Immunogenic response in obese patients undergoing rabies post-exposure prophylaxis with combined equine rabies immunoglobulin and rabies vaccination

• Published in: Vaccine Vol. 36; no. 2; pp. 285 - 291
• Main Authors: Sirikun, Jatuporn, Suputtamongkol, Yupin, Rattanachinakorn, Ploypailin, Primsirikunawut, Athiwat
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 04-01-2018; Elsevier Limited
• Subjects: Antibodies; Body mass index; Body size; Combined vaccines; Drug dosages; Exposure; Fluorescence; Hypersensitivity; Hypersensitivity (immediate); Immune response (humoral); Immunization; Immunogenicity; Immunoglobulin; Immunoglobulins; Immunosuppression; Infectious diseases; Influenza; Laboratories; Lyssavirus; Morbidity; Obese; Obesity; Patients; Post-exposure; Prophylaxis; Public health; Rabies; Rabies vaccine; Risk factors; Seroconversion; Statistical analysis; Tetanus; Vaccination; Vaccines; Viruses; Thailand; India; Immunoglobulin; Obese; Post-exposure; Rabies vaccine; Immunogenicity; Rabies
• DOI: 10.1016/j.vaccine.2017.11.058
• EISSN: 1873-2518
• ISSN: 0264-410X

•There is limited data on immunogenicity of combined ERIG and rabies vaccination in obese patients.•No suppression of antibody responses after combined ERIG and rabies vaccination in obese patients.•Combined ERIG and rabies virus vaccination for post exposure treatment is safe.
Obesity is a risk factor for increased morbidity and mortality associated with many vaccine preventable infectious diseases such as influenza. Moreover, higher volume of passive rabies immunoglobulin (RIG) due to weight based dosing might suppress vaccine-induced immune responses in obese patients. This study aimed to evaluate the effect of obesity on humoral immune responses to combined equine RIG and rabies vaccine treatment among patients with WHO category III exposure to a rabies suspected animal.
A single centre, prospective, open-labelled study among WHO category III rabies exposed patients was conducted to compare serum rabies virus neutralizing antibody (RVNA) responses measured by rapid fluorescent focus inhibition test between obese (body mass index, BMI > 30 kg/m2) and control (BMI < 25 kg/m2) patients after combined immunization with equine rabies immunoglobulin and purified chick-embryo cell rabies vaccine for post exposure prophylaxis treatment.
Post-vaccination geometric mean titer (GMT) of RVNA concentrations between two groups at day 7 were 0.33 (95% CI: 0.23, 0.46) vs 0.39 (95% CI: 0.27, 0.55), 4.61 (95% CI: 3.20, 6.63) vs 3.78 (95% CI: 2.77, 5.16) at day 14, and 7.45 (95% CI: 5.86, 9.49) vs 5.93 (95%CI: 4.46–7.90) at day 28 for obese and control patients, respectively. There was no statistically significant difference of RVNA GMT between two groups. Seroconversion to at least adequate concentration (RVNA titer ≥0.5 IU/mL) rates were 34% at day 7 and 100% at days 14 and 28 in both groups. There were no immediate hypersensitivity reaction and no serious adverse events observed during the study period.
There was no evidence of immunosuppression of antibodies’ responses in obese patients. Combined ERIG and rabies virus vaccination for post exposure treatment is safe.