Intradermal vaccination for rabies prophylaxis: conceptualization, evolution, present status and future

Rabies is a fatal viral encephalitis which can be effectively prevented by prophylactic measures. The currently available cell culture vaccines used for rabies prophylaxis are expensive for use by the standard intramuscular route of administration. In the last 3 decades, intradermal (ID) routes of vaccination using lesser amounts of vaccine as compared to that used for standard intramuscular vaccination have been used extensively in some Asian countries which has reduced the economic burden of rabies prophylaxis and also contributed in achieving a decline in the incidence of human rabies. ID vaccination is based on sound immunological principles and has been found to be safe and immunogenic. New short duration regimens to further economize the cost and enhance patient compliance, and novel non-invasive devices for ID vaccine delivery are being evaluated. Considering the success of ID rabies vaccination in Asian countries, its implementation in rabies endemic African countries should be encouraged.