The Swiss Rabies Centre carries out rabies antibody measurements (post-vaccination titre determination) as well as testing for rabies virus.
In rabies vaccination, a distinction is drawn between preventive vaccination before any contact with the virus (pre-exposure prophylaxis) and the more complicated vaccination after possible contact (post-exposure prophylaxis) (FOPH guidelines and recommendations: pre- and post-exposure rabies prophylaxis in humans, German).
Pre-exposure prophylaxis (PrEP)
PrEP is recommended for people likely to come into contact with rabies virus in the course of their work (such as veterinarians, veterinary students, veterinary practice staff or animal keepers) or for people travelling to rabies risk countries, especially if they have contact with animals there. Post-exposure prophylaxis (PEP) is shorter and less complicated for people who have had prior PrEP. Pre-travel vaccination is also recommended because vaccines and immunoglobulins (antibodies) are not always available in many destination countries.
Diagram of pre-exposure prophylaxis (PrEP) and PEP according to FOPH guidelines (adults and children without immunosuppression):
Please note that special requirements apply to people suffering from immunosuppression (german or french).
Post-exposure prophylaxis (PEP)
A combination of vaccination and administration of antibodies (immunoglobulins) is used to prevent rabies viruses that have been transmitted to a human, e.g. by a dog bite, from reaching the nerve pathways. Once viruses are in the nerve cells, nothing more can be done to combat them, which is why PEP should be started as soon as possible after a chance of infection.
In most cases, rabies is transmitted to humans by bites and scratches from infected animals or by contact between their saliva and human mucous membranes (e.g. in the eye, nose or mouth). Whether PEP is indicated can be assessed by means of a risk evaluation (Pre- and post-exposure prophylaxis for human rabies, see chapter 6 > fig 1, p 13), German).
Immediate steps after contact with a potentially rabid animal
Wash out injuries with soap and water for 15 minutes and disinfect if possible. Then consult a medical facility immediately to clarify whether to initiate PEP. This is necessary even for people who have already been vaccinated against rabies.
Serological checks
A serological check is recommended after all PEP and in special situations also after PrEP. An antibody level of ≥0.5 IU/ml (in the rapid fluorescent focus inhibition test (RFFIT)) is the WHO-defined correlate for post-vaccination protection. If the antibody level is not high enough, further vaccination doses are recommended until the figure of 0.5 IU/ml is reached.
Diagram of post-exposure prophylaxis (PEP) according to FOPH guidelines:
Information for doctors on sample submission and testing
Rabies antibody titre determination
Test days, duration of testing and reporting
The test is to be carried out once a week early on Monday morning.
Samples must reach the laboratory by 10 am on Friday at the latest for registration and sample preparation.
Results are available on the following Wednesday afternoon and are sent by A-Post priority mail or, if requested, by email.
We aim to keep to the above times but it may take longer to produce results under certain circumstances (e.g. very high sample volumes, holiday periods, peak travel season, repeat tests due to non-valid results, etc.); results are generally available within 14 days. Please also note our general terms and conditions (IVI GTC).
Sample material, test request form, packaging and dispatch
Sample material: 0.5–2 ml of serum from 2–10 ml of native whole blood (without anticoagulants).
Each sample must be accompanied by a fully completed and signed test request form (Document see below, request form for rabies antibodies tests in humans, German).
Test tubes must be clearly labelled and packaged in a metal or plastic sleeve to prevent breakage.
No refrigeration is required for sending by post.
Important: For biosafety reasons, samples must not be brought to the laboratory in person but must be sent by post or by courier. And once samples have arrived at the laboratory they cannot leave again; we are no longer able to return samples.
Rabies investigation of suspected clinical cases
Please give advance notification by phone or email.
There are currently no tests that can detect an infection during incubation. Diagnosis is difficult even where symptoms are present. A single laboratory test is insufficient to confirm a clinical suspicion of rabies (virus excretion may be intermittent or absent). The laboratory tests need to be repeated. A negative result from a single serum sample or CSF sample in particular is not conclusive. (FOPH guidelines and recommendations: pre- and post-exposure rabies prophylaxis in humans ; chap 7.1. Laboratory diagnosis, p16 - german or french; WHO expert consultation on rabies: third report).
Sample material for intra-vitam diagnostics
Saliva (3 samples taken 3–6 hours apart give the best sensitivity)
Serum
CSF
Neck skin biopsy (including hair follicle).
Sample material for post-mortem diagnostics
Brain stem or fresh, unfixed brain tissue
If samples cannot be brought to the laboratory immediately, they must be refrigerated or stored at -20°C.
