Randomised feasibility trial of pre-exposure rabies vaccination with DTP-IPV in infants

Background Pre-exposure vaccination against rabies generally simplifies treatment and could be especially beneficial to children in countries where the disease is enzootic. We studied the feasibility of administering to infants pre-exposure rabies vaccination with combined diphtheria, tetanus, whole-cell pertussis, and inactivated poliomyelitis vaccine (DTP-IPV). Methods 84 Vietnamese infants were randomly assigned to groups that received three doses of DTP-IPV vaccine at 2, 3, and 4 months of age alone (n=43) or with two doses of purified Vero cell rabies vaccine (PVRV) at 2 and 4 months (n=41). The safety and immunogenicity data of the groups were compared. Findings All infants in both groups developed protective antibody concentrations against diphtheria, tetanus, pertussis, and polio. All infants who received the PVRV vaccine developed protective antibody concentrations against rabies. No serious adverse effects were reported, nor did systemic reactions differ between groups. Interpretation Administration of PVRV with DTP-IPV proved safe, and elicited what are presumed to be protective antibody concentrations to all antigens in all 41 infants. Confirmation of these results could lead to integration of pre-exposure rabies vaccination into Expanded Programme on Immunisation (EPI) sessions in selected countries where rabies is enzootic.