High rate of insufficient antibody titers after single-day immunization with human diploid-cell-strain vaccine against rabies

Summary We examined the possibility of simplifying the currently recommended immunization schedule against rabies. Four groups of 11 healthy volunteers were each immunized with either one, two, four, or eight doses of 0.1 ml human diploid cell vaccine (HDCV) intradermally on 1 single day. Antibody titers in serum were determined using a rapid fluorescent focus inhibition test. Geometric mean antibody titers 10, 30 and 90 days after immunization were all >0.5 IU/ml, which is considered protective. A dose-proportional increase in the geometric mean antibody titer was observed for all four groups. However, at each dose level, at least 1 of the 11 volunteers on day 30 and 2 of the 11 volunteers on day 90 had insufficient antibody titers <0.5 IU/ml. Single-day immunization against rabies with HDCV vaccine cannot be recommended because of the unacceptably high failure rate.Abbreviations DEV Duck-embryo-vaccine - GMT geometric mean titer - HDCV human diploid cell vaccine - IU international units     

Cell-mediated immune response following intracutaneous immunisation with human diploid cell rabies vaccine

Specific cell-mediated immune response (CMIR) against rabies antigens was studied in recipients of two regimens of human diploid cell rabies vaccine (HDCV) using the antigen-stimulated lymphocyte transformation test (LTT) as a measure of CMIR. Reconstituted HDCV could be conveniently used as the in vitro stimulating antigen and the response was antigen-dependent. Conventional intramuscular immunization with full-dose HDCV resulted in positive LTT as early as 14 days after starting immunisation, and peaked on day 28. Intracutaneous immunisation with 0.1 ml of HDCV at four sites on days 0, 3 and 7 was a more efficient means of inducing specific lymphocyte response. Specific CMIR was evident as early as seven days and became maximal on day 14. In addition to the more rapid induction of specific CMIR, our intracutaneous regimen also resulted in a brisker and higher antibody response than the intramuscular regimen. The peak antibody level of the intracutaneous regimen was reached on day 14 whereas that of the intramuscular regimen was reached on day 28 and the geometric mean antibody titre on day 14 of the intracutaneous route was significantly higher than that of the intramuscular regimen. We therefore conclude that our closely spaced intracutaneous immunisation with HDCV was effective both in the induction of specific antibodies and the cell-mediated immune response.     

Rabies and post-exposure prophylaxis in Thai children

Thailand is an endemic area for rabies, with approximately 300 human deaths reported annually. More than half of the rabies patients are children under 14 years of age. This paper reports clinical data of paediatric rabies cases occurring from 1980 to 1986, and the protective efficacies of human diploid cell rabies vaccine (HDCV) and purified Vero cell rabies vaccine (PVRV) in children exposed to rabid animals. The analysis of 120 medical records revealed that rabies in children had incubation periods which ranged from less than fifteen days to more than three months, but generally between one to three months. The most frequent symptoms observed in the patients were hydrophobia, restlessness, fever, vomiting and aerophobia. Most of the rabid children admitted to hospital died within 24 hours. HDCV was administered to 50 children exposed to rabies with the cumulative dosages of 327 ml. All patients survived without serious adverse effects during a-two year follow-up. Mild reactions were seen in 1.5 percent (5/327 doses). Unfortunately, levels of rabies antibody in these vaccinees were not determined. Among another series of children exposed to rabid animals, comprising 27 individuals who received a total of 168 doses of PVRV, only mild local reactions were seen in 6 subjects. No rabies deaths were reported in 2 years of follow-up. The children who received PVRV either with or without human rabies immune globulin developed similar levels of rabies neutralizing (NT) antibody, which reached the high titers on day 30. At one year after the first dose of vaccination, all vaccinees still had NT antibody at titers higher than 0.5 IU/ml.(ABSTRACT TRUNCATED AT 250 WORDS)     

Humoral and cell-mediated immune responses to various economical regimens of purified Vero cell rabies vaccine

