Rabies Vaccines

Rabies Vaccines 2023

Rabies is a vaccine-preventable viral disease found in more than 150 countries and territories, according to the World Health Organization (WHO). Rabies vaccination can prevent infections before and after exposure to the rabies virus. The WHO recommends preexposure prophylaxis (PrEP) for persons at high exposure risk. In the United Kingdom, rabies vaccines must be inactivated or recombinant and approved in the country of use. In Europe, preventing human rabies remains challenging for the European Union and the European Economic Area.

The U.S. Centers for Disease Control and Prevention (CDC) updated its recommendations for rabies PrEP for humans, replacing the three-dose vaccination schedule with a two-dose program, intending to protect people for about least three years. On May 6, 2022, the U.S. CDC published: Use of a Modified Preexposure Prophylaxis Vaccination Schedule to Prevent Human Rabies: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. 

In the U.S., stray dog control programs initiated in the 1940s and routine rabies vaccination of owned dogs eliminated the canine rabies virus variant from circulation by 2008. The American Animal Hospital Association Canine Vaccination Guidelines were updated in 2022.

Rabies Vaccines Approved 2023

Unlike the conventional, inactivated rabies vaccine, live-attenuated viruses are genetically modified viruses that can replicate in a vaccinated person without causing adverse effects while eliciting robust and effective immune responses against the viral infection. 

Chirorab®, previously known as Rabipur, is an inactivated rabies virus of Flury LEP. Chiron Behring Vaccines is re-launching Rabipur, a purified chick embryo cell vaccine. It will continue manufacturing at its WHO pre-qualified facility in Ankleshwar, Gujarat, India.

Imovax Rabies is an inactivated vaccine made from an attenuated rabies virus. It is a sterile, stable, freeze-dried suspension of Rabies Vaccine Inactivated virus prepared from WISTAR Rabies PM/WI 38 1503-3M strain.

RabAvert is a vaccine that contains an inactivated rabies antigen. Bavarian Nordic's RabAvert vaccine is indicated for preexposure vaccination, primary and booster doses, and postexposure prophylaxis against rabies in all age groups.

Rabivax-S is a lyophilized vaccine manufactured by Serum Institute of India Pvt. Ltd., containing inactivated purified rabies antigen. Rabivax-S has been developed on Vero ATCC CCL81 cells using the Pitman Moore strain. It is an inactivated vaccine that is freeze-dried until ready for immunization.

Rabies Vaccine Candidates 2023

Replicate Bioscience announced on September 12, 2023, the dosing of the first participant in a Phase 1 trial of its RBI-4000 vaccine candidate for rabies prevention. The trial marks the first time a human has been dosed with Replicate's next-generation srRNA technology, which will be a benchmark for utility in this indication.

YS Biopharma Co., Ltd. announced on May 16, 2023, that its novel PIKA Rabies Vaccine received Phase 3 clinical trial approval from the Drug Regulatory Authority of Pakistan. This vaccine is powered by proprietary PIKA adjuvant technology to induce accelerated immunity and produce a higher immune response. On June 1, 2023, the Food and Drug Administration of the Philippines granted Phase 3 clinical trial approval, including approximately 4,500 subjects in the Philippines, Singapore, and Pakistan. 

Rabies Vaccines Raccons

The U.S. Department of Agriculture's Animal and Plant Health Inspection Service announced on August 4, 2023, that it will begin its annual distribution of RABORAL V-RG®, an oral rabies vaccine bait, in select areas in the eastern United States to prevent the spread of raccoon rabies. Raccoons, foxes (red and gray), skunks, and bats are considered primary carriers of the rabies virus in the U.S.

Rabies Vaccine Breakthrough Infections

The Lancet Infectious Disease reported in December 2022 that sporadic breakthrough infections (i.e., rabies in people who have started PEP) had been reported. Researchers identified 52 articles, which included a total of 122 breakthrough infections. Timely and appropriate administration of PEP is crucial to prevent rabies. Although people with high-risk exposures or immunosuppression can develop rabies despite adherence to core practices, this occurrence remains exceedingly rare.

