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
● Dose of 0.1 ml per ID site
Please Remember

● Rabies can only be

prevented- PEP
● It is 100% fat if clinically
manifests
● PET is the only Treatment.
IMA Sincerely Thanks

AVANTIS