Rabies-Monoclonal Antibody - A Perspective
Rabies is an acute viral zoonotic disease that affects the central nervous system (CNS) of all warm-blooded animals, including mammals. Research studies and experience from across the world have demonstrated
that appropriate administration of a combination of (a) local wound treatment, (b) anti-rabies vaccination and (c) passive immunization have proved to be quite effective in preventing the occurrence of rabies. As far as passive immunization is concerned, polyclonal plasma-derived rabies immunoglobulins (RIG) pose a number of limitations with scarce supply, high cost, etc. amongst many others. On the contrary Rabies Monoclonal Antibodies (R-mAb) are much cheaper, permit longer-term storage, etc. and hence could offer a more standardized, accessible, affordable and equally efficacious and safer alternative to RIG. Accordingly, this article has tried to throw light on the transition from RIG to monoclonal antibody-based Post Exposure Prophylaxis (PEP) which has been recommended by the WHO strongly. The advantages, limitations and future scope of R-mAb have been discussed at length to give a comprehensive idea about this novel invention in the field
How to cite this article:
Panda M, Kishore J, Gongal G. Department of Community Medicine, VMMC and Safdarjung Hospital, New Delhi, India. J Commun Dis. 2022;54(3):22-26.
World Health Organization. WHO Expert Consultation on Rabies: Third Report, No. 1012. Geneva, Switzerland:
World Health Organization; 2018. Available from: http://www.who.int/rabies. Last accessed on 2021
World Health Organization. Rabies Fact Sheet. Available from https://www.who.int/news-room/factsheets/detail/rabies#:~:text=Key%20facts,and%20prevention%20of%20dog%20bites. Last accessed on Jun 1, 2020.
Association for prevention and control of rabies in India. Report of the National MultiCentric Survey.
Bangalore; 2004. Available from: http://www.apcri.org. Last accessed on 2021 Oct 9.
Sudarshan MK, Madhusudana SN, Mahendra BJ, Rao NS, Ashwath Narayana DH, Abdul Rahman S, Meslin
F, Lobo D, Ravikumar K, Gangaboraiah. Assessing the burden of human rabies in India: Results of a national
multicenter epidemiological survey. Int J Infect Dis. 2007 Jan;11(1):29-35. [PubMed] [Google Scholar]
National Centre for Disease Control, DGHS, MOHFW Govt of India. National Rabies Control Program
National Guidelines on Rabies Prophylaxis, 2015. Available from http://clinicalestablishments.gov.in/
WriteReadData/238.pdf. Last accessed on 2021 Oct 9.
Center for disease control and prevention: Human Rabies Prevention, United States, 1999 Recommendations of the Advisory Committee on Immunization Practices (ACIP). Available from https://www.cdc.gov/mmwr/
preview/mmwrhtml/00056176.htm. Last accessed on 2021 Oct 9.
Sudarshan MK, Narayana DH. Background paper for developing a policy for the use of rabies biologicals
and vaccination of humans in India. Indian J Public Health. 2019 Sep;63(Supplement):S51-3. [PubMed]
Hampson K, Coudeville L, Lembo T, Sambo M, Kieffer A, Attlan M, Barrat J, Blanton JD, Briggs DJ, Cleaveland S,
Costa P, Freuling CM, Hiby E, Knopf L, Leanes F, Meslin FX, Metlin A, Miranda ME, Müller T, Nel LH, Recuenco
S, Rupprecht CE, Schumacher C, Taylor L, Vigilato MA, Zinsstag J, Dushoff J; Global Alliance for Rabies Control
Partners for Rabies Prevention. Estimating the global burden of endemic canine rabies. PLoS Negl Trop Dis.
Apr;9(4):e0003709. [PubMed] [Google Scholar]
Warrell MJ. Current rabies vaccines and prophylaxis schedules: preventing rabies before and after exposure.
Travel Med Infect Dis. 2012 Jan;10(1):1-15. [PubMed] [Google Scholar]
Wilde H, Khawplod P, Hemachudha T, Sitprija V. Postexposure treatment of rabies infection: can it be
done without immunoglobulin? Clin Infect Dis. 2002 Feb 15;34(4):477-80.[PubMed] [Google Scholar]
De Benedictis P, Minola A, Rota Nodari E, Aiello R, Zecchin B, Salomoni A, Foglierini M, Agatic G, Vanzetta
F, Lavenir R, Lepelletier A, Bentley E, Weiss R, Cattoli G, Capua I, Sallusto F, Wright E, Lanzavecchia A, Bourhy
H, Corti D. Development of broad-spectrum human monoclonal antibodies for rabies post-exposure
prophylaxis. EMBO Mol Med. 2016 Apr;8(4):407-21. [PubMed] [Google Scholar]
National List of Essential Medicines. Annexure-IV, Ministry of Health and Family Welfare, Government
of India; 2015; pp.57-59.
Report of the sixth WHO consultation on monoclonal antibodies in rabies diagnosis and research, Part II; 2-3
April 1990. Philadelphia, USA: The Wistar Institute 6-9.
WHO consultation on a rabies monoclonal antibody cocktail for rabies post exposure treatment. WHO,
Geneva, 23–24 May 2002. Available from: https://apps.who.int/rabies/resources/WHO_consultation_
Report: WHO meeting on monoclonal antibodies against rabies and evaluation of mechanisms to improve
access to other blood-derived Immunoglobulins. Silver Spring, Maryland, USA.
Background paper: proposed revision of the policy on rabies vaccines and rabies immunoglobulins.
Prepared by the SAGE working group on rabies vaccines and immunoglobulins and the World Health
Organization (WHO). Available from https://www.who.int/immunization/sage/meetings/2017/october/1_
Marasco WA, Sui J. The growth and potential of human antiviral monoclonal antibody therapeutics.
Nat Biotechnol. 2007 Dec;25(12):1421-34. [PubMed] [Google Scholar]
Both L, Banyard AC, van Dolleweerd C, Horton DL, Ma JK, Fooks AR. Passive immunity in the prevention
of rabies. Lancet Infect Dis. 2012 May;12(5):397-407. [PubMed] [Google Scholar]
WHO. Expert Consultation on Rabies: third report. Geneva: World Health Organization 2018.
Sparrow E, Torvaldsen S, Newall AT, Wood JG, Sheikh M, Kieny MP, Abela-Ridder B. Recent advances in the
development of monoclonal antibodies for rabies post exposure prophylaxis: A review of the current status
of the clinical development pipeline. Vaccine. 2019 Oct;37 Suppl 1:A132-9.[PubMed] [Google Scholar]
Rabishield rabies human monoclonal antibody. Serum Institute of India Pvt. Ltd. Available from: https://www.
Gongal G, Sampath G. Monoclonal antibodies for rabies post-exposure prophylaxis: A paradigm shift in passive immunization. Archives of Preventive Medicine. 2020 Aug;5(1):035-8. [Google Scholar]
Shivalingaiah AH, Shankaraiah RH. Safety of new indigenous human rabies monoclonal antibody (RMAb)
for post exposure prophylaxis. IJCH. 2018;30(3):196-201. [PubMed] [Google Scholar]
Fan L, Zhang L, Li J, Zhu F. Advances in the progress of monoclonal antibodies for rabies. Hum Vaccin
Immunother. 2022 Dec 31;18(1):2026713.[PubMed] [Google Scholar]
Application for inclusion of anti-rabies virus monoclonal antibodies to the world health organization’s model
lists of essential medicines and essential medicines for children. Available from: https://cdn.who.int/media/
Copyright (c) 2022 Author's
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.