Current WHO Guide – Rabies

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 2-1-1 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 • 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

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