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- Title
Effect of Antimalarial Drugs on the Immune Response to Intramuscular Rabies Vaccination Using a Postexposure Prophylaxis Regimen.
- Authors
Endy, Timothy P; Keiser, Paul B; Cibula, Don; Abbott, Mark; Ware, Lisa; Thomas, Stephen J; Polhemus, Mark E
- Abstract
<bold>Background: </bold>Chloroquine can impair the immune responses to intradermal rabies vaccination. Current guidelines recommend an extra intramuscular dose be given for postexposure prophylaxis in previously unvaccinated persons taking any antimalarial drug.<bold>Methods: </bold>We conducted a randomized, open-label, single-site study in 103 previously unvaccinated healthy adults age ≥18 to ≤60 years old to evaluate the effects of chloroquine, atovaquone/proguanil (Malarone), and doxycycline on the antibody response to a purified chick embryo cell vaccine, given on a postexposure prophylaxis schedule. All treatment groups received antimalarials 14 days prior to and during vaccination.<bold>Results: </bold>All subjects achieved accepted neutralizing antibody titers of ≥0.5 IU/mL following the second rabies vaccination dose and maintained this protection through the duration of the study. We observed a reduction in rabies antibody geometric mean titer in the chloroquine versus control groups 28 days after vaccination: 2.3 versus 6.87 IU/mL, respectively (P < .001, t test). A significant difference was not observed for those taking Malarone or doxycycline.<bold>Conclusions: </bold>We conclude that there is no reduction of rabies antibody response in subjects taking Malarone or doxycycline, but a significant reduction in those taking chloroquine; however, accepted antibody levels were achieved for all 3 antimalarials.<bold>Clinical Trials Registration: </bold>NCT02564471.
- Subjects
RABIES vaccines; PHARMACOLOGY; IMMUNE response; PREVENTIVE medicine; ANTIBODY formation; RABIES prevention; RESEARCH; IMMUNIZATION; IMMUNOGLOBULINS; RESEARCH methodology; EVALUATION research; MEDICAL cooperation; MEDICAL protocols; COMPARATIVE studies; DRUG interactions; ANTIMALARIALS; VIRAL antibodies; RNA viruses; PHARMACODYNAMICS
- Publication
Journal of Infectious Diseases, 2020, Vol 221, Issue 6, p927
- ISSN
0022-1899
- Publication type
journal article
- DOI
10.1093/infdis/jiz558