National Academy of Sciences | 150 Year Anniversary

Questions? Call 800-624-6242

| Items in cart [0]

The National Academies Press

PAPERBACK
price:$43.50
add to cart

Rights & Permissions

topleft topright

New Vaccine Development: Establishing Priorities: Volume II, Diseases of Importance in Developing Countries (1986)
Board on Population Health and Public Health Practice (BPH)

Citation Manager

. "Appendix D-11: The Prospects for Immunizing Against Rabies Virus." New Vaccine Development: Establishing Priorities: Volume II, Diseases of Importance in Developing Countries. Washington, DC: The National Academies Press, 1986.

Please select a format:

BibTeX EndNote RefMan


Page
290
bottomleft bottomright

The following HTML text is provided to enhance online readability. Many aspects of typography translate only awkwardly to HTML. Please use the page image as the authoritative form to ensure accuracy.


New Vaccine Development: Establishing Priorities, Volume II, Diseases of Importance in Developing Countries

leading to the production of large numbers of viral particles in the salivary glands. This replication may occur before clinical symptoms appear, facilitating transmission through the saliva. In addition, some animals may become viral secretors, spreading disease over long periods of time without developing the disease.

Humans are nontransmitting hosts for rabies virus. There are no documented cases of human-to-human spread of rabies, other than several cases resulting from corneal transplantation from unrecognized rabies victims.

HOST IMMUNE RESPONSE

Infection with rabies virus induces a humoral immune response, which in humans is not sufficient to prevent disease and death. Antirabies antibodies can prevent disease, however, if given passively before or shortly after infection. Possible explanations for this situation are that the humoral immune response is not rapid enough after infection, that a disrupted cell-mediated immune response (CMI) interferes with eradication of the virus, or that the intraneural infection is protected from the antibody response.

Rabies virus does cause immunosuppression of the CMI response through enhancement of suppressor T-cell action. A state of anergy develops in which cytotoxic T-cells fail to act against rabies and other antigens.

It also appears that low levels of protective antibody, resulting either from a suboptimal or decayed vaccination response, or from inadequate passive immunization, can lead to paradoxical immunosuppression and accelerated disease (Shope, 1984). The possibility of such an occurrence dictates that any new vaccine must be strongly immunogenic and that the duration of protective immunity be predictable.

Rabies infection also induces interferon production, which may provide some protection by slowing the progress of disease. It is not yet known if the interferon response could be utilized therapeutically in early post-exposure prophylaxis or treatment.

Finally, incomplete viral particles, called T particles (Shope, 1984), may be present in the infective inoculum or produced during the early course of disease. These particles cannot cause disease, but may interfere with the early course of infection by competing for cell membrane receptor sites, for example. The effect of T particles on the development of the immune response is not clear, although they may prolong the incubation period and allow more time for post-exposure prophylaxis.

DISTRIBUTION OF DISEASE

Geographic Distribution

Canine rabies is enzootic in at least 87 countries and on every continent except Australia. Such islands as Hawaii, New Zealand, and

Page
290
Front Matter (R1-R16)
1. Summary (1-18)
2. Priority Setting for Health-Related Investments: A Review of Methods (19-29)
3. Overview of the Analytic Approach (30-43)
4. Comparison of Disease Burdens (44-62)
5. Predictions of Vaccine Development (63-75)
6. Assessing the Likely Utilization of New Vaccines (76-81)
7. Calculation and Comparison of the Health Benefits and Differential Costs Associated with Candidate Vaccines (82-105)
8. Additional Issues in the Selection of Priorities for Accelerated Vaccine Development (106-120)
9. Findings, Conclusions, and Recommendations (121-142)
Appendix A: Selection of Vaccine Candidates for Accelerated Development (143-148)
Appendix B: The Burden of Disease Resulting from Acute Respiratory Illness (149-158)
Appendix C: The Burden of Disease Resulting from Diarrhea (159-169)
Appendix D-1: The Prospects for Immunizing Against Dengue Virus (170-177)
Appendix D-2: The Prospects for Immunizing Against Escherichia coli (178-185)
Appendix D-3: The Prospects for Immunizing Against Hemophilus influenzae Type b (186-196)
Appendix D-4: The Prospects for Immunizing Against Hepatitis A Virus (197-207)
Appendix D-5: The Prospects for Immunizing Against Hepatitis B Virus (208-222)
Appendix D-6: The Prospects for Immunizing Against Japanese Encephalitis Virus (223-240)
Appendix D-7: The Prospects for Immunizing Against Mycobacterium leprae (241-250)
Appendix D-8: The Prospects for Immunizing Against Neisseria meningitidis (251-266)
Appendix D-9: The Prospects for Immunizing Against Parainfluenza Viruses (267-274)
Appendix D-10: The Prospects for Immunizing Against Plasmodium spp. (275-286)
Appendix D-11: The Prospects for Immunizing Against Rabies Virus (287-298)
Appendix D-12: The Prospects for Immunizing Against Respiratory Syncytial Virus (299-307)
Appendix D-13: The Prospects for Immunizing Against Rotavirus (308-318)
Appendix D-14: The Prospects for Immunizing Against Salmonella typhi (319-328)
Appendix D-15: The Prospects for Immunizing Against Shigella spp. (329-337)
Appendix D-16: The Prospects for Immunizing Against Streptococcus Group A (338-356)
Appendix D-17: The Prospects for Immunizing Against Streptococcus pneumoniae (357-375)
Appendix D-18: The Prospects for Immunizing Against Vibrio cholerae (376-389)
Appendix D-19: The Prospects for Immunizing Against Yellow Fever (390-402)
Appendix E: Questionnaire for Assessing Morbidity-Mortality Trade-Offs (403-411)
Appendix F: Technical Notes (412-412)
Appendix G: Biographical Notes on Committee Members (413-417)
Appendix H: Additional Sources of Advice to the Committee (418-419)
Appendix I: Contents of Supplement to Volume II (420-420)
Appendix J: Preface to Volume I (421-422)
Appendix K: Contents to Volume I (423-423)
Index (424-432)