Current WHO Guide Rabies Prophylaxis and Treatment Rabies
Current WHO Guide – Rabies
Prophylaxis and Treatment – Rabies l PEP of – Pre exposure prophylaxis l PET – Post exposure Treatment
Rabies - PEP 3 dose regimen l A dose is 1 ml IM or 0. 1 ml intra-dermal l Days 0, 7, 28 l Deltoid or Anterio-lateral thigh l Booster only one dose of 1 ml IM or 0. 1 ml intra-dermal l 1 to 3 years (depending on risk) or If titre fall below 0. 5 IU/ml l After each suspected rabid bite l
General Considerations PET WHO strongly advocates the use of modern (purified products prepared on cell-culture) vaccines for PET that comply with WHO criteria l WHO urges to abandon completely the production of brain-tissue vaccines l 14 Asian countries that still produce nerve tissue vaccine to discontinue production by 2006. l
Rabies PET Immediate washing / flushing and disinfection of the wound, ethanol, Iodine l It is an emergency and as a general rule should not be delayed or deferred l Does not have contraindications if modern purified rabies biologicals are used l Must be applied using vaccine regimens and routes of administration that have been proven to be safe and effective. l Never change the schedule prescribed l
General rules Wounds should be treated immediately. l Vaccine and serum therapy as soon as possible, l should not await the results of laboratory diagnosis l Or be delayed by dog observation l pregnancy and infancy are never contraindications l persons who present even months after having been bitten need PET l
Rabies PET - Modalities
HRIG - PET l l l Infiltrate into the depth of the wound around the wound the HRIG Any remainder should be injected at an IM site distant from that of vaccine inoculation Quantities/volume of RIG: 20 IU/ kg for Human RIG or 40 IU/ kg of Equine RIG Should not exceed the total recommended dose If the calculated dose is insufficient to infiltrate all wounds, sterile saline may be used to dilute it 2 to 3 fold to permit thorough infiltration
WHO Approved Vaccines l Purified chick embryo cell vaccine (PCECV) Rabipur l Human diploid cell vaccine (HDCV) Rabivac l Purified vero cell vaccine (PVCV) Verorab, Imovax
Which of the Three ? ? WHO recommends any of the three l All three produce good AB titres well above the desired 0. 5 IU/ml l All three have equal long lasting efficacy l Choice is YOURS. l Claims of superiority of any one over the others are not TRUE l Other vaccines - be careful in accepting them l
Rabies PET – IM - Vaccination Never into the Gluteal region l Only into deltoid or Anterio-lateral thigh l Classical 5 dose intramuscular regime l “Essen” regimen on days 0, 3, 7, 14 and 28 l As an alternative, the 2 -1 -1 regimen l 2 doses are given on day 0 -right and left arm. l One dose in the deltoid on day 7 & 21 l
Rabies PET – Intra-dermal Vaccin. Intra-dermal injections reduce the volume of vaccine required l There by the vaccine cost by 60% to 80% l
Intra-dermal Regimens 8 -4 -1 -1 -1 when no HRIG is available l 8 -site intra-dermal for Rabivac, Rabipur l Dose of 0. 1 ml per ID site l 2 site intradermal for Verorab, Imovax l 2 -2 -2 -1 -1 l Dose of 0. 1 ml per ID site l
Please Remember l Rabies can only be prevented- PEP l It is 100% fat if clinically manifests l PET is the only Treatment.
IMA Sincerely Thanks AVANTIS
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