Rabies: Pre-exposure and Post-Exposre Prophylaxis
PRE EXPOSURE AND POST EXPOSURE PROPHYLAXIS FOR RABIES
INTRODUCTION
- Devloped by Louis Pasteur
- Rabies vaccine is prepared from fixed virus strain of virus.
TYPE OF RABIES VACCINE
- Semple Vaccine grown in neural tissue of embryonated Hen’s egg .
- Duck embryo Vaccine
- Killed sheep vaccine
- HDCV vaccine (safest)
- Chick embryo fibroblast
- Vero continous cell line
- Human dipliod cell vaccine
GIVEN TO
- People at high risk of exposure to rabies
- Laboratory staff working with rabies virus
- Veterinarians, animal handlers and wildlife officers
- Travelling to isolated areas.
- Consists of three full i.m doses of cell-culture- or embryonated-egg-based vaccine
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)
INTERACTION
- Chloroquine reduce the antibody response
ADVERSE REACTION
- Well tolerated
- Minor Adverse reactions
- local pain
- erythema
- swelling
- Puritis
- Neurological comlication with semple vaccine
- Duck embryo Vaccine allergies
POST-EXPOSURE PROPHYLAXIS
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CATEGORY(as per WHO) |
FEATURES |
TREATMENT |
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II |
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III |
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WOUD TREATMENT
- Thorough washing of the wound with soap/detergent and water
- Application of ethanol or an aqueous solution of iodine or povidone.
NOT VACCINATED BEFORE
Intramuscular schedule
- Routine schedule: doses on 0, 3, 7, 14 and 28 days, booster on day
- Abbreviated multisite schedule: 2-1-1 regimen one dose
Intradremal schedules
- 2-site intradermal schedule : One dose at each of two sites on days 0, 3 and 7 and at one site on days 28 and 90.
- 8-site intradermal schedule: On day “0” at 8 site, Day 7 at 4 site,Days 28 and 90 at one site 8-0-4-0-1-1
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.
VACCINATED PREVIOUSLY
- 3 doses of IM HDC vaccine on day 0, 3, 7 are recommended if :
- The patient’s antibody titre is not known.
- The antibody titre < 0.5 IU/ml.
- 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.
Exam Question
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)
- Chick embryo fibroblast
- Vero continous cell line
- 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
|
CATEGORY(as per WHO) |
FEATURES |
TREATMENT |
|
I |
|
|
|
II |
|
|
|
III |
|
|
- 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 :
- The patient’s antibody titre is not known.
- The antibody titre < 0.5 IU/ml.
- 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
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