Post-Exposure Treatment of Subjects Exposed to Rabies. — Essen Scheme

Summary

A post-exposure vaccination procedure (Essen-Scheme, vaccination on days 0, 3, 7, 14, 30 and 90) for immunization of man with a highly antigenic tissue culture vaccine (antigenic value ≥ 1.3) is described which induces an early and long-lasting immunity against Rabies. Some characteristic features of this procedure are discussed. So far, this procedure was applied to at least 50,000 persons exposed to infectious Rabies virus.

Due to the extremely low and mostly unstandardized antigenicity of the brain type, such as Semple-, Hempt-, Fermi-, Suckling Mouse Brain and Duck-Embryo-vaccines, multiple daily injections of large amounts of virus-containing tissue suspension up to 25 times plus eventual additional boosters on days 30 and 90 were necessary to induce the protective immune mechanism(s) in post-exposure Rabies vaccination treatment. This regimen, originally introduced by L. Pasteur and coworkers was never doubted and systematic comparative trials aiming at dose reduction were only rarely performed. On the contrary, a theory on “permanent antigenic stimulus” was put forward not taking into consideration the class diversification of the humoral immune response or the cellular events during antibody formation. Local and systemic adverse reactions accompanied—and still are characteristic and highly feared— post-exposure rabies vaccination and made this “treatment” a dreadful experience to many of the vaccinees.