People with potential rabies exposure who started post-exposure prophylaxis overseas are recommended to complete the rabies vaccine course in Australia
Australians travelling overseas who are exposed to a potentially rabid animal (including bats from any country) may receive post-exposure prophylaxis using cell culture–derived vaccines and schedules that are not used in Australia.
If the person received an older nerve tissue–derived rabies vaccine, do not regard these doses as valid. This is a very rare circumstance. See Table. Completing post-exposure prophylaxis in Australia that started overseas.
If a person received either a chick embryo–derived or a cell culture–derived vaccine overseas, they are recommended to continue the standard post-exposure prophylaxis regimen in Australia with either human diploid cell vaccine or purified chick embryo cell vaccine. See Interchangeability of rabies vaccines.
In general, cell culture–derived vaccines are acceptable if they contain at least 2.5 IU of rabies virus per dose and there is scientific literature demonstrating an acceptable post-exposure antibody response (rabies virus neutralising antibody ≥0.5 IU per mL). See Table. Rabies vaccines available globally, and compatibility with vaccines registered in Australia.
| Rabies vaccine | Vaccine information | Compatible |
|---|---|---|
| Human diploid cell vaccine (HDCV) |
Imovax, Sanofi Pasteur SA Kanghua Rabies, Chengdu Kanghua Biological Products China |
Yes |
| Purified chick embryo cell vaccine (PCECV) |
RabAvert, GSK Vaxirab-N, Cadila Healthcare India |
Yes |
| Purified Vero cell rabies vaccine (PVRV) |
RABIVAX-S, Serum Institute India SPEEDA, Chengda Bio China Abhayrab, Human Biologicals Institute India Indirab, Bharat Biotech India |
Yes |
| Purified duck embryo vaccine (PDEV) |
Lyssavac, Cadila Healthcare India Vaxirab, Cadila Healthcare India |
Yes |
| Primary Syrian hamster kidney cell vaccine (PHKCV) | Local producers in China | Yes |
| Baby hamster kidney cell vaccine (BHKV) | Kokav, Russia | Yes |
| Recombinant nanoparticle-based rabies G protein virus-like particle (VLP) vaccine | ThRabis, Cadila Pharmaceuticals India | No |
| Suckling mouse brain vaccine (SMBV) | Used in South America | No |
| Nervous tissue vaccine (sheep, goat) | Used in Asia, Ethiopia and Argentina | No |
Intramuscular dosing schedules for post-exposure rabies vaccination for people who have not been vaccinated for rabies that are approved by the World Health Organization include:
- Zagreb regimen — 2 doses on day 0, doses on days 7 and 21 (annotated as 2-0-1-0-1)
- Essen regimen — doses given on days 0, 3, 7, 14, and 28 or 30 (annotated as 1-1-1-1-1)
- modified Essen regimen — doses given on days 0, 3, 7 and 14-28 (annotated as 1-1-1-1-0)
Intradermal dosing regimens for post-exposure rabies vaccination that are approved by the World Health Organization include:
- Institut Pasteur du Cambodge (IPC) regimen — 2 doses on days 0, 3 and 7 (annotated as 2 2 2 0 0)
- updated Thai Red Cross (TRC) regimen — 2 doses on days 0, 3, 7 and 28 (annotated as 2 2 2 0 2)
A person is recommended to receive HRIG (human rabies immunoglobulin) in Australia if:
- it is indicated for the type of exposure and the person’s immune status (see Figure. Rabies post-exposure prophylaxis: terrestrial animal exposures or Figure. Rabies post-exposure prophylaxis: bat exposures) and
- the potential exposure was within the past 12 months and
- they started post-exposure prophylaxis overseas but HRIG or ERIG (equine rabies immunoglobulin) was not given and
- they received the 1st post-exposure prophylaxis vaccine dose within the past 7 days (168 hours). HRIG should be given in a different limb to the vaccine.
If the person in Australia had their 1st post-exposure prophylaxis dose more than 7 days ago, they should not receive HRIG. However, they should still complete the appropriate number of remaining rabies vaccine doses.
For these and other scenarios, Table. Completing rabies post-exposure prophylaxis in Australia that started overseas outlines the most common post-exposure prophylaxis regimens that may be started overseas and the recommended schedule to complete post-exposure prophylaxis in Australia.
Advise travellers that, if they start post-exposure prophylaxis while overseas, they must request a post-exposure prophylaxis certificate from the vaccination centre, and obtain or record the following information (preferably in English):
- the contact details for the clinic attended (telephone and email address)
- the batch and source of RIG (rabies immunoglobulin) used (some countries may use ERIG or monoclonal RIG rather than HRIG)
- the volume of RIG administered
- the type of cell culture vaccine used
- the vaccine batch number
- the number of vials used
- the route of vaccine administration
- the date and time of administration of RIG and/or vaccine
These details help inform decisions about how to complete post-exposure prophylaxis when the traveller returns home.