Rabies vaccine

Rabies remains a major health problem. In the world, about 50,000 people die from it every year, about 10 million people receive post-exposure prophylaxis. In Russia in 2004 there were 17 cases of rabies (including 6 children), in 2005 - 14 (4 children), in 2007 - 8 (there were no children); The vaccine against rabies is introduced 200-300 thousand persons per year.

The source and reservoir of the virus are wild carnivores, especially foxes and wolves, as well as dogs, cats, and in the countries of America - bats. A person becomes infected with a bite, with the oozing of damaged skin or mucous membranes, rarely through objects contaminated with saliva, when cutting carcasses, etc. Rabdovirus in the saliva of a sick animal appears no earlier than 10 days before the development of his symptoms of rabies, which determines the period of observation of a pet bite. The incubation period - from several days to 1 year (usually 30-90 days) depends on the infectious dose and the place of the bite: the most dangerous are the bites of the face, fingers and of the hands, genitals.

[1], [2], [3], [4], [5], [6]

Purpose of Rabies Vaccination

Emergency (post-exposure) - rabies prophylaxis is performed for people who have been in contact with animals, pre-exposure is for people of a number of professions - inactivated vaccines and specific immunoglobulins.

[7], [8], [9], [10], [11]

Contraindications for rabies vaccine

For post-exposure use of rabies vaccine there are no contraindications.

[12], [13], [14], [15], [16], [17], [18], [19], [20]

Dose and Administration Methods for Rabies Vaccine

[21], [22], [23], [24], [25], [26]

COCOVER

Prior to use in a vial make 1 mL of a solvent, the solution should be used within no more than 5 minutes, it is introduced slowly intramuscularly at a dose of 1 ml for children over 5 years and adults. deltoid, children up to 5 years - anterolateral thigh surface. Introduction to the buttock is not allowed.

[27]

Rabivak-Vnukovo-32

3 ml of the solvent are introduced into the ampoule with the vaccine; with vigorous shaking, the time for complete dissolution is no more than 5 minutes. Enter into the subcutaneous tissue of the abdomen, some 2-3 fingers from the midline, at or below the navel (as an exception, in the interscapular region). In case of salivation, superficial bites, scratches of the trunk or limbs of domestic animals that have become ill within 10 days after the bite, children under 8 years of age have a dose of 2 ml, over 8 years old - 3 ml. For more serious injuries at home and for any bites by wild animals, a single dose is 4 and 5 ml, respectively.

Rabipur

The rabies vaccine is diluted with 1 ml of water for injection and injected intramuscularly into the deltoid muscle, young children - into the anterolateral surface of the thigh with a dose of 1 ml, regardless of age.

Drugs used to prevent rabies

A drug	Content
COCAW - dry concentrated concentrated inactivated culture vaccine, Russia	Attenuated rabies virus grown in a Syrian hamster kidney cell culture, inactivated by UV rays, activity> 2.5 IU. Contains kanamycin sulfate up to 150 µg / ml. Store at 2-8 °
Rabivak-Vnukovo-32 (KAV) - dry culture vaccine, Russia	The same virus as COKAV, but with an activity of 0.5 ME. Contains kanamycin sulfate up to 150 µg / ml and traces (up to 0.5 µg) of bovine albumin. Store at 4-8 °
Rabipur - Novartis Vaccine and Diagnostics GmbH & Co., KG, Germany	The strain of the virus Flury LEP grown on a culture of chicken fibroblasts, inactivated by beta-propiolactone. Activity> 2.5 ME. Store at 2-8 °
Immunoglobulin rabies out of human serum - Sichuan Yuanda Shuyang, China	Solution for injection 150 IU / ml. Bottles of 1, 2, 5 ml. (Supplier of Allergen Trading House)
Immunoglobulin rabies from horse serum, Russia, Ukraine	Activity not less than 150 IU / ml. Ampoules of 5 and 10 ml; set with IG in dilution 1: 100. Store at 3-7

Anti-rabies immunoglobulin from human serum is injected intramuscularly, adults and children - 1 dose of 20 IU / kg - but no more, because it can suppress the production of antibodies. Part of the dose - as much as possible - is injected, infiltrating the wound, and the remainder - intramuscularly (thigh, buttock) along with the 1st dose of the vaccine - into the deltoid muscle - farther from the Ig.

In the event of a delay, the immunoglobulin must be administered no later than the eighth day after the first dose of the vaccine, regardless of the time interval between contact with the virus and the start of therapy. To ensure good infiltration of the affected areas in children (especially with multiple bites), the drug is diluted 2-3 times with a 0.9% NaCl solution.

