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Current WHO Guide –Current WHO Guide –RabiesRabies

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Prophylaxis and Prophylaxis and Treatment – of RabiesTreatment – of Rabies

qPEP – Pre exposure prophylaxis

qPET – Post exposure Treatment

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Rabies - PEPRabies - PEP

q3 dose regimenqA dose is 1 ml IM or 0.1 ml intra-

dermalq

Days 0, 7, 28qDeltoid or Anterio-lateral thighqBooster only one dose of 1 ml IM or

0.1 ml intra-dermalq

1 to 3 years (depending on risk)or If titre fall below 0.5 IU/mlqAfter each suspected rabid bite

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General ConsiderationsGeneral ConsiderationsPET PET 

qWHO strongly advocates the use of modern (purified products preparedon cell-culture) vaccines for PET thatcomply with WHO criteria

qWHO urges to abandon completelythe production of brain-tissuevaccines

q 14 Asian countries that still produce

nerve tissue vaccine to discontinueproduction by 2006.

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Rabies PET Rabies PET 

q Immediate washing / flushing and disinfection of the wound, ethanol, Iodine 

q It is an emergency and as a general rule shouldnot be delayed or deferred

qDoes not have contraindications if modern

purified rabies biologicals are usedqMust be applied using vaccine regimens and

routes of administration that have been provento be safe and effective.

qNever change the schedule prescribed

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General rulesGeneral rules

q Wounds should be treated immediately.

q Vaccine and serum therapy as soon as possible,

q should not await the results of laboratory diagnosis

q Or be delayed by dog observation

q pregnancy and infancy are nevercontraindications

q persons who present even months after having been bitten need PET 

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Rabies PET - ModalitiesRabies PET - Modalities

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HRIG - PET HRIG - PET 

q Infiltrate into the depth of the wound andaround the wound the HRIG

q Any remainder should be injected at an IMsite distant from that of vaccine inoculation

q Quantities/volume of RIG: 20IU/ kg for HumanRIG or 40 IU/ kg of Equine RIG

q Should not exceed the total recommendeddose

q If the calculated dose is insufficient to

infiltrate all wounds, sterile saline may beused to dilute it 2 to 3 fold to permitthorough infiltration

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WHO Approved VaccinesWHO Approved Vaccines

qPurified chick embryo cellvaccine (PCECV) Rabipur

qHuman diploid cell vaccine

(HDCV) RabivacqPurified vero cell vaccine(PVCV) Verorab, Imovax

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Which of the Three ??Which of the Three ??

qWHO recommends any of the three

qAll three produce good AB titres wellabove the desired 0.5 IU/ml

qAll three have equal long lasting efficacy

qChoice is YOURS.

qClaims of superiority of any one over theothers are not TRUE

qOther vaccines - be careful in acceptingthem

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Rabies PET –Rabies PET –IM - VaccinationIM - Vaccination

q Never into the Gluteal region

q Only into deltoid or Anterio-lateral thigh

q Classical 5 dose intramuscular regime

q “Essen” regimen on days 0, 3, 7, 14 and 28 

q As an alternative, the 2-1-1 regimen

q 2 doses are given on day 0 -right and leftarm.

q One dose in the deltoid on day 7 & 21

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Rabies PET –Rabies PET –Intra-dermal Vaccin.Intra-dermal Vaccin.

q Intra-dermal injections reduce thevolume of vaccine required

q There by the vaccine cost by 60%

to80%

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Intra-dermal RegimensIntra-dermal Regimens

q8-4-1-1-1 when no HRIG is available

q8-site intra-dermal for Rabivac, Rabipur

qDose of 0.1 ml per ID site

q2 site intradermal for Verorab, Imovax

q2-2-2-1-1

qDose of 0.1 ml per ID site

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Please Remember Please Remember 

qRabies can only beprevented- PEP

qIt is 100% fat if clinicallymanifests

qPET is the only Treatment.

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IMA Sincerely ThanksIMA Sincerely Thanks

 AVANTIS