Thursday, July 20, 2017

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:
  • Interim Guideline for Human Rabies Prevention and Control in Malaysia.
  • http://www.who.int/rabies/human/postexp/en/
  • WHO Guide for Rabies Pre and Post Exposure Prophylaxis In Humans

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