The Australian Immunisation Handbook 10th Edition 2013

Interchangeability of rabies vaccines
The World Health Organization (WHO) does not recommend interchanging
rabies cell culture-derived vaccines (CCV), but states that, in situations where
it is unavoidable, a PreP or PEP course can be completed with an alternative
rabies CCV, providing the vaccine is WHO-endorsed (also termed ‘prequalified’).
22 Various international vaccine advisory groups state that rabies
CCV are interchangeable. This is supported by the similarities in tissue culture
vaccine production methods as well as antibody responses and adverse
reactions following vaccination. In one study that specifically assessed the
interchangeability of HDCV and PCECV, 165 subjects were randomised to receive
rabies PreP (days 0, 7 and 21–28) using either HDCV or PCECV. 34 One year
following PreP, each group received 1 or 2 booster doses of PCECV. The booster
dose resulted in an anamnestic response (geometric mean titre several orders of
magnitude >0.5 IU/mL) in all subjects by day 7, independent of the vaccine that
was used to deliver the primary course. It is expected that this response would be
similar with other rabies CCV.
4.16.8 Recommendations
Measures to avoid potential rabies virus and other lyssavirus (including ABLV)
exposures
Travellers to rabies-enzootic regions should be advised to avoid close contact
with either wild or domestic animals; this is particularly important for
children. 35-37 They should be advised about pre-travel (i.e. pre-exposure) rabies
vaccination (or, if appropriate, booster doses), and on what to do should they
be either bitten or scratched by an animal while abroad. 37-41 It is recommended
that prior to travel, travellers be educated regarding first aid treatment for rabies
exposures, irrespective of prior vaccination.
Recommendations to decrease the risk of exposure to rabies include:
• Do not allow young children to feed, pat or play with animals. The height of
young children makes bites to the face and head more likely.
• Avoid contact with stray dogs or cats. Remain vigilant when walking,
running or cycling.
• Do not carry food, and do not feed or pat monkeys, even in popular areas
around temples or markets where travellers may be encouraged to interact
with the monkeys. In particular, avoid focusing attention on monkeys
carrying their young, as they may feel threatened and bite suddenly.
In addition, contact with bats should be avoided anywhere in the world,
including Australia. Only appropriately vaccinated and trained persons should
handle bats. If bats must be handled, safety precautions, such as wearing
protective gloves and clothing, should be observed.
358 The Australian Immunisation Handbook 10th edition