies: A Review |
| title_full_unstemmed | Circulating Antibody’s Role During Post-Exposure Prophylaxis, and Beyond for Rabies: A Review |
| title_short | Circulating Antibody’s Role During Post-Exposure Prophylaxis, and Beyond for Rabies: A Review |
| title_sort | circulating antibody s role during post exposure prophylaxis and beyond for rabies a review |
| topic | rabies circulating antibody PEP failure monoclonal antibodies |
| url | https://www.mdpi.com/2076-393X/13/7/775 |
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