Rabies: Pre-exposure and Post-Exposre Prophylaxis

INTRODUCTION

• Devloped by Louis Pasteur
• Rabies vaccine is prepared from fixed strain of virus.

TYPE OF RABIES VACCINE

• Devloped by Louis Pasteur
• Semple Vaccine grown in neural tissue of embryonated Hen’s egg .
• Duck embryo Vaccine 
• killed sheep vaccine
• HDCV vaccine (safest)

1. Chick embryo fibroblast
2. Vero continous cell line
   
3. Human dipliod cell vaccine

PRE-EXPOSURE VACCINATION

GIVEN TO

• People at high risk of exposure to rabies
• Laboratory staff working with rabies virus
• Veterinarians, animal handlers and wildlife officers

SCHEDULE

• Given on days 0, 7 and 21 or 28
• 1 or 0.5 ml/dose depending on the vaccineor i.d. (0.1 ml/inoculation site)

REGION OF ADMINISTRATION

• Deltoid area of the arm(adult)
• Anterolateral area of the thigh (children).
• Never administered in the gluteal area( in lower neutralizing antibody titres)

ADVERSE REACTION

• Well tolerated
• Minor Adverse reactions
• local pain
• erythema
• swelling
• Puritis
• Neurological comlication with semple vaccine.
• Duck embryo Vaccine allergies 

POST-EXPOSURE PROPHYLAXIS 

• Thorough washing of the wound with soap/detergent and water
• Application of ethanol or an aqueous solution of iodine or povidone.
• Standard WHO Intramuscular regimen- 0, 3, 7, 14, 28 (one dose each at day 0, 3, 7, 14, 28)
• Reduced Multisite Intramuscular regimen — 2-1-1 (two dose on each arm on day 0, one dose each at day 7 & 21)
• Intradermal schedules : 2 site = 2  2 2 0 1  1 (At 2 sites on day 0, 3, 7 and single site on day 28, 90)
• Intradermal schedules: 8 site = 8-0-4-0-1-1 (on 8 sites at day 0, on 4 sites at day 7, on one site at day 28 & 90)

VACCINATED PREVIOUSLY

• 3 doses of IM HDC vaccine on day 0, 3, 7 are recommended if :

1.  The patient’s antibody titre is not known.
2. The antibody titre < 0.5 IU/ml.
3. The bite is severe.

Only 2 doses are recommended if

• Antibody titre is more than 0.5 IU/ml.
• The bite is not so severe

 Dosage HRIG

• The dose for HRIG is 20 IU/kg body weight
• For ERIG and F(ab’)2 products 40 IU/kg body weight.
• Administered into and around the wound site.
• Standard WHO Intramuscular regimen- 0,3,7,14,28 (one dose each at day 0,3,7,14,28)
• Reduced Multisite Intramuscular regimen — 2-1-1 (two dose on each arm on day 0, one dose each at day 7 & 21)
• Intradermal schedules : 2 site= 2  2 2 0 1  1 (At 2 sites on day 0,3,7 and single site on day 28, 90)
• Intradermal schedules: 8 site= 8  0 4 0 1  1 (on 8 sites at day 0, on 4 sites at day 7, on one site at day 28 & 90)
• Pre exposure prophylaxis — 0,7,28
• Post exposure prophylaxis for those already immunized- 0,3,7