Intradermal route for rabies vaccination should be generalized in travelers

摘要

We agree with Wieten and colleagues [1] that an abbreviated intradermal (ID) schedule would greatly reduce preexposure rabies vaccination cost, including for travelers [2, 3]. However, because lyophilized vaccines do not contain a preservative, once reconstituted, an ampoule must be kept in a refrigerator at <8degC and used within 8 hours. Therefore, for this approach to be cost-effective, several travelers have to be vaccinated around the same time, which is feasible only in busy travel clinics or if families, students, or other groups are all immunized on the same day. Also, ID preexposure rabies prophylaxis is off-label in the United States, Australia, and a number of countries in Europe, and practitioners have little legal protection if adverse events occur [4].