Can Recombinant Technology Improve Rabies Prevention?

Rabies postexposure prophylaxis entails administration of rabies vaccine and immunoglobulins of human or equine origin (HRIG or ERIG). Given the expense of both immunoglobulins, most exposures are managed solely with vaccines. Recombinant monoclonal antibodies (RmAb) represent scalable alternatives.

To evaluate the safety of RmAb — as well as the neutralizing activity of RmAb given with rabies vaccine versus ERIG given with vaccine — investigators in India randomized 3994 patients with suspected rabies exposure (mean age, 30 years) to receive RmAb (2996 patients) or ERIG (998 patients) and followed them for 1 year. Within each group, participants were randomized to receive vaccine intramuscularly (5 doses) or intradermally (4 doses).