Dog bite

Weeraput Chadbunchachai, MD.

Reference.
• Rabies vaccines and immunoglobulins:
WHO position April 2018
• Replace WHO 2010 recommendation
Background
• Rabies is a viral zoonotic disease
• Causing 59000 human death every year
• occurs mainly in underserved populations
• Most cases occur in Africa and Asia
• 40% of cases in children aged <15 years
• diagnosis of rabies relies on clinical presentation and
history of exposure to the rabid animal
• Administeres to different route (rabies vaccine)
• Intradermal or intramuscular
Administration of rabies vaccines
• vaccination for post-exposure
prophylaxis (PEP) and vaccination
for pre-exposure prophylaxis
(PrEP)
• both PEP and PrEP can be
administered either ID or IM route
• ID injection sites are the deltoid
region and either the anterolateral
thigh or suprascapular regions
• One ID dose is 0.1 mL of vaccine
Administration of rabies
vaccines
• The recommended site for IM
administration
• deltoid area of the arm for
adults and children aged ≥2
years
• anterolateral area of the thigh
for children aged <2 years
• one IM dose is an entire vial of
vaccine, irrespective of the vial
size
Post-exposure
prophylaxis
The WHO rabies exposure
categories
• Category I :
• touching or feeding animals, animal licks on intact skin
• Non exposure
• Category II :
• nibbling of uncovered skin, minor scratches or abrasions
without bleeding (exposure)
• Category III :
• single or multiple transdermal bites or scratches,
contamination of mucous membrane or broken skin with
saliva from animal licks, (severe exposure).
PEP consists of the following steps
• 1. all exposure wound should be irrigated with large
amount of water for 15 minutes, topical viricidal should
be administered
• 2. A series of rabies vaccine injections should be
administered promptly after an exposure.
• 3.RIG should be administered for severe category III
exposures. Wounds that require suturing should be
sutured loosely and only after RIG infiltration into the
wound
Rabies immunoglobulin (RIG)
:passive immunization
Rabies immunoglobulin
administration
• Should not be administered beyond 7 days after last
dose of vaccine
• skin test for ERIG is no longer required
• Administration
• maximum dose is 20 IU (hRIG) and 40 IU (eRIG) / kilogram
• Infiltrate as much as possible into the wound , the remain rig
could be used for another patient
Pre-exposure
prophylaxis
Pre-exposure prophylaxis (PrEP)
• recommended for individuals at higher risk due to
occupation
• sub-populations living in remote, rabies endemic areas,
where access to PEP is difficult
• 2 sites ID or a 1-site IM vaccine administration on
days 0 and 7 (immunocompromised patient should add
day 21 to day 28)
THANK YOU …