What are the most effective rabies vaccine brands in India based on efficacy?

Most Effective Rabies Vaccine Brands in India Based on Efficacy

Based on comparative studies, Rabipur (PCECV), Vaxirab (PDEV), and Verorab (PVRV) demonstrate equivalent efficacy in producing protective antibody titers and are the most effective rabies vaccine brands available in India.

Cell Culture and Embryonated Egg-Based Vaccines (CCEEVs)

Modern rabies vaccines used in India can be categorized into several types, all of which show high efficacy:

• Purified Chick Embryo Cell Vaccine (PCECV)

  • Brand name: Rabipur
  • Considered a gold standard along with HDCV
  • Provides nearly 100% protection when used appropriately 1
  • Does not cause immune-mediated hypersensitivity reactions following booster doses that are sometimes seen with HDCV 1

• Purified Duck Embryo Vaccine (PDEV)

  • Brand name: Vaxirab
  • Manufactured in India since 2003
  • WHO-recommended for post-exposure prophylaxis 2

• Purified Vero Cell Rabies Vaccine (PVRV)

  • Brand name: Verorab
  • WHO-approved cell culture vaccine 2
  • Widely used in post-exposure prophylaxis 2

• Purified Vero Cell Rabies Vaccine (Indian)

  • Brand name: Abhayrab
  • Manufactured by Human Biologicals Institute, Ooty, India 3

Comparative Efficacy

Head-to-Head Comparisons

• A randomized clinical trial comparing Vaxirab (PDEV), Rabipur (PCECV), and Verorab (PVRV) found:

  • All three vaccines produced protective neutralizing antibody titers (>0.5 IU/mL) by day 14 2
  • No significant difference in geometric mean titers (GMT) between the three vaccines 2
  • Minimal side effects across all three vaccine groups 2

• Abhayrab (Indian PVRV) demonstrated:

  • Good immunogenicity with GMT >0.5 IU/mL in both pre-exposure and post-exposure settings 3
  • Few adverse side effects 3

Clinical Protection

• Rabipur (PCECV) has demonstrated excellent clinical protection:
  • In a study of 32 people severely bitten by confirmed rabid dogs, multi-site intradermal regimen with Rabipur prevented rabies development in all subjects 4
  • All subjects developed protective antibody titers (>0.5 IU/mL) by day 7 and maintained protection throughout the 3-year observation period 4
  • Effective with or without passive immunization with rabies immunoglobulin 4

Historical Context and Evolution

• Older nerve tissue vaccines (NTV) like Semple vaccine showed lower efficacy:

  • 1923 study in India showed 2.9% mortality with 1% Semple NTV compared to 6.2% in unvaccinated persons 5
  • 1946-1951 study showed 8.3% mortality with "completely treated" 5% Semple vaccine versus 43.2% in unvaccinated persons 5

• Modern cell culture vaccines have replaced these older formulations due to:

  • Higher efficacy 5, 1
  • Better safety profile with fewer adverse reactions 1, 2
  • Consistent production of protective antibody titers 2, 4, 3

Clinical Considerations

• All WHO-approved CCEEVs available in India (Rabipur, Vaxirab, Verorab, Abhayrab) produce protective antibody titers when administered according to recommended schedules 2, 4, 3

• For post-exposure prophylaxis, the combination of rabies immunoglobulin and vaccine provides optimal protection 5

• The multi-site intradermal regimen with Rabipur offers a cost-effective approach with excellent efficacy, particularly important in resource-limited settings 4

Key Points for Vaccine Selection

• Equivalent efficacy: Comparative studies show Rabipur (PCECV), Vaxirab (PDEV), and Verorab (PVRV) have similar immunogenicity profiles 2

• Safety considerations: Rabipur may have advantages for patients requiring booster doses, as it doesn't cause the hypersensitivity reactions sometimes seen with HDCV 1

• Availability and cost: All these vaccines are manufactured or available in India, with some (like Abhayrab and Vaxirab) being produced locally 2, 3

• Administration options: Vaccines like Rabipur have been proven effective in both standard intramuscular and cost-saving intradermal regimens 4