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Animal available for testing
Animal available for testing

Animal available for testing

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Action

Decision

Will test results be available expeditiously?

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No → Administer PEP; if result returns negative, discontinue PEP (Class III)

Background

PEP is a medical urgency, not an emergency, but should not be delayed. PEP is fully effective in preventing rabies if the regimen is adhered to correctly. For previously unvaccinated individuals, PEP consists of active immunization with rabies vaccine combined with passive immunization with HRIG. Rabies vaccination induces an immune response by triggering the recipient to produce neutralizing antibodies, which takes 7 to 10 days to develop. Passive immunization with HRIG, administered concurrently with the first dose of vaccine, provides antibodies and covers the gap period until active immunity is produced.25,30^{25,30}

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References
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  50. Kerdpanich P, Chanthavanich P, De Los Reyes MR, et al. Shortening intradermal rabies post-exposure prophylaxis regimens to 1 week: results from a phase III clinical trial in children, adolescents and adults. PLoS Negl Trop Dis. 2018;12(6):e0006340. (Randomized controlled trial; 885 patients)
  51. Soentjens P, Andries P, Aerssens A, et al. Preexposure intradermal rabies vaccination: a noninferiority trial in healthy adults on shortening the vaccination schedule from 28 to 7 days. Clin Infect Dis. 2019;68(4):607-614. (Randomized controlled trial; 500 patients)
  52. Tarantola A, Ly S, Chan M, et al. Intradermal rabies post-exposure prophylaxis can be abridged with no measurable impact on clinical outcome in Cambodia, 2003-2014. Vaccine. 2019;37 Suppl 1:A118-A127. (Retrospective; 3318 patients)
  53. Cantaert T, Borand L, Kergoat L, et al. A 1-week intradermal dose-sparing regimen for rabies post-exposure prophylaxis (RESIST-2): an observational cohort study. Lancet Infect Dis. 2019;19(12):1355-1362. (Observational; 116 patients)
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Results available expeditiously
Results available expeditiously
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