ASK DIS: Rabies: Vaccine and Rabies Immunoglobulin

Availablity in Hospital Keningau:

Verorab (PVRV - purified inactivated rabies vaccine, prepared on vero cell) – Sanofi Pasteur

Risk Category:

RISK CATEGORY	TYPE OF EXPOSURE	ACTION TO BE TAKEN
1	Touching/feeding animal. Licking of intact skin.	Nil if history is reliable. If history not reliable, treat as category 2.
2	Nibbling of uncovered skin. Superficial scratch, no bleeding. Licking of broken skin.	Apply wound treatment. Administer vaccine. Do not administer anti-rabies immunoglobulin. Stop vaccination if animal is rabies negative in laboratory tests, or remains healthy after 10 -14 days observation (dog or cat). Continue vaccination if animal is not found/captured.
3	Bites/scratches which penetrate the skin and draw blood. Licking mucous membrane. Multiple bites. Any wild animals bites	Apply wound treatment. Administer vaccine. Administer anti-rabies immunoglobulin. Administer anti-tetanus and antibiotic treatment. Stop vaccination if animal is rabies negative in laboratory tests, or remains healthy after 10 - 14 days observation (dog or cat). Continue vaccination if animal is not found/captured.

Effective treatment soon (within a few days, but as soon as possible) after exposure to rabies can prevent the onset of symptoms and death.
Post-exposure prevention consists of local treatment of the wound, administration of rabies immunoglobulin (if indicated), and immediate vaccination

Post Exposure Vaccine (PEP)

Indicated for Risk Category 2 and 3
Vaccination after exposure (post-exposure) is recommended for all individuals who have had contact with an animal (e.g., bites or abrasions) that they believe may be, or which is proven to be, rabid.
Area for injection for vaccine;
i. Adult - IM at deltoid area
ii. Children – IM at anterolateral aspect of thigh.
Pregnancy and Infancy are never contraindications to PEP.

Status	Dosing
Previously unvaccinated people	4 doses at day 0, 3, 7, and 14. In addition to rabies vaccine, these people should also receive a dose of RIG at the same time as the first dose of the vaccine to provide rapid protection that persists until the vaccine works
Previously vaccinated people	2 doses at day 0 & 3 and RIG is unnecessary and should not be given.
Immunocompromised patient (corticosteroids, other immunosuppressive agents, chloroquine, and immunosuppressive illnesses e.g. congenital immunodeficiency, HIV, leukaemia, lymphoma, generalized malignancy)	5 doses at day 0, 3, 7, 14 and 28. In addition to rabies vaccine, these people should also receive a dose of RIG at the same time as the first dose of the vaccine to provide rapid protection that persists until the vaccine works.

Rabies Immunoglobulin:

Rabies Immunoglobulin is indicated for Risk Category 3 only
Human anti-rabies immunoglobulin(HRIG)-20iu/kg body weight
Heterologous (equine) immunoglobulin(RIG) -40iu/kg body weight
Route of administration: IM at an anatomical site distant from vaccine administration.
If immunoglobulin is not available, it can be delayed up to 7 days post 1st vaccine given.
Beyond the seventh day, RIG is not recommended since an antibody response to the vaccine is presumed to have occurred.

References:

ASK DIS