A case report by Holzbauer et al. in the March 2023 issue of Clinical Infectious Diseases is not a situation of inappropriate prophylaxis; rather, it represents a textbook response to accurate rabies exposure. An 84-year-old awoke to a bat biting his finger. The man washed his finger with soap and water, as recommended. Post-exposure prophylaxis was initiated three days after exposure, and he received a complete four doses of vaccine on schedule and more than the recommended 20 IU/kg of human rabies immunoglobulin (actual dose reportedly 30.9 IU/kg according to potency testing of the immunoglobulin used) partially injected into the bite site with the remaining amount given intramuscularly. Yet, five months later, he developed clinical rabies and succumbed to it.

Importation of Dogs Without Rabies

All foreign-vaccinated dogs entering the U.S. from high-risk rabies countries must have either a CDC-issued Dog Import Permit or a CDC-approved animal care facility reservation. As of August 2023, a valid CDC Rabies Vaccination and Microchip Record are needed to obtain a permit or make a reservation. The CDC does not accept foreign-issued pet passports or other certificates for foreign rabies vaccinations. Dogs vaccinated against rabies in the U.S. by a US-licensed veterinarian may re-enter the country from a high-risk country without a CDC Dog Import Permit if the dog has a current, valid US-issued rabies vaccination certificate and ISO-compatible microchip. The CDC extended its temporary suspension of dog importation from high-risk dog rabies countries until July 31, 2024.

High-Risk Rabies Countries

Before you travel, the United Kingdom says people should check if rabies is a risk at your destination. Globally, rabies causes an estimated cost of US$ 8.6 billion annually, and almost 60,000 people worldwide die from rabies annually.

Rabies Vaccine News 2023

September 7, 2023 - Dog vaccination hesitancy was identified as a concern for rabies.

August 4, 2023 - The U.S. Department of Agriculture's Animal and Plant Health Inspection Service launched its annual distribution of RABORAL V-RG®, an oral rabies vaccine bait, in select areas in the eastern U.S. to prevent the spread of raccoon rabies.

June 1, 2023 - The local health department announced 116 Queenslanders have potentially been exposed to the deadly rabies virus in 2023.

March 29, 2023 - Clinical Infectious Diseases reported an 84-year-old male died from rabies six months after being bitten by a rabid bat despite receiving timely rabies PEP. Clinicians should consider measuring rabies-neutralizing antibody titers after completion of PEP if there is any suspicion of immunocompromise.

January 23, 2023 - Bharat Biotech initiated a voluntary, limited recall for a batch of its anti-rabies vaccine, Chirorab®.

January 12, 2023 - Jefferson County Public Health (Colorado) encourages residents to take precautions to prevent exposure and minimize harm from rabies.

January 10, 2023 - The Texas Department of State Health Services Zoonosis Control Branch launched the 2023 Oral Rabies Vaccination Program's aerial distribution of oral rabies vaccine baits for wildlife.

December 14, 2022 - Everest Medicines announced it had achieved the preclinical proof-of-concept milestone for its mRNA rabies vaccine program, intended for rabies post-exposure prophylactic.

May 19, 2022 - New research published in Nature Communications shows that eliminating human dog-mediated rabies by combining mass dog vaccination, human education, and intensified rabies surveillance is feasible and cost-effective – at the state level.

May 5, 2022 - The U.S. CDC issued a Watch - Level 1, Practice Usual Precautions, regarding the rabies outbreak in Haiti.

April 9, 2022 - NPR reported D.C. Health, the District of Columbia's health agency, confirmed that the fox tested positive for the rabies virus.

March 10, 2022 - Garrett County Health Department, located near Oakland, CA, reported the first case of laboratory-confirmed rabies for 2022, involving a gray fox attacking a person.

January 17, 2022 - Rabies was confirmed in a four-year-old child from South Africa from Eastern Cape Province. In addition, a case was confirmed as a patient who contracted the disease in Lusaka, Zambia, but was hospitalized and died in Johannesburg. In 2021, a total of 19 confirmed human rabies were reported from the Eastern Cape (n=9), KwaZulu-Natal (n=6), and Limpopo (n=4) provinces.

January 7, 2022 - The U.S. CDC published Notes from the Field: Three Human Rabies Deaths Attributed to Bat Exposures — United States, August 2021.