Purified Vero cell rabies vaccine (PVRV) is a new effective but inexpensive tissue culture rabies vaccine for human use. We investigated if the cost of immunization with PVRV could be further reduced by intradermal immunization. Fifty-eight subjects with low-risk exposure to rabies were randomized into 4 groups to receive full-dose (0.5 ml) intramuscular injection of PVRV on days 0, 3, 7, 14 and 28 or 4, 2 or 1 intradermal injections of PVRV (0.1 ml) on days 0, 3, and 7, followed by another intradermal injection on day 28. Neutralizing antibodies and specific cell-mediated response (CMIR) were sequentially followed up to day 36. The antibody levels in the intradermal groups increased with the number of injection sites and the levels achieved by the 2-site i.d. regimen were not significantly different from those obtained by the full-dose i.m. even though only 1/3 of the amount of PVRV was used. Specific CMIR occurred 1 week sooner in the 2 and 4-site i.d. regimens than the full-dose i.m. We therefore recommended that our 2-site i.d. regimen of PVRV should be further tested with a view to substituting it for the more expensive full-dose i.m. regimen in order to further reduce the cost of rabies prophylaxis particularly in the developing countries.     

An effective economical intradermal regimen of human diploid cell rabies vaccination for post-exposure treatment.

A closely-spaced multisite intradermal regimen of human diploid cell rabies vaccine (HDCV) was evaluated in 39 patients after low-risk exposure to rabies, in comparison to full-dose intramuscular HDCV and sheep brain-derived rabies (Semple) vaccine. The regimen consisted of four intradermal injections, 0.1 ml each of HDCV on days 0, 3 and 7, followed by two booster doses of only 0.1 ml each on days 28 and 91 administered intradermally. Although the total amount of HDCV used in this intradermal regimen was 1.4 ml or one-quarter of the conventional intramuscular regimen, a higher proportion of the recipients of this economical intradermal regimen, as compared to the full-dose intramuscular regimen, developed neutralizing antibodies above the hypothetical protective level of 0.5 iu/ml 7 days after starting immunization. Besides the earlier antibody response, the peak antibody level of the intradermal regimen was also satisfactorily high and not significantly different from that after the intramuscular regimen. Simultaneous administration of inosiplex, an antiviral and immunopotentiating agent, during the first 10 days of intradermal immunization resulted in an even higher antibody response for as long as 91 days. In contrast, but not unexpectedly, Semple vaccine evoked lower, more sluggish and inconsistent antibody responses. The side-effects of intradermal HDCV were mild, mainly local and self-remitting. We therefore recommend our intensive intradermal regimen of HDCV vaccination for safe, effective and economical use in post-exposure rabies immunization.     

The development of monoclonal human rabies virus-neutralizing antibodies as a substitute for pooled human immune globulin in the prophylactic treatment of rabies virus exposure

To provide a more defined and safer replacement for the human rabies immune globulin (HRIG) from pooled serum which is currently used for treatment of exposure to rabies virus we have developed a series of human rabies virus-specific monoclonal antibodies. Mouse-human heterohybrid myeloma cells producing rabies virus-specific human monoclonal antibodies were prepared using B cells obtained from volunteers recently-immunized with a commercial rabies virus vaccine (HDCV). Cell lines producing antibody which neutralized the Evelyn-Rokitnicki-Abelseth (ERA) rabies virus strain in vitro were cloned and the resulting monoclonal antibodies characterized for isotype, specificity against a variety of rabies virus isolates, and neutralization capacity. The ability of the monoclonal antibodies to neutralize a variety of rabies virus strains in vitro correlated with their binding specificity for these viruses in an enzyme-linked immunoadsorbant assay (ELISA). A number of these antibodies have proven suitable for the formulation of a prophylactic human monoclonal antibody-based reagent which would provide significant advantages to the HRIG in having defined, reproducible specificity, lessened possibility of contamination with viral pathogens, and consistent availability.     

