Immunogénicité des schémas courts dans la prophylaxie vaccinale préexposition de la rage chez les voyageurs internationaux : revue de la littérature et étude pilote d’évaluation d’un schéma court en 2 doses à J0-J7 par voie intramusculaire, étude RABICOURT

Abstract : Introduction: since April 2018, WHO recommend a short-course rabies pre-exposure prophylaxis (short PrEP) vaccine in 2 intradermic (ID) or intramuscular (IM) doses at D0-D7. The High Council of Public Health (HCSP) must issue in 2019, the French position in a global context of vaccine shortage. The purpose of our work is to support the HCSP to decide. Methods: literature review on the immunogenicity of short-course PrEP and observational RABICOURT pilot study including international travelers who received 2 IM doses (D0-D7), CHU Bordeaux. Immunogenicity was considered satisfactory if the level of neutralizing anti-rabies antibodies > 0.5 IU / ml by Rapid Fluorescent Focus Inhibition Test (RFFIT). Results: RABICOURT is the only study evaluating 2 IM vaccine doses D0-D7. The short-term immunogenicity in RABICOURT and 11 other vaccine studies assessing 15 short-course PrEP strategies was a) 96%, 90% and 100% IM (1 single dose at D0 for Khawplod and Jonkers and 3 IM doses D0-D3-D7 for Jelinek); b) 76% and 100% ID in 1 day (2 ID 0.1ml doses at D0 for Khawplod and 2 or 3 ID 0.1ml doses at D0 for Jonkers); c) 94%,94% and 99% ID in 2 days (2 ID 0.1ml doses at D0-D7 for Mills, Lau and De Pijper); d) 100% of the 19 RABICOURT travelers, of whom 6/19 (32%) have an RFFIT <10 IU / ml considered unsustainable according to Soentjens. Short-course PrEPs initiate a satisfactory immune memory in the short term. The literature shows a declining immunogenicity in the medium term, leading to discuss its sustainability in the absence of vaccination booster in susceptible populations (SP): age <20 years or >60 years (RABICOURT and Khawplod), immunocompromised and pregnant women (WHO). Conclusion: we recommend: i) Short PrEP 2 doses IM J0, J7 without serology; ii) PrEP 3 IM doses (D0-D7-D21/D28 or D0-D3-D7) in SP; iii) a booster dose at 1 year if PrEP is short in susceptible populations and regardless the type of PrEP for children at risk of not reporting rabies contact.
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Jean-Benoît Zabbé. Immunogénicité des schémas courts dans la prophylaxie vaccinale préexposition de la rage chez les voyageurs internationaux : revue de la littérature et étude pilote d’évaluation d’un schéma court en 2 doses à J0-J7 par voie intramusculaire, étude RABICOURT. Médecine humaine et pathologie. 2018. ⟨dumas-01970417⟩

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