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Pulling for a one-dose vaccine

By revere on September 19, 2009.

It's a virus that kills someone every 20 minutes in this world, usually a child. A vaccine is on the way but isn't here yet. The good news is that what usually requires multiple doses may only require a single dose. It's big news. It's also not about swine flu vaccine:

A replication-deficient rabies virus vaccine that lacks a key gene called the matrix (M) gene induced a rapid and efficient anti-rabies immune response in mice and non-human primates, according to James McGettigan, Ph.D., assistant professor of Microbiology and Immunology at Jefferson Medical College of Thomas Jefferson University.

"The M gene is one of the central genes of the rabies virus, and its absence inhibits the virus from completing its life cycle," Dr. McGettigan said. "The virus in the vaccine infects cells and induces an immune response, but the virus is deficient in spreading."

The immune response induced with this process is so substantial that only one inoculation may be sufficient enough, according to Dr. McGettigan. In addition, the vaccine appears to be efficient in both pre-exposure and post-exposure settings. (Eurekalert)

I've written about it here before, but when I was a medical student (it was long ago, alas) we were shown a short film clip of a young man in Iran dying of rabies. I can still see his face in my mind's eye. Of course he is long dead, killed by a virus that, once it starts the disease process, is essentially a death sentence. Once bitten by a rabid or potentially rabid animal there is about a month to get a series of rabies shots. In the US it's a series of six shots, five with vaccine and one with rabies immunoglobulin. The standard vaccine is inactivated virus, but the new vaccine removes the M gene and is a live virus. Presumably that's why it is so immunogenic.

Rabies deaths are rare in the US and most seem to be related to bat bites, not rabid dogs or cats as elsewhere, but in the US wild raccoons, foxes and skunks also have rabies and can transmit it to humans. But the disease is so deadly no one wants to take a chance, so many thousands of post-exposure prophylaxis gets done and at substantial cost. Globally rabies deaths are estimated at 31,000 in Asia and 24,000 in Africa. Those aren't just deaths. They are tens of thousands of truly horrible deaths. A one-shot regimen will make the difference between feasibility and impossibility in many rabies endemic areas.

This vaccine still has to prove itself. But I'm pulling for it. This is a terrible, terrible -- but preventable -- disease.

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Totally OT:

Yesterday $EMPLOYER published a new influenza policy. From my nonexpert eye, it looked remarkably good; I got permission to publish it and wondered if you'd like to use it to discuss good, bad, and batshit insane employer policies.

By D. C. Sessions (not verified) on 19 Sep 2009 #permalink

DC: I'll be traveling and giving talks (not on flu) for a couple of weeks but send it along. Whether I use it or not will depend on happenstance. There is so much material these days and this blog is, shall we say, "eclectic."

I wasn't able to find an address; I used mine to post.

By D. C. Sessions (not verified) on 19 Sep 2009 #permalink

nuder contact? I can hardly wait!!!

While I'm thrilled about the prospects for making rabies easier for humans ourselves to deal with, I'm also pulling for this for our companion animals. Hopefully it will show promise as a single dose preexposure vaccine in them and we can extend the vaccination protocol beyond the current three year interval.

Making it easier to vaccinate dogs and cats looks like it may help people as well, if they're the main vectors in some areas of the world. I know some people would like to lump the pet owners pulling for less frequent rabies vaccination with the anti-vaxxers, but the AVMA recognizes vaccine site sarcomas as a problem:

http://www.avma.org/vafstf/default.asp,

Because most of the problems have been seen in cats, the AVMA and manufacturers are doing research there. Many dog owners are actively seeking to do something for dogs by raising money for research that the manufacturers have no great financial incentive to perform.

http://www.rabieschallengefund.org/

This research is looking at the duration of immunity provided by our current vaccines. These aren't anti-vax people - they're people who recognize the value of the rabies vaccine, but feel that we need to do the best we can for those we give the vaccine to. It's just not in the manufacturer's interest to test to see if the vaccines last longer.

It may however be in the public interest - if more animals which are allowed to roam at least got initial vaccinations when their owners first got them, it would undoubtedly be helpful. Seven years would cover beyond the lifespan of most roaming animals.

Thank you for this very interesting post. Rabies has been in the newspaper and the local gossip lately in our American town. In August a woman who lives in town walked out on her front porch to have a bat swoop down on her and bite her, then flop down to the floor. She saved the bat and had it tested: indeed, it was proven by the health department to be rabid, and she received her series of shots. I'm not so certain about the other news: although I live in town, there are very small patches of trees that you might call woodlands for want of a better word between some houses where raccoons live. A neighbor claimed that animal control trapped a raccoon that had been acting strangely in the alley behind our homes, and that it tested positive for rabies as well. I expected that this would be big news (after all, this is a town, not the country, with many pet cats that are allowed outside), but never read anything in the papers. Would the public health department be obliged to make some sort of announcement?

I have six cats (trust me, not my idea), which are allowed outside, but are all vaccinated. We used to have a pet door in the basement for them but had to block it off when raccoons began entering and boldly coming upstairs into the kitchen to partake of the Purina One. It would be a Bad Thing if the town raccoon population became rabies-infected. In this economy, you can't be certain who is getting their pets vaccinated (it cost me $300.00 for shots alone for five of the cats recently). As Karen stated, to devise an animal vaccination protocol requiring less frequent shots for pets would certainly help with compliance when cost is an issue.

Of course, in other nations our idea of economic hardship is an unimaginably generous lifestyle, so revere's news regarding a one-shot rabies treatment for exposed humans is great news for those for whom having access to six different health care episodes is impossible (not that it is always possible in our nation, either).

So where's the blog topic "Pulling for a one-dose antiviral"?

Let's hope Roche successfully bids on U.S. rights for laninamivir, otherwise the "public health information" at E.M. will have another wealth of information to match zanamivir (that's sarcasm).

On June 24, 2009, the Advisory Committee on Immunization Practices (ACIP) approved new recommendations on the use of rabies vaccine for PEP for the prevention of human rabies in the US. The recommendations, already adopted by a number of states, is for 4 vaccine doses of rabies vaccine on days 3, 7, and 14 after the first vaccination. HRIG recommendations remain unchanged.