@article{nokey,

title = {Real-world evidence of rabies post-exposure prophylaxis in Serbia: Nation-wide observational study (2017–2019)},

author = {Pavle Banović and Dragana Mijatović and Verica Simin and Nenad Vranješ and Eleftherios Meletis and Polychronis Kostoulas and Dasiel Obregon and Alejandro Cabezas-Cruz},

doi = {https://doi.org/10.1016/j.tmaid.2024.102697},

year  = {2024},

date = {2024-02-17},

journal = {Travel Medicine and Infectious Disease},

abstract = {Background

Rabies remains a deadly zoonotic disease, primarily prevalent in Eastern European countries, with a significant global burden in Asia and Africa. Post-exposure prophylaxis (PEP) is critical to prevent clinical rabies. Serbia, a country with a relatively low animal rabies incidence, has been implementing a 4-dose Essen PEP regimen for 13 years. This real-world study aimed to assess the effectiveness of the 4-dose Essen regimen, considering demographic and clinical factors, after WHO Category III exposure.



Method

The study included 601 patients who received the 4-dose Essen PEP and 79 who received an additional 5th dose.



Results

Age emerged as a critical factor influencing seroconversion rates after the 4-dose regimen, with older individuals exhibiting lower RVNA titers. Logistic regression indicated a 3.18% decrease in seroconversion odds for each added year of age. The Cox proportional hazards mixed model highlighted age-related risks, with age groups 45–60 and 75–92 at the highest risk of non-seroconversion. Human Rabies Immune Globulin (HRIG) administration was associated with lower RVNA values after the 4-dose regimen, suggesting interference with vaccine immunogenicity among people who received larger doses of HRIG.



Conclusions

This study provides valuable real-world evidence for rabies PEP in a non-homogeneous population with potential comorbidities. The results underscore the importance of optimizing PEP strategies, particularly in older individuals, and reconsidering HRIG dosing to improve seroconversion rates.},

keywords = {immunization, Rabies, seroconversion, vaccine},

pubstate = {published},

tppubtype = {article}

}