Rabies (hydrophobia): prevention

Immunization against rabies can be preventative and preventive. With a preventive purpose, immunize persons whose work is associated with the risk of infection (veterinarians, foresters, hunters, dogs, slaughterhouse workers, taxidermists, laboratory staff working with a street rabies virus). Primary immunization includes three injections (0th, 7th and 30th day) of 1 ml each. The first revaccination is carried out after 1 year - one injection in a dose of 1 ml. The next revaccination every 3 years - one injection at a dose of 1 ml. Vaccination is carried out taking into account contraindications.

Treatment and prophylactic immunization is carried out by contact and bites of people with rabies, suspicious for rabies or unknown animals, there are no contraindications in this case. Pregnancy and infancy are not grounds for refusing to perform therapeutic and prophylactic immunization.

Post-exposure prophylaxis of rabies includes wound treatment and the introduction of an antirabicococcus vaccine in combination with an antirabic immunoglobulin. At the same time, tetanus prophylaxis is carried out in accordance with the existing schemes.

First aid should be given to those affected by animal bites immediately or as soon as possible after bite. Wounds, scratches, abrasions, places of lavage are abundantly washed with a jet of water with soap or other detergent, the edges of the wounds are treated with 70 ° alcohol or 5% iodine solution, impose a sterile bandage. The edges of the wound in the first 3 days are not cut and not sewn. The application of sutures is shown exclusively in the following cases: with extensive wounds, when several leading skin seams should be applied after pre-treatment of the wound; to stop external bleeding (bleeding vessels need to be stitched); for cosmetic indications (application of cutaneous sutures to facial wounds). After local treatment, the wounds immediately begin treatment and prophylactic immunization, for