Comparative Long-Term Immunogenicity and Boosting of 3-Session Versus 4-Session Intradermal Rabies Post-Exposure Prophylaxis Regimens in Cambodia and Madagascar: The RESIST-3 Study
Abstract
Background The abridged Institut Pasteur du Cambodge 3-session intradermal (ID) rabies post-exposure prophylaxis (PEP) regimen has been shown to be as safe and immunogenic as the 4-session regimen previously recommended by the World Health Organization. This regimen reduces time and cost and improves adherence and access to PEP for underserved people. In our study, we aimed to compare long-term and anamnestic immune response after a rabies vaccine booster dose in people previously vaccinated with a 3- or 4-session ID PEP. Methods In this prospective, multisite, comparative immunogenicity study, we measured rabies virus (RABV)–neutralizing antibody in 181 persons who had previously received 3- or 4-session ID PEP 2, 5, or 10 years earlier in Cambodia or Madagascar at day 0 and day 7 after a booster. In addition, RABV-specific T-cell response was evaluated in a subgroup of 35 Cambodian participants. Results All participants had RABV-neutralizing antibody titers considered adequate (≥0.5 IU/mL) on day 7 after the booster dose. The overall geometric mean titer of rabies antibody on day 0 and day 7 did not differ significantly between the 2 groups. Furthermore, RABV-specific T-cell response was similar regardless of the ID PEP regimen initially received in a subgroup of 35 participants. Conclusions In this multisite, real-world study, we showed that the 3-session ID PEP regimen provides robust long-term immunogenicity for up to 10 years after initial PEP and ensures the induction of an adequate anamnestic response within 7 days after an additional booster in all participants.
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BibTeX
@article{parize2026comparative,
title = {{Comparative Long-Term Immunogenicity and Boosting of 3-Session Versus 4-Session Intradermal Rabies Post-Exposure Prophylaxis Regimens in Cambodia and Madagascar: The RESIST-3 Study}},
author = {Perrine Parize and Sothy Touch and Vaomalala Raharimanga and Nisa Ya and Katherine Worsley-Tonks and Lauriane Kergoat and Pisey Thai and Soa Fy Andriamandimby and Saraden In and Anou Dreyfus and Malen Chan and Mino Harimbola Razafindramparany and Veasna Duong and Ravo Ramiandrasoa and Yiksing Peng and Tineke Cantaert and Philippe Dussart and Guilherme Dias de Melo and Sowath Ly and Rindra Vatosoa Randremanana and Arnaud Tarantola and Hervé Bourhy},
journal = {Clinical Infectious Diseases},
year = {2026},
month = jun,
doi = {10.1093/cid/ciag368},
url = {https://pasteur.hal.science/pasteur-05842462v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Comparative Long-Term Immunogenicity and Boosting of 3-Session Versus 4-Session Intradermal Rabies Post-Exposure Prophylaxis Regimens in Cambodia and Madagascar: The RESIST-3 Study
AU - Perrine Parize
AU - Sothy Touch
AU - Vaomalala Raharimanga
AU - Nisa Ya
AU - Katherine Worsley-Tonks
AU - Lauriane Kergoat
AU - Pisey Thai
AU - Soa Fy Andriamandimby
AU - Saraden In
AU - Anou Dreyfus
AU - Malen Chan
AU - Mino Harimbola Razafindramparany
AU - Veasna Duong
AU - Ravo Ramiandrasoa
AU - Yiksing Peng
AU - Tineke Cantaert
AU - Philippe Dussart
AU - Guilherme Dias de Melo
AU - Sowath Ly
AU - Rindra Vatosoa Randremanana
AU - Arnaud Tarantola
AU - Hervé Bourhy
PY - 2026
DA - 2026/06/15
JO - Clinical Infectious Diseases
DO - 10.1093/cid/ciag368
UR - https://pasteur.hal.science/pasteur-05842462v1
AB - Background The abridged Institut Pasteur du Cambodge 3-session intradermal (ID) rabies post-exposure prophylaxis (PEP) regimen has been shown to be as safe and immunogenic as the 4-session regimen previously recommended by the World Health Organization. This regimen reduces time and cost and improves adherence and access to PEP for underserved people. In our study, we aimed to compare long-term and anamnestic immune response after a rabies vaccine booster dose in people previously vaccinated with a 3- or 4-session ID PEP. Methods In this prospective, multisite, comparative immunogenicity study, we measured rabies virus (RABV)–neutralizing antibody in 181 persons who had previously received 3- or 4-session ID PEP 2, 5, or 10 years earlier in Cambodia or Madagascar at day 0 and day 7 after a booster. In addition, RABV-specific T-cell response was evaluated in a subgroup of 35 Cambodian participants. Results All participants had RABV-neutralizing antibody titers considered adequate (≥0.5 IU/mL) on day 7 after the booster dose. The overall geometric mean titer of rabies antibody on day 0 and day 7 did not differ significantly between the 2 groups. Furthermore, RABV-specific T-cell response was similar regardless of the ID PEP regimen initially received in a subgroup of 35 participants. Conclusions In this multisite, real-world study, we showed that the 3-session ID PEP regimen provides robust long-term immunogenicity for up to 10 years after initial PEP and ensures the induction of an adequate anamnestic response within 7 days after an additional booster in all participants.
SN - 1058-4838
SN - 1537-6591
ER -