Antibody response to preexposure human diploid-cell rabies vaccine given concurrently with chloroquine

We conducted a randomized controlled trial to evaluate the antibody response of freshman veterinary students to intradermal human diploid-cell rabies vaccine administered concurrently with chloroquine, a drug frequently used for chemoprophylaxis against malaria. Fifty-one students who had not been vaccinated against rabies were enrolled: 26 received 300 mg of chloroquine base per week (the recommended dose for malaria prophylaxis); 25 did not receive chloroquine and served as controls. All subjects received 0.1 ml of rabies vaccine intradermally on days 0, 7, and 28. Chloroquine was administered weekly to the treatment group, beginning nine days before the first dose of vaccine and continuing until day 48. The mean rabies-neutralizing antibody titer for the chloroquine group was significantly lower than that for the control group on each day of testing--i.e., day 28 (P = 0.0094), day 49 (P = 0.0008), and day 105 (P = 0.0002)--although both groups had neutralizing antibody titers on days 49 and 105, according to the criteria of the Centers for Disease Control. The blood concentrations of chloroquine and desethylchloroquine (the major metabolite of chloroquine, which also has antimalarial properties) were negatively associated with log antibody titers. These results indicate that chloroquine taken in the dose recommended for malaria prophylaxis can reduce the antibody response to primary immunization with intradermal human diploid-cell rabies vaccine.     

精制Vero细胞狂犬病疫苗的临床观察及免疫学效果 …

目的 目前我国使用的人用狂犬病疫苗生产工艺较落后,致使用后副反应较严重,而国际上Ｖｅｒｏ细胞狂犬病疫苗已研制成功和使用近２０年,不仅免疫效果良好而且副反应很轻。为了改变我国狂犬病疫苗生产工艺的落后和质量较差的状况,而开展此项研究。方法 海南省生物制品研究所和河南省生物技术研究所联合研制的Ｖｅｒｏ细胞狂犬病疫苗获得卫生部批准进行临床观察,该疫苗以ａＧ株适应Ｖｅｒｏ细胞后为生产毒种,转瓶培养、并浓缩适     

Development and evaluation of a recombinant-glycoprotein-based latex agglutination test for rabies virus antibody assessment

The measurement of neutralizing antibodies induced by the glycoprotein of rabies virus is indispensable for assessing the level of neutralizing antibodies in animals or humans. A rapid fluorescent focus inhibition test (RFFIT) has been approved by WHO and is the most widely used method to measure the virus-neutralizing antibody content in serum, but a rapid test system would be of great value to screen large numbers of serum samples. To develop and evaluate a latex agglutination test (LAT) for measuring rabies virus antibodies, a recombinant glycoprotein was expressed in an insect cell system and purified, and the protein was coated onto latex beads at concentrations of 0.1, 0.25, 0.5, 0.75, and 1 mg/ml to find out the optimal concentration for coating latex beads. It was found that 0.5 mg/ml of recombinant protein was optimal for coating latex beads, and this concentration was used to sensitize the latex beads for screening of dog serum samples. Grading of LAT results was done with standard reference serum with known antibody titers. A total of 228 serum samples were tested, out of which 145 samples were positive by both RFFIT and LAT, and the specificity was found to be 100 %. In RFFIT, 151 samples were positive, the sensitivity was found to be 96.03 %, and the accuracy/concordance was found to be 97.39 %. A rapid field test—a latex agglutination test (LAT)—was developed and evaluated for rabies virus antibody assessment using recombinant glycoprotein of rabies virus expressed in an insect cell system.     

小鼠对表达狂犬病毒3aG株糖蛋白的重组复制缺陷型腺病毒的免疫应答

目的研究表达狂犬病毒3aG株糖蛋白(GP)的重组复制缺陷型腺病毒Ad/GP＇及Ad/GP免疫小鼠后所产生的特异性体液免疫应答,体外脾细胞增殖反应,及免疫小鼠对狂犬病毒致死性颅内攻击的保护力。方法1×10     

Evaluation of tests for rabies antibody and analysis of serum responses after administration of three different types of rabies vaccines.

Humoral antibody response to three types of rabies vaccines were assayed by the neutralization (NT), the mixed hemadsorption (MH), and the indirect immunofluorescence (IF) tests. The NT and MH tests were used to detect antibodies combining with antigens at the surface of virions and infected cells, whereas the indirect IF test measured antibodies mainly to the rabies nucleocapsid antigen. After immunization with a human diploid cell vaccine, antibodies were detected by both the NT and the MH test in the 14th- and 30th-day serum samples from each of eight vaccinated persons. There was a good correlation between titers obtained with the two tests in this group of vaccinees. Antibodies elicited by duck embryo and nervous tissue vaccines occurred less frequently and in lower titers. In these groups of vaccinees, 5 of 14 and 5 of 10, respectively, had antibodies detectable by the NT test in the 14th- and 30th-day sera but were negative by the MH test. It is suggested that this was due to the high levels of immunoglobulin M antibodies, which are known to be elicited by daily injections of vaccine. Since antibodies of the immunoglobulin M class are considered to be less important for protection against rabies, the MH test is recommended for immunity determinations. Compared with the NT test, this test also offers the advantage of being technically more convenient because of its capacity for testing numerous sera in a single run. Antibody titers obtained by the indirect IF test in the human diploid cell vaccine group were relatively low. Titers in the duck embryo and nervous tissue vaccine groups were higher but did not correlate with the results of the NT test.     

