Current WHO Guide – Current WHO Guide – Rabies Rabies

Prophylaxis and Prophylaxis and Treatment – of RabiesTreatment – of Rabies

PEP – Pre exposure prophylaxis

PET – Post exposure Treatment

Rabies - PEPRabies - 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 General Considerations PETPET

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 PETRabies 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 rulesGeneral 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 - ModalitiesRabies PET - Modalities

HRIG - PETHRIG - 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 VaccinesWHO 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 ??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 –Rabies PET –IM - Vaccination 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 – Rabies PET – Intra-dermal Vaccin.Intra-dermal Vaccin.

Intra-dermal injections reduce the volume of vaccine required

There by the vaccine cost by 60% to80%

Intra-dermal RegimensIntra-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 Dose of 0.1 ml per ID site

Please RememberPlease Remember

Rabies can only be prevented- PEP

It is 100% fat if clinically manifests

PET is the only Treatment.

IMA Sincerely ThanksIMA Sincerely Thanks

AVANTIS