Table 2.
Summary of available information on vaccination schedules, within the retrieved documents, by country.
| Country | Document Title | Published by, (Year) | Available Vaccine Types (Route) | PEP Vaccination Schedule | PrEP Vaccination Schedule |
|---|---|---|---|---|---|
| Bangladesh | National Guideline for Rabies Prophylaxis and Intra-dermal Application of Cell Culture Rabies Vaccines [23] | Disease Control Unit, Ministry of Health & Family Welfare (2010) | PVRV (IM, ID) PCECV (IM, ID) ID administration is recommended as cost-effective and the technique is thoroughly described (not indicated for immunocompromised individuals) |
IM: 4-dose Zagreb (Essen schedule described but not favored by the government) | IM: 3 doses, one injection on each of days 0, 7, and 21 or 28 |
| ID: Updated Thai Red Cross | ID: 3 doses, one injection on each of days 0, 7, and 21 or 28 | ||||
| Re-exposed previously vaccinated: 2 doses, one injection (IM or ID) on each of days 0 and 3, if re-exposure was ≤5 years after full PEP + wound washing (RIG not necessary) | Booster: 1 dose when titers <0.5 IU/mL, for individuals working under risk for rabies exposure, monitoring Ab titers every 6 months | ||||
| Bhutan | National Guideline for Management of Rabies [24] | Ministry of Health, Department of Public Health Zoonotic Disease Program (2014) | HDCV (IM) PVRV (IM, ID) |
IM: 5-dose Essen | IM: 3 doses, one injection on each of days 0, 7, and 21 or 28 |
| ID: Updated Thai Red Cross | ID: 3 doses, one injection on each of days 0, 7, and 21 or 28 | ||||
| Re-exposed previously vaccinated: 2 doses (IM or ID), each on days 0 and 3, for those who have documented previous full vaccination. | Booster: 1 site ID at 1 year and every 3 years to lab staff, veterinarians, animal handlers, dog catchers, wildlife workers. Regular (exact timing not specified) monitoring of Ab titers and administration of a booster dose when titers <0.5 IU/mL. | ||||
| Cambodia | Rabies Vaccine Procedure SOP-OPD-02-004 [25] |
National Institute of Public Health, National Public Health Laboratory (2012) | PDEV (IM) PCECV (IM, ID) HDCV (IM) PVRV (IM, ID) |
IM: 5-dose Essen 4-dose Zagreb |
IM: 3 doses, one injection on each of days 0, 7, 21–28 |
|
ID: The updated Thai Red Cross 8-site Oxford (8-0-4-0-1-1 injection sites on days 0, 7, 28 and 90) |
ID: 3 doses, one injection on each of days 0, 7, 21–28 | ||||
| Re-exposed previously vaccinated: 2 doses, one injection on each of days 0 and 3, in individuals who had receive at least 3 doses of any PEP regimen | |||||
| China | Technical Guidelines for Human Rabies Control and Prevention [26] | Chinese Center for Disease Control and Prevention (2016) | PVRV, (IM) HDCV, (IM) PHKCV, (IM) PCECV, (IM) |
IM: 5-dose Essen 4-dose Zagreb |
IM: 3 doses, one injection on each of days 0, 7, and 21 or 28 |
| Re-exposed previously vaccinated: 2 injections each on days 0 and 3 if >3 months have passed from previous full vaccination, if <3 months have passed, booster may be deferred if animal is healthy, vaccinated and accessible for observation | Booster: 1 booster dose when titers <0.5 IU/mL, for individuals working under risk for rabies exposure (monitoring every 6 months for lab workers and every 24 months for veterinarians/animal health officers) | ||||
| Hong Kong | Web page: Rabies [37] | Center for Health Protection, Department of Health (2017) | (not specified) | Thorough wound cleansing Vaccination if necessary |
Travelers to endemic areas |
| Web page: Vaccine and Prophylaxis—Rabies Vaccination [39] | Travel Health Service, Department of Health (2012) | (not specified) | (not specified) | For Travelers to endemic areas, one month before the trip: 3 doses, one injection on each of days 0, 7, and 21 or 28 (Route is not specified) | |