Comparison of rabies humoral antibody titers in rabbits and humans by indirect radioimmunoassay, rapid-fluorescent-focus-inhibition technique, and indirect fluorescent-antibody assay.

Rabies humoral antibodies were induced in eight New Zealand rabbits by a single intramuscular injection of inactivated suckling mouse brain rabies vaccine. The primary response to immunization was measured in blood samples taken at selected intervals for 6 months. The anamnestic response was measured in blood samples obtained 2 weeks after the rabbits received a booster immunization. The humoral antibody concentrations were measured by the rapid-fluorescent-focus-inhibition technique (RFFIT), indirect fluorescent-antibody assay (IFA), and indirect radioimmunoassay (RIA). The maximal neutralizing antibody titers as measured by RFFIT were attained by the 4th week and persisted into the 24th week. After booster immunization the antibody response was almost 10-fold higher than the highest level attained in the primary response. The antibody levels as measured by IFA and RIA were similar, but the titers as measured by either procedure were almost 10-fold lower than those determined by RFFIT. After booster immunizations the antibody levels, as measured by IFA and RIA, were three- and sixfold higher, respectively, than the maximal levels attained in the primary response. Twenty-two human serum specimens were tested by the same serological procedures, with disparate results. Both RIA and RFFIT effectively differentiated antirabies-positive sera from antirabies-negative sera.     

Persistence of rabies antibody 5 years after postexposure prophylaxis with vero cell antirabies vaccine and antibody response to a single booster dose

This study was done to investigate the antibody response to a Vero cell antirabies vaccine, the persistence of antibody for 5 years, and the effect of a booster dose after this interval. From August 2005 to February 2011, a total of 195 patients were enrolled into our study due to an animal bite. The Essen intramuscular (i.m.) regimen, which is recommended by the WHO for modern vaccines used in postexposure treatment, was adopted in this study. Blood samples were obtained on day 0, day 7, day 14, day 45, year 1, year 2, year 3, year 4, year 5, and year 5 plus 14 days. Immunogenicity was evaluated by the titration of neutralizing antibodies with a rapid fluorescent focus inhibition test (RFFIT). Seroconversion was expressed as the seroconversion rate (SCR). A secondary quantitative evaluation criterion, other than the seroconversion level, was the geometric mean titer (GMT). Of the 195 enrolled patients, 168 (86.4%) of them completed the whole study. No serious adverse reactions to the vaccine were reported during vaccination, the 5-year follow-up period, or revaccination. On day 14, the rabies antibody GMT value was 8.87 IU/ml in the vaccinees. During the next 5 years, the SCR in the ChengDa vaccine group gradually decreased to 34.0% at year 5, down from 90.5% at year 1. There was a significant booster effect: the GMT was 15.22 IU/ml on year 5 plus 14 days. Our findings demonstrate that the ChengDa rabies vaccine offers an alternative with a high degree of efficacy and yet limited side effects and ensures that the exposed patient will be on the safe side of the risk of rabies by the 14th day. Moreover, when followed by a booster dose 5 years later, it could boost the immunity. A further booster is effective in inducing a good neutralizing antibody response even after an interval of 5 years.     

