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Article Dans Une Revue Travel Medicine and Infectious Disease Année : 2024

Real-world evidence of rabies post-exposure prophylaxis in Serbia: Nation-wide observational study (2017–2019)

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Background: Rabies remains a deadly zoonotic disease, primarily prevalent in Eastern European countries, with a significant global burden in Asia and Africa. Post-exposure prophylaxis (PEP) is critical to prevent clinical rabies. Serbia, a country with a relatively low animal rabies incidence, has been implementing a 4-dose Essen PEP regimen for 13 years. This real-world study aimed to assess the effectiveness of the 4-dose Essen regimen, considering demographic and clinical factors, after WHO Category III exposure. Method: The study included 601 patients who received the 4-dose Essen PEP and 79 who received an additional 5th dose. Results: Age emerged as a critical factor influencing seroconversion rates after the 4-dose regimen, with older individuals exhibiting lower RVNA titers. Logistic regression indicated a 3.18% decrease in seroconversion odds for each added year of age. The Cox proportional hazards mixed model highlighted age-related risks, with age groups 45-60 and 75-92 at the highest risk of non-seroconversion. Human Rabies Immune Globulin (HRIG) administration was associated with lower RVNA values after the 4-dose regimen, suggesting interference with vaccine immunogenicity among people who received larger doses of HRIG. Conclusions: This study provides valuable real-world evidence for rabies PEP in a non-homogeneous population with potential comorbidities. The results underscore the importance of optimizing PEP strategies, particularly in older individuals, and reconsidering HRIG dosing to improve seroconversion rates.
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hal-04557483 , version 1 (24-04-2024)

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Pavle Banović, Dragana Mijatović, Verica Simin, Nenad Vranješ, Eleftherios Meletis, et al.. Real-world evidence of rabies post-exposure prophylaxis in Serbia: Nation-wide observational study (2017–2019). Travel Medicine and Infectious Disease, 2024, 58, pp.102697. ⟨10.1016/j.tmaid.2024.102697⟩. ⟨hal-04557483⟩
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