| Scientific Committee on Emerging and Zoonotic Diseases — Prevention and Control of Rabies [38] | Center for Health Protection (2005) | (not specified) | (not specified) | (not specified) | |
| India | National Guidelines on Rabies Prophylaxis [27] | National Center for Disease Control (2015) | PCECV (IM, ID) PVRV (IM, ID) HDCV (IM) PDEV (IM) |
IM: 5-dose Essen | IM: 3 doses, one injection on each of days 0, 7, and 21 or 28 |
| ID: Updated Thai Red Cross | Booster: 1 booster dose when Ab titers <0.5 IU/mL, for individuals working under risk for rabies exposure (monitoring every 6 months for the first 2 years and every 24 months thereafter) | ||||
| Re-exposed previously vaccinated: 2 doses (IM or ID), each on days 0 and 3, for those who have received full vaccination and re-exposed | |||||
| Indian Academy of Pediatrics (IAP) Recommended Immunization for Children Aged 0 through 18 years—India, 2016 and Updates on Immunization [28] | Indian Pediatrics (2016) | HDCV (IM) PCECV (IM) PDEV (IM) PVRV (IM) ID not in individual practice |
IM: 5 doses, one dose on each day 0, 3, 7, 14, and 30, and for individuals with severe debility or immunosuppressed, and optional 6th dose on day 90 | IM: 3 doses, one injection on each of days 0, 7, 21, or 28 (day 28 is preferred) | |
| Re-exposed previously vaccinated: 2 doses for those who have received full vaccination and re-exposed | |||||
| Indonesia | National Guidelines for Rabies Vaccination [29] | Center for Disease Control, Ministry of Health (2011) | PVRV (IM) PCECV (IM) |
IM: 4-dose Zagreb | IM: 3 doses, one injection on each of days 0, 7, 21, or 28 |
| Re-exposed previously vaccinated: 1 dose if re-exposure occurred 3–12 months from full vaccination, no vaccination below 3 months, full vaccination over 12 months | |||||
| Japan | Questions and answers on rabies [40] | Ministry of Health (2017) | (not specified) ID is not approved RIG is not approved |
SC: 6 doses on days 0, 3, 7, 14, 30, and 90 | SC: week 0, 4 and month 6–12 |
| Re-exposed previously vaccinated: 2 injections for those who have received full vaccination, on days 0 and 3 | |||||
| Lao People’s Democratic Republic | Intradermal application of rabies vaccines. Report of a WHO consultation. Bangkok, Thailand 2000 [41] | WHO, Communicable Disease Surveillance and Control (2000) | PVRV (IM) PCECV (IM) ID not yet used, RIG is rarely used due high cost The ID route is not used |
(not specified) | (not specified) |
| Malaysia | Interim guideline for human rabies prevention & control [30] | Ministry of Health, Disease Control Division (2015) | PVRV (IM) | IM: 4-dose shortened Essen | (not specified) |
| Re-exposed previously vaccinated: 2 doses on days 0 and 3 | |||||
| Pakistan | Country Guidelines for Prevention of Rabies. Pakistan Rabies Control Programme [31] | WHO in consultation with Provincial Health Departments (2013) | PVRV (IM, ID) PCECV (IM, ID) PDEV (IM) |
IM: 4-dose Zagreb | IM: 3 doses, one injection on each of days 0, 7, 21, or 28 |
| ID: The updated Thai Red Cross | ID: 3 doses, one injection on each of days 0, 7, 21, or 28 | ||||
| Re-exposed previously vaccinated: 2 injections (IM or ID), for those who have received full vaccination, on days 0 and 3 | |||||
| Philippines | New Guidelines on the Management of Rabies Exposure [32] | Republic of Philippines. Department of Health (2014) | PVRV (IM, ID) PCECV (IM, ID) Among the first countries that adopted ID |
IM: 5-dose Essen 4-dose Zagreb 4-dose shortened Essen |
