Rabies: Pre-exposure and Post-Exposre Prophylaxis

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)
  1. Chick embryo fibroblast
  2. Vero continous cell line
  3. 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 

CATEGORY(as per WHO)

FEATURES     

TREATMENT

I

  • Touching/feeding suspect animals
  • skin is intact
  • None

II

  • minor scratches without bleeding from contact
  • broken skin
  • Immediate vaccination
  • Local treatment of wound

III

  • More bites, scratches, licks on broken skin
  • Contact that breaks the skin
  • Exposure to bats
  • Immediate vaccination
  • Adminstration of rabies immunoglobin
  • Wound treatment

 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

  1. Routine schedule: doses on 0, 3, 7, 14 and 28 days, booster on day
  2. Abbreviated multisite schedule: 2-1-1 regimen one dose  

Intradremal schedules

  1. 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.
  2. 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 :
  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.
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)
  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 

CATEGORY(as per WHO)

FEATURES     

TREATMENT

               I

  • Touching/feeding suspect animals
  • skin is intact
  • None

              II

  • minor scratches without bleeding from contact
  • broken skin
  •  Immediate vaccination
  • Local treatment of wound

              III

  • More bites, scratches, licks on broken skin
  • Contact that breaks the skin
  • Exposure to bats
  • Immediate vaccination
  • Adminstration of rabies immunoglobin
  • Wound treatment
  • 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
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