Safety and immunogenicity of SURE RAB™, an inactivated cell culture derived rabies vaccine: A comparative,phase III clinical trial

IntroductionRabies is a viral zoonotic disease widespread across the world. In India, various cell culture vaccines are available for pre and post exposure prophylaxis (PEP) but are not sufficient to meet the rising demand. The present study evaluated the safety and immunogenicity of Rabies vaccine Human I.P. (Brand name: SURE RAB™) in PEP and demonstrated its non-inferiority to already approved rabies vaccine (Brand name: VERORAB).Material and methodsIt was a phase-III randomized, open label, comparative, single centre clinical trial in post exposure subjects. Safety and immunogenicity were evaluated at Day 0, 14 and 45 ± 7 post vaccination. Day 14 serum samples were analyzed by Enzyme Linked Immunesorbent assay (IgG ELISA, Bio-Rad) and Day 0, 14 and 45 ± 7 serum were tested by Rapid Fluorescent Focus Inhibition Test (RFFIT). Paired t-test was applied to compare the results of Rabies virus neutralizing antibody (RVNA). The severity of adverse reactions was measured on a scale of excellent, good, fair and bad; p-value (p < 0.05) was considered as statistically significant.ResultsAll the subjects achieved a protective titer value between 0.5 and 9.0 IU/ml by Day 14 tested by ELISA and significant rise in the antibody titer in all the groups when tested after 45 days. Statistically significant p-value (p < 0.001) observed with RFFIT test indicated biological potency of rabies vaccine. Adverse events and safety was comparable statistically between three groups (p ​= ​0.886) and Group I ​+ ​II combined versus Group III (p = 0.495).ConclusionThe study results conclusively demonstrate that SURE RAB™ is comparable to VERORAB in terms of safety and immunogenicity and can be used for PEP in rabies.     

Rapid test for detection of rabies antibodies in human serum.

A simple, sensitive, rapid method based on the principle of immunoadherence hemagglutination (IAHA) has been devised for the detection of rabies antibody. In this test, fixation of complement to complexes of rabies antigen with specific antibodies is readily detected by agglutination of human erythrocytes bearing receptors for C3. Sera from individuals undergoing preexposure rabies immunization were tested for rabies antibodies by the IAHA method and by a virus neutralization test performed in tissue culture, the rapid fluorescent focus inhibition test. IAHA titers showed a high degree of correlation with rapid fluorescent focus inhibition test titers, although it is not known whether results of the IAHA test represent the detection of neutralizing antibodies. An advantage of the IAHA test over the rapid fluorescent focus inhibition test was that results were obtained in a shorter period of time. In some instances, this can be of clinical significance in determining antibody levels to rabies virus. Furthermore, the IAHA test is most applicable as a rapid screening tool for the detection and quantitation of rabies antibodies in vaccinated subjects.     

Application of the soluble antigen fluorescent antibody (SAFA) test to the serodiagnosis of rabies.

The adaptation and evaluation of the Soluble Antigen Fluorescent Antibody (SAFA) test for the serologic diagnosis of rabies is described. Evaluation of the SAFA test was based on a comparison between serum titers obtained in the SAFA test, the mouse Serum Neutralization (SN) test and in the Indirect Fluorescent Antibody (IFAT) test. Dog, fox, raccoon and skunk sera were used for the comparison with mouse SN titers. Human serum was used for the comparison with the IFAT titer. The purity and concentration of the test antigen is a crucial factor in determining the efficiency of the SAFA test for rabies serodiagnosis. Viral antigen obtained by the AIPO4 gel method for rabies virus purification and concentration was found to be sufficiently purified and concentrated for use in the SAFA test. Conjugate dilution decreased the level of non-specific staining. Although specific activity was also decreased, there was a statistically significant difference (P less than or equal to 0.05; Student's t test) between the rabies positive and the rabies negative serum samples at all conjugate dilutions for all species studied. In three cases (fox, raccoon, skunk) SAFA titers were greater than mouse SN titers. In one case (dog) the SAFA titer was less than the mouse SN titer. The IFAT titer of the human serum sample was greater than the SAFA titer. Comparison of Fluorometer Dial Readings (FDR) of sera obtained in separate protocols demonstrated satisfactory reproducibility of the SAFA test for rabies serodiagnosis.     