IM: 3 doses, one injection on each of days 0, 7, 21, or 28 |
| ID: The updated Thai Red Cross | ID: 3 doses, one injection on each of days 0, 7, 21, or 28 | ||||
| Re-exposed previously vaccinated: 2 injections (IM or ID), each on days 0 and 3 if the re-exposed individual had previously receive full vaccination, and full vaccination if he/she had not receive full vaccination course | Booster: Routine booster for individual with occupational risk: 1 dose after one year from full vaccination and one more thereafter in case of Ab titers <0.5 IU/mL | ||||
| Republic of Korea | Recommended Adult Immunizations for Foreign Travel [42] | Korea Society of Infectious Disease (2012) | (not specified) | 3 doses | |
| Sri Lanka | Protocol for anti-rabies post exposure therapy [33] | Director General of Health Services (2016) | PVRV (IM, ID) PCECV (IM, ID) |
IM: 5-dose Essen 4-dose Zagreb |
IM: 3 doses, one injection on each of days 0, 7, 21, or 28 |
|
ID: Updated Thai Red Cross Modified 4-site ( 4-2-2-0-2): one dose at 4 sites on day 0 and one dose at 2 sites on days 3, 7, and 30 |
ID: 3 doses, one injection on each of days 0, 7, 21, or 28 | ||||
| Re-exposed previously vaccinated: 2 injections (IM or ID), one on each of day 0 and 3, OR 4 ID at four sites on the same visit | Booster: One injection on the 1st year following full vaccination, and one more every five years | ||||
| Taiwan | Post-exposure guidelines [34] | Centers for Disease Control (2016) | (not specified, ID not recommended) | IM: 5-dose Essen | IM: one dose, on day 0, 7, 21 or 28 (3 doses) |
|
Booster: For individuals at high risk (e.g., laboratory workers): 2 injections, one on each day 0 and 4 when Ab titers <0.5 IU/mL, For workers in animal health: One booster dose one year following full vaccination and every 3–5 years thereafter | |||||
| Thailand | Thai rabies management guidelines [35] | Queen Saovabha Memorial Institute (2015) | PCEVC (IM, ID) PVRV (IM, ID) PDEV (IM) | IM: 5-dose Essen | IM: 3 doses, one injection on each of days 0, 7, 21, or 28 |
| ID: Updated Thai Red Cross |
ID: 3 doses, one injection on each of days 0, 7, 21, or 28 Only for PVRV: 2 doses, one injection on each of days 0 and 28 |
||||
| Re-exposed previously vaccinated: (a) 2 injections, each on day 0 and 3 if exposure occurred within 6 months from vaccination, no RIG; (b) same as previous or 4-site ID on a single visit if >6 months have elapsed from previous vaccination to exposure | Booster: For individuals at continuous or frequent risk of exposure: One booster vaccination if Ab titers <0.5 IU/mL | ||||
| Vietnam | Guidelines on human rabies surveillance and prevention [36] | Ministry of Health (2014) | Cell culture vaccines (not specified) | IM: 5-dose Essen |
IM: 3 doses, one injection on each of days 0, 7, 21, or 28 One repeated injection every year |
| ID: Updated Thai Red Cross | Booster: One injection on 1st year from previous full vaccination and every year thereafter | ||||
| Re-exposed previously vaccinated: (a) 2 injections, each on days 0 and 3 if time from previous full vaccination <5 years; (b) Full vaccination if previous was not completed or >5 years have elapsed from previous full vaccination |
Abbreviations: Ab, antibody; APCRI, Association for Prevention and Control of Rabies in India; HDCV, human diploid cells vaccine; IAP, Indian Academy of Pediatrics; ID, intradermal; IM, intramuscular; PCECV, primary chick embryo cell vaccine; PDEV, purified duck embryo vaccine; PEP, post-exposure prophylaxis; PHKCV, primary hamster kidney cell vaccine; PrEP, pre-exposure prophylaxis; PVRV, purified Vero rabies cell vaccine; SC, subcutaneous.