1. Current WHO Guide – Rabies

2. Prophylaxis and Treatment – of Rabies
PEP – Pre exposure prophylaxis
PET – Post exposure Treatment

3. Rabies - PEP 3 dose regimen A dose is 1 ml IM or 0.1 ml intra-dermal
Days 0, 7, 28
Deltoid or Anterio-lateral thigh
Booster only one dose of 1 ml IM or 0.1 ml intra-dermal
1 to 3 years (depending on risk)
or If titre fall below 0.5 IU/ml
After each suspected rabid bite

4. General Considerations PET
WHO strongly advocates the use of modern (purified products prepared on cell-culture) vaccines for PET that comply with WHO criteria
WHO urges to abandon completely the production of brain-tissue vaccines
14 Asian countries that still produce nerve tissue vaccine to discontinue production by 2006.

5. Rabies PET
Immediate washing / flushing and disinfection of the wound, ethanol, Iodine
It is an emergency and as a general rule should not be delayed or deferred
Does not have contraindications if modern purified rabies biologicals are used
Must be applied using vaccine regimens and routes of administration that have been proven to be safe and effective.
Never change the schedule prescribed

6. General rules Wounds should be treated immediately.
Vaccine and serum therapy as soon as possible,
should not await the results of laboratory diagnosis
Or be delayed by dog observation
pregnancy and infancy are never contraindications
persons who present even months after having been bitten need PET

7. Rabies PET - Modalities

8. HRIG - PET
Infiltrate into the depth of the wound and around the wound the HRIG
Any remainder should be injected at an IM site distant from that of vaccine inoculation
Quantities/volume of RIG: 20IU/ 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

9. WHO Approved Vaccines
Purified chick embryo cell vaccine (PCECV) Rabipur
Human diploid cell vaccine (HDCV) Rabivac
Purified vero cell vaccine (PVCV) Verorab, Imovax

10. Which of the Three ?? WHO recommends any of the three
All three produce good AB titres well above the desired 0.5 IU/ml
All three have equal long lasting efficacy
Choice is YOURS.
Claims of superiority of any one over the others are not TRUE
Other vaccines - be careful in accepting them

11. Rabies PET – IM - Vaccination
Never into the Gluteal region
Only into deltoid or Anterio-lateral thigh
Classical 5 dose intramuscular regime
“Essen” regimen on days 0, 3, 7, 14 and 28
As an alternative, the regimen
2 doses are given on day 0 -right and left arm.
One dose in the deltoid on day 7 & 21

12. Rabies PET – Intra-dermal Vaccin.
Intra-dermal injections reduce the volume of vaccine required
There by the vaccine cost by 60% to80%

13. Intra-dermal Regimens
when no HRIG is available
8-site intra-dermal for Rabivac, Rabipur
Dose of 0.1 ml per ID site
2 site intradermal for Verorab, Imovax

14. Please Remember Rabies can only be prevented- PEP
It is 100% fat if clinically manifests
PET is the only Treatment.

15. IMA Sincerely Thanks
AVANTIS