Current WHO Guide – Rabies

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

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

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.

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

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

Rabies PET - Modalities

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

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

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

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 2-1-1 regimen 2 doses are given on day 0 -right and left arm. One dose in the deltoid on day 7 & 21

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

Intra-dermal Regimens 8-4-1-1-1 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 2-2-2-1-1

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

IMA Sincerely Thanks AVANTIS