Generic Name: Rabies Vaccine (Human) BP,
Manufacturer: Incepta Pharmaceuticals Ltd.
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Indications
The rabies vaccine is suitable for the prevention of immunity against rabies and the treatment of patients with suspected exposure to rabies.
Pharmacology
When rabies immunoglobulin is administered, it may cause either immediate or delayed hypersensitivity reactions. The most common initial responses are hypotension, dyspnea, and urticaria. Delay reactions include inflammation, fever, pruritis, rash or urticaria, adenopathy, and arthralgia.
Dosage & Administration
Boosters: After that, one injection every 5 years or when the titer is less than 0.5 lU/ml.
Post-exposure immunization:
Intramuscular schedules: One Intramuscular (IM) dose comprised of 1 ml.
Standard intramuscular (1-1-1-1-1) regimen:
Abbreviated multisite (2-1-1) regimen:
Intradermal schedules: One intradermal (ID) dose is comprised of 0.1 ml.
Thai Red Cross (2-2-2-0-1-1) schedule:
Or
WHO Modified Thai Red Cross (2-2-2-0-2) schedule:
In case of severe (WHO category 3) wounds, rabies immunoglobulin should be administered as soon as possible with the first dose of the rabies vaccine. The anti-rabies immunoglobulin should be used as local wound soakage injections as much as possible, with the rest part for muscle injection. The rabies vaccine should be administered in the different injection sites.
Vaccination of immunized subjects:
If the vaccine was administered in less than 5 years of exposure (cell culture rabies vaccine): 2 injections one on each of DO, D3. If vaccine administered in more than 5 years of exposure or incomplete vaccination: 5 injections on DO, D3, D7, D14 and D28 with the administration of immunoglobulin if required. Post-exposure vaccination must be administered on the basis of severity under medical supervision.
WHO guidelines on post-exposure treatment depending on wound severity-
Touching or feeding of animals, licks on intact skin:
Recommended treatment: None, if reliable case history is available.
Nibbling of uncovered skin, minor scratches, superficial bites (except on the head, neck, shoulder girdle. arms, or hands) or abrasions without bleeding, licks on broken skin:
Recommended treatment: Administer vaccine immediately on Day 0, D3, D7, D14, and D28.Stop treatment if the animal remains healthy throughout the observation period of 10 days or if the animal is killed humanely and found to be negative by appropriate laboratory techniques.
Single or multiple transdermal bites or scratches especially on the head, neck, shoulder girdle, arms, or hands. Contamination of mucus membrane with saliva (i.e. licks on broken skin):
Recommended treatment: Administer rabies immunoglobulin immediately with the first dose of rabies vaccine. Administer rabies vaccine on Day 0, D3, D7, D14, and D28 or D90 (optional). Stop treatment if the animal remains healthy throughout the observation period of 10 days or if the animal is killed humanely and found to be negative by appropriate laboratory techniques
Administrations:
Prompt and gentle thorough washing with soap or detergent and flushing the wound with running tap water for at least 15 minutes.
After washing, disinfectants like either ethanol (700 ml/l) or tincture, or an aqueous solution of iodine or povidone-iodine must be applied.
Don’t bandage or suture the wound.
Co-administration: Corticosteroids and immunosuppressive treatment may interfere with antibody production and cause vaccination failure. In these cases, a titration of neutralizing antibodies should be performed.
Interaction
Vaccine effectiveness may be reduced if immunosuppressants are used at the same time.
Contraindications
The rabies vaccination is not recommended in the following situations:
Pre-exposure symptoms include severe fever, febrile infection, acute illness, and chronic illnesses that worsen with time.
Hypersensitivity responses to the rabies vaccination or any of its components have been documented. Post-exposure
Because rabies is a fatal illness, any contraindication to exposure, treatment, or anti-rabies therapy should be carefully examined before rejecting an individual for anti-rabies treatment.
Side Effects
Minor local responses such as discomfort, erythema, edema, pruritus, and induration might occur at the injection site and can persist for up to 48 hours. Shivering, fainting, asthenia, dizziness, respiratory signs (dyspnoea, wheezing), fever, stomach discomfort, vomiting, and allergic skin responses are all symptoms of a moderate fever (urticaria, rash, itching).
Pregnancy & Lactation
Pregnancy. The possibility of rabies vaccination administration during pregnancy is uncertain. Pregnancy is not regarded as a contraindication to post-exposure prophylaxis due to the severity of the illness.
It is unknown if the vaccination is secreted in human breast milk during lactation. Breastfeeding is not regarded as a contraindication due to the severity of the illness.
Precautions & Warnings
The rabies vaccine is suitable for the prevention of immunity against rabies and the treatment of patients with suspected exposure to rabies.
Pre-exposure immunization:
Immunization after exposure:
Storage Conditions
Keep out of the reach and sight of children. Store at +2 °C to +8 °C. Transportation should also be at +2 °C to +8 °C. Protect from light. Do not freeze
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