狂犬病毒3aG株糖蛋白基因在人5型重组腺病毒中的表达研究

目的 构建表达狂犬病毒糖蛋白基因（ＧＰ）的重组人腺病毒。方法 克隆狂犬病毒疫苗株ＧＰ基因并测序，将其插入Ｅ３区缺失的Ａｄ５载体，置于Ｅ３区早期启动子的控制下，通过同源重组，蚀斑纯化，筛选表达ＧＰ的重组人腺病毒。用ＥＬＩＳＡ法检测表达的糖蛋白，快速荧光灶抑制试验（ＲＦＦＩＴ）法测定此重组病毒免疫小鼠后产生的中和抗体。结果 获得的３ａＧ株基因的开放读码框为１５７５个核苷酸，编码５２４个氨基酸；经同源重     

Development and evaluation of a rapid neutralizing antibody test for rabies

The level of virus-neutralizing antibody, which plays a crucial role in the prevention of rabies, is determined by rabies virus (RABV) neutralizing test, which are time- and cost-consuming. In order to determine the level of neutralizing antibody in vaccinees, an easy and reliable method is needed. Based on the principle of immunochromatography, we developed a RAPINA (RAPId Neutralizing Antibody) test to determine the presence of neutralizing antibody in serum. In the RAPINA test, if neutralizing antibody equivalent to 0.5 IU/ml of serum sample are mixed with an optimal amount of inactivated RABV (iRABV) and are completely absorbed by the virus, none of the iRABV can bind with monoclonal antibody that recognizes the iRABV glycoprotein (G) on the test strip. A total of 115 human sera samples were tested. The sensitivity, specificity and accuracy of the RAPINA test compared with rapid fluorescent focus inhibition test (RFFIT) as a standard test, were 88.7, 91.9 and 90.4%, respectively. The RAPINA test is a simple, safe and rapid method, which can be a substitute for neutralizing tests that use live viruses, cultured cells and fluorescence microscopy. This test might be useful for screening a large number of sera.     

Comparison of antibody titers determined by hemagglutination inhibition and enzyme immunoassay for JC virus and BK virus

A comparison of antibody titers to JC virus (JCV) or BK virus (BKV) was made by hemagglutination inhibition (HI) and enzyme immunoassay (EIA) with 114 human plasma samples. Antibody titers to JCV or BKV determined by HI were lower than those determined by EIA. Nevertheless, as HI titers increased so did EIA titers. When antibody data were compared by the Spearman rank correlation test, highly significant correlations were found between HI and EIA titers. Results obtained by plotting EIA antibody titers for JCV against those for BKV generally showed a reciprocal relationship, i.e., samples with high antibody titers to JCV had lower antibody titers to BKV and vice versa. Some samples, however, had antibody titers to both viruses. Of the samples tested, 25.4% (25 of 114) had HI and EIA antibody titers to JCV and BKV which were identical or closely related. This is not the scenario one would expect for cross-reactive epitopes shared by the two viruses, but one suggesting that these samples were from individuals who had experienced infections by both viruses. Adsorption with concentrated JCV or BKV antigen of sera with high antibody titers to both JCV and BKV and testing by JCV and BKV EIA gave results which support this conclusion. Although 52.6% (51 of 97) of the samples from the Japanese population tested had very high antibody titers (>/=40,960) to either JCV or BKV, none of the samples were found by a dot blot immunoassay to have antibodies which cross-reacted with simian virus 40. The results from this study, in agreement with those of others, suggest that humans infected by JCV or BKV produce antibodies to species-specific epitopes on their VP1 capsid protein, which is associated with hemagglutination and cellular binding.     

Expression of the nucleoprotein gene of rabies virus for use as a diagnostic reagent

The nucleoprotein (N) gene of rabies virus CTN strain, was cloned, sequenced and expressed in Escherichia coli as a fusion with maltose binding protein (MBP). The antigenicity of this recombinant MBP-N fusion protein was examined by Western blotting and enzyme linked immunosorbent assay (ELISA). Subsequently, an indirect ELISA was developed to detect rabies specific antibody levels. Using sera from naive and vaccinated animals the ELISA results were compared with virus neutralizing antibodies detected by a rapid fluorescent focus inhibition test (RFFIT). Neutralizing titres by RFFIT were found to correlate well with the OD values in the ELISA (r=0.9436) and the sensitivity and specificity of the ELISA were shown to be 93.4 and 100%, respectively. The data indicate that the recombinant MBP-N fusion protein can be expressed and isolated straightforwardly and may be useful as a safe and abundant source of antigen to monitor seropositivity in vaccinated canines.