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Clin Infect Dis. 2018 Nov 28;67(12):1932-1947. doi: 10.1093/cid/ciy420.

Rabies Antibody Response After Booster Immunization: A Systematic Review and Meta-analysis.

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Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, The Netherlands.
Medical Library, Academic Medical Center, University of Amsterdam, The Netherlands.
Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Clinical Research Unit, Academic Medical Center, University of Amsterdam, The Netherlands.


Although fatal once symptomatic, rabies is preventable by administration of pre- and post-exposure vaccines. International guidelines suggest lifelong protection by a pre-exposure vaccination scheme followed by timely post-exposure vaccines. Rapidity and magnitude of the antibody recall response after booster inoculation are essential, as many people have been previously immunized a long time ago. The objective of this study was therefore to systematically review the evidence on the boostability of rabies immunization to date. We included 36 studies, of which 19 studies were suitable for meta-analysis. Reduced antibody levels were found after intradermal primary schedules as compared to intramuscular schedules. However, responses after booster immunization were adequate for both routes. Although studies showed that antibody levels decline over time, adequate booster responses were still retained over long time intervals indicating that post-exposure treatment is effective without extra measures after long periods of time.


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