Current WHO Guide

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Current WHO Guide Rabies
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Prophylaxis and Treatment of Rabies

• PEP Pre exposure prophylaxis
• PET Post exposure Treatment

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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

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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.

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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

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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

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Rabies PET - Modalities
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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

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WHO Approved Vaccines

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

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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

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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

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Rabies PET Intra-dermal Vaccin.

• Intra-dermal injections reduce the volume of
  vaccine required
• There by the vaccine cost by 60 to80

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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

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Please Remember

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

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IMA Sincerely Thanks

• AVANTIS