Prevention and immunisation against rabies

By: MOHIT KADYANRoll no: 26

Rabies is 100% fatal disease, till date only 4 victims had survived following intensive life support and nursing care

It is preventable only with modern vaccines and immunoglobulins

Rabies is preventable through wound care and correct rabies prophylaxis

Incorrect/ wrong treatment physician can lead to death of animal bite victims and he may be sued under Consumer Protection Act.

Rabies vaccine is defined as fluid or dried preparation of rabies “fixed” virus grown in neural tissues of rabbits,sheep,goats,rats or in embryonated duck eggs or in cell cultures

inactivated by a suitable method

RABIES VACCINES

TYPES:

Neural vaccines

Non neural vaccines

(a). Semple vaccine: 5% suspension of sheep brain infected with fixed virus, inactivated with phenol at 37⁰c leaving no residual virus.

(b). BPL vaccine: semple vaccine inactivated with beta propiolactone, more antigenic.

(c). Infant brain vaccine: prepared from suckling mouse brain, inactivated by UV radiation, BPL or phenol.

Neural vaccines

Chance of neurological complication is 1 in 1600

Egg vaccines

Tissue culture vaccines

Non neural vaccines

Subunit vaccines

1. Duck egg vaccine: fixed virus grown in duck eggs and inactivated with BPL

2. Live attenuated chick embryo vaccine: LEP- 40-50 eggs HEP- 180 eggs for cats and cattle

Egg vaccines

1. Human diploid cell culture vaccine: purified concentrated preparation of “PITMAN-MOORE” strain grown on diploid cells

highly antigenic , costly

2. Purified chick embryo vaccine: (PCEV) contains “ FLURY LEP” strain inactivated by BPL.

---WHO recommended most effective

Tissue culture vacccines

Recombinant vaccines containing cloned surface glycoprotein.

Subunit vaccine

Post-exposure prophylaxis local wound care vaccine administration • Pre-exposure prophylaxis• Post-expore treatment of persons who have

been vaccinated previously

Anti-rabies immunisation

Indicated when person has been bitten , scratched , or licked by an animal

Aims at neutralizing the inoculated virus before it enters the nervous system

Post-exposure prophalyxis

Local treatment of wound1.Cleaning: Immediate flushing and washing wounds or

scratches with soap and water for atleast 15 minutes under tap water

In case of puncture wounds, catheters should be used to irrigate wounds.

It minimises the risk and this procedure is standard worldwide.

2.Chemical treatment: after cleaning, virucidal agents alcohol(400-700ml/l) or 0.01% aqueous solution of iodine or povidone iodine

Quaternary ammonium compounds like savlon, cetavlon are no longer recommended.

3 Suturing: bite wounds should not be immediately sutured to prevent trauma which may spread virus to deeper tissues. If necessary after 24-48 hrs later with minimum stitches

4 Anti-rabies serum: local application of anti-rabies serum or its infiltration around the wound is highly effective. Dosage is 20 IU/kg wt.

5 Antibiotics and anti-tetanus measure: application of antibiotics and anti-tetanus procedures when indicated should follow local treatment

Observing animal: the only way to estimate the risk after bite is to observe animal for atleast 10 days after bite. If symptoms of rabies are seen the animal is killed humanely and head sent under refrigeration to laboratory for rabies examination

If animal remains alive and healthy after 10 days of bite, there is no indication of anti-rabies treatment

Cell culture and purified duck embryo vaccine with a potency of at least 2.5 IU should be applied .

Post-exposure vaccination

A. Intramuscular schedule

B. Intradermal schedule

Vaccine used: HDCS vaccine(tissue culture vaccine)

Site: deltoid Dose: 1 ml

Day

Intramuscular regimen

0 3 7 14 28

Rabies Ig

Standard WHO vaccination regimen

Dose: one IM dose (1.0 or0.5 ml) into deltoid

Rabies Ig

On day 0 two doses are given one in right arm and other in left arm

On day 7 and 21 one dose IM in deltoid.

Reduced multisite regimen (2-1-1)

Day 0 Day 7 Day 21

2 site intradermal regimen

8 site intradermal regimen

B. Intradermal schedule

Vaccine used: HDCV, PCECV and PVRV Site: ID on anterior abdominal wall Dose : 0.2 ml of HDCV and PCEC and 0.1

ml of PVRV

REGIMEN: 2 doses simultaneously on two sites on days 0,3,7. no dose on day 14 and one dose each on day 28 and 90.

2 site intradermal regimen(2-2-2-0-1-1)

Day0 Day3 Day7 Day28 Day 90

Rabies Ig

Vaccine: HDCV and PECE Dose: 0.1 ml Schedule: 8 doses on different sites, deltoid,

lateral thigh, suprascapular region and lower quadrant of abdomen on day 0, no dose on day 4, then 4 doses simultaneous at four sites on deltoid , thighs , no dose on day 14 and single dose on day 28 and 90.

(b) 8-site intradermal method

Day 0 Day7 Day 28 Day90

8 4

Rabies Ig

Indications:

Lab. staff handling virus and infected animals

Veterinarians Animal handlers and catchers Wildlife officers and naturalists Taxidermist and quarantine officers Vaccine used: tissue culture vaccine

Pre-exposure prophylaxis

3 injections in doses of 1 ml IM or 0.1 ml intradermally in deltoid region or anterolateral area of thigh in children.

Regimen:

Day 0 Day 7 Day 28 1year(booster) Every3 yrs(booster)

Rabies Ig

Boosters: if serum samples after one month of third dose shows titre less than 0.5 IU/ml , booster doses are a given in dose of 1ml IM or ID till antibody becomes demonstrable.

Futher booster doses should be given at interval of 3 yrs as long as person remains exposed

If antibody titre is unknown , or if wound is severe, three 1ml doses of HDC vaccine are given

If antibody titre is known and is more than 0.5IU/ml and bite is not severe only 2 doses are needed

Post-exposure treatment of previously vaccinated persons

Day0 Day3 Day7

Day0 Day 3

Registration and licensing of all domestic dogs.

Immediate destruction of dogs and cats bitten by rabid animals

Restraint of dogs in public place

Immunization of dogs

Health education about abies prevention of rabies

Control of urban rabies

Animal India Trust runs an anti-rabies vaccination programme along with animal birth control programme.

Dogs captured for sterilisation are vaccinated against rabies at the same time.

This helps by reducing the no. of infective dogs and thus less dogs transfer disease to humans.

Reduces medical expenses and reduction in risk of human health

Animal India Trust’s anti rabies vaccination programme