A revised Green Book chapter of rabies recommendations is published this week. The main changes in recommendations are:
- Inclusion of a rapid pre-exposure rabies immunisation schedule on days 0, 3 and 7 where there is no time to complete the day 0, 7 and 21/28 day schedule.
- Routine booster doses are not recommended for most travellers. A single booster dose of vaccine can be considered, following a risk assessment, in those who have completed a primary course over one year ago and are travelling again to a high risk (enzootic) area. A complete pre-exposure primary course is considered to be three doses over 21/28 days or an accelerated three dose course (over 7 days) plus an additional dose of vaccine at one year.
- Reduction in number of doses of vaccine required for post-exposure rabies immunisation to four doses on days 0, 3, 7 and 21/28 for immunocompetent individuals. For anyone who may be immunocompromised, the 5 dose post exposure regime remains treatment of choice.
- Inclusion of a composite risk category for assessment for post exposure treatment, which combines risk associated with the country, animal/bat, and category of exposure.
The post exposure changes have already been notified on an earlier news item. The TRAVAX rabies page has been updated accordingly. Within the pages is a direct link into the revised Green Book chapter, which should be used for post exposure rabies advice.