Immunoglobulin rabies from the serum of a horse is injected at a dose of 40 IU / kg body weight after the mandatory introduction of an intracutaneous test with the drug diluted 1: 100. In the case of a negative sample, 0.7 ml of immunoglobulin diluted 1: 100 is injected under the skin of the shoulder, and after 10 minutes in the absence of a reaction, fractionally in 3 doses with an interval of 10-15 minutes - the entire dose of undiluted preparation warmed to 37 ± 0.5 °. A portion of the dose is injected around the bite and the rest is intramuscular. With a positive skin or subcutaneous sample, the drug is administered for vital indications with fractional desensitization. Before the first injection, antihistamines are injected intramuscularly, a subcutaneous injection of a 0.1% solution of epinephrine in the age dose is recommended.

[28], [29], [30], [31], [32]

Rabies prevention regimens

Vaccination against rabies provides immunity in 10-14 days from its onset. For severe bites at dangerous locations, the incubation period may be too short, so a specific immunoglobulin is injected with the vaccine.

Therapeutic and prophylactic (post-exposure) immunization is carried out with an anti-rabies immunoglobulin or without it. In case of severe injuries or death from rabies, the antimicrobial immunoglobulin is administered intramuscularly at the same time as the first injection of the vaccine (if it was not administered on the first day, it should be administered as early as possible during the first 3 days after the bite). The vaccine is administered regardless of the period after the bite. In areas free of rabies for 2 years or more, for bites inflicted by domestic animals with an unspecified diagnosis or wild animals, the immunoglobulin is not injected, but is vaccinated. Schemes for the prevention of vaccine COKAV.

Vaccine administration is stopped if the animal is healthy after 10 days of observation. In case of a bite from a previously vaccinated person, 2 doses of COCAW vaccine are administered on days 0 and 3.

Rabivak (CAV) - the course is from 9 to 25 injections, depending on the severity of the damage and information about the animal.

Rabipur is administered in 1 dose on days 0, 3, 7, 14 and 28 after the bite to all persons not vaccinated or not fully vaccinated against rabies. In Denmark, bites are given 6 bats instead of 5 doses of vaccine.

Preventive (pre-exposure) immunization is carried out by three intramuscular administration of 1 dose of vaccine (0, 7, 30 days) with revaccination 12 months later, then every 3 years; similar schemes are used for foreign vaccines. Individuals at risk are recommended annual monitoring of the level of specific antibodies in the blood: in cases of decreasing their level below 0.5 IU / ml, a single immunization dose is performed once a booster dose.

The scheme of therapeutic and prophylactic vaccinations KOKAV and anti-rabies immunoglobulin (AIG)

Damage category Contact type *	Animal data	Treatment
1. There is no damage and salting of the skin. No direct contact	Rabid patient	Not assigned
2. Salting intact skin, abrasions, single superficial bites or scratches of the trunk, upper and lower extremities (except for the head, face, neck, hand, fingers and toes, perineum, genitalia, caused by domestic or agricultural animals.	If within 10 days. The animal remained healthy, treatment is stopped (ie, after the 3rd injection). When it is impossible to observe the animals (killed, died, ran away, etc.), complete the treatment.	Start treatment immediately: COCAW 1.0 ml in 0.3, 7, 14, 30 and 90 days.
Any oslivleniya mucous, any bites of the head, face, neck, hand, fingers and toes, perineum, genitalia; multiple bites and deep single bites of any location, caused by domestic or agricultural farms. Animals. Any debris and damage caused by wild carnivores, bats and rodents.	If it is possible to observe the animal and it for 10 days. Stays healthy, treatment is stopped (i.e. After the 3rd injection). When it is impossible to observe the animal, the treatment is complete.	Start treatment immediately and simultaneously: AIG on day 0 + COKAV (1 ml) on day 0, 3.7, 14, 30 and 90.

* - By contact is meant bitten wounds, scratches, abrasions and places of sedation.

[33], [34], [35], [36], [37], [38], [39], [40]

Vaccination reactions and complications after rabies vaccine

Rabies culture vaccines do not cause neurological complications and can be used in patients with an unfavorable neurological history. At the injection site may be mild reactions - pain, swelling and thickening. General malaise fever, swollen lymph nodes, Pain in the joints, muscle pain are rare. A break in the vaccine for 1-2 days and taking antipyretics usually eliminates the symptoms of the disease. Described isolated cases of allergic reactions.

Following the use of a heterologous rabies immunoglobulin, allergic reactions of immediate type (rash, angioedema, anaphylactic shock) and serum sickness may develop.