One question that arises is the age at which PrEP should be
administered. This is discussed frequently among rabies experts,
but without clear resolution. In our opinion, vaccination may be
offered as soon as the risk exists, which usually increases once
children begin to walk, explore actively their surroundings, and
play outside. For this increased risk, toddlers may be the right age.
The advantage of a toddler targeted program also lies in the fact
that toddlers come for routine immunization as part of national
immunization programs and therefore the full birth cohort can be
reached. In Thailand for instance JEV is on the national EPI calendar
and this may be an opportunity to reach the largest number
of children possible. Therefore, one of the pediatric PrEP studies
using PCECV was conducted in this age group with concomitant
JEV administration, demonstrating that the vaccines do not interfere
with each other. While at the time of the study, inactivated
mouse brain derived JEV was available and used, today’s inactivated
JEV, which is produced on Vero cells, has a better safety
profile.35 Once toddlers are missed, the next age to reach a cohort
would be school-aged children. However by then, an exposure
may already have occurred,5 and consequently a reduced number
of cases prevented. From an individual’s perspective, PrEP can
be given at any age. In countries where ID vaccination is not yet
approved by regulatory authorities or at travel clinics which may
be attended for visiting canine rabies endemic countries, the full
IM dose can be administered, safely and effectively.
For large scale implementation of rabies PrEP one of
One question that arises is the age at which PrEP should be
administered. This is discussed frequently among rabies experts,
but without clear resolution. In our opinion, vaccination may be
offered as soon as the risk exists, which usually increases once
children begin to walk, explore actively their surroundings, and
play outside. For this increased risk, toddlers may be the right age.
The advantage of a toddler targeted program also lies in the fact
that toddlers come for routine immunization as part of national
immunization programs and therefore the full birth cohort can be
reached. In Thailand for instance JEV is on the national EPI calendar
and this may be an opportunity to reach the largest number
of children possible. Therefore, one of the pediatric PrEP studies
using PCECV was conducted in this age group with concomitant
JEV administration, demonstrating that the vaccines do not interfere
with each other. While at the time of the study, inactivated
mouse brain derived JEV was available and used, today’s inactivated
JEV, which is produced on Vero cells, has a better safety
profile.35 Once toddlers are missed, the next age to reach a cohort
would be school-aged children. However by then, an exposure
may already have occurred,5 and consequently a reduced number
of cases prevented. From an individual’s perspective, PrEP can
be given at any age. In countries where ID vaccination is not yet
approved by regulatory authorities or at travel clinics which may
be attended for visiting canine rabies endemic countries, the full
IM dose can be administered, safely and effectively.
For large scale implementation of rabies PrEP one of
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