Rabipur vs Rabishield: Which Vaccine is Better?
Both Rabipur (PCECV) and Rabishield (PDEV) are equally safe and effective for rabies post-exposure prophylaxis when administered according to WHO-recommended protocols, and the choice between them should be based primarily on availability and cost rather than efficacy differences. 1
Evidence of Comparable Efficacy
Direct Comparative Studies
A randomized phase IV clinical trial directly comparing Rabipur (PCEC) with Vaxirab (PDEV) in 152 animal bite victims found no significant difference in neutralizing antibody titers at days 14,28,90, and 180 (p>0.5), with all subjects achieving protective levels (>0.5 IU/mL) by day 14. 1
Both vaccines demonstrated minimal and comparable side effects in this head-to-head comparison, with the study concluding that PDEV is "as safe, tolerable and immunogenic" as PCEC. 1
A 2015 study comparing Rabipur with another cell culture vaccine (Verorab) using an accelerated one-week intradermal regimen found geometric mean RVNA concentrations of 14.5 IU/mL for Rabipur versus 14.43 IU/mL for Verorab on day 14, demonstrating essentially identical immunogenicity. 2
Regulatory Recognition
WHO and FDA Approval Status
The 2008 CDC/ACIP guidelines acknowledge that purified duck embryo vaccine formulations (like Rabishield) and different formulations of PCECV (like Rabipur) are used widely abroad, though specific formulations may not be FDA-approved for use in the United States. 3
Both vaccine types are WHO-prequalified and recommended for post-exposure prophylaxis globally. 2, 1
The CDC states that persons receiving post-exposure prophylaxis outside the United States with these vaccines would be considered adequately protected if rabies virus neutralizing antibody titers show complete neutralization at 1:5 serum dilution. 3
Safety Profile
Adverse Event Rates
In the comparative trial, adverse drug reactions were minimal: 2.96% for Rabipur versus 1.14% for Verorab, with no serious adverse events reported for either vaccine type. 2
The 2009 comparative study found that side effects (redness, induration, local pain, fever, lymphadenopathy) were minimal and did not vary significantly among PDEV, PCEC, and PVRV groups. 1
Immunogenicity Duration
Long-term Antibody Response
Both Rabipur and comparable vaccines maintain protective antibody levels well beyond the immediate post-exposure period, with geometric mean concentrations remaining above 5.5 IU/mL at one year post-vaccination. 2
The antibody response pattern is similar for both vaccine types, with peak titers at day 14 and gradual decline over 12 months while maintaining protective levels. 2
Practical Considerations
Administration Flexibility
Both vaccines can be administered via intramuscular or intradermal routes, though specific formulations must be verified for intradermal use approval. 2, 4
The one-week, four-site intradermal regimen (4-4-4-0-0) has been validated for both vaccine types, offering a more economical and practical alternative to traditional one-month regimens. 2, 4
Cost and Accessibility
PDEV vaccines like Rabishield may offer cost advantages in resource-limited settings while maintaining equivalent efficacy to more expensive cell culture vaccines. 1, 4
The choice between vaccines should prioritize accessibility and timely administration over brand preference, as delays in prophylaxis pose greater risk than vaccine selection. 3, 4
Critical Caveats
What Actually Matters for Preventing Rabies Death
The most important factor for preventing rabies mortality is not which vaccine you choose, but rather: immediate thorough wound washing with soap and water, timely administration of rabies immunoglobulin (20 IU/kg) with proper wound infiltration, and completion of the full vaccine series without delays. 3
Failures of post-exposure prophylaxis have occurred when less than the recommended amount of rabies immunoglobulin was infiltrated at wound sites, when vaccines were administered in the gluteal area instead of the deltoid, or when wound cleansing was inadequate—not because of vaccine brand selection. 3
Never administer rabies vaccine in the gluteal area, as this results in lower neutralizing antibody titers regardless of vaccine type. 3
Bottom Line for Clinical Practice
Select whichever WHO-prequalified vaccine is immediately available and affordable in your setting—Rabipur, Rabishield, or other approved alternatives—and focus your attention on proper wound management, correct rabies immunoglobulin administration, and ensuring the patient completes the full vaccination series. 1, 4 The evidence demonstrates that vaccine brand is far less important than proper prophylaxis technique and patient compliance for preventing this 100% fatal disease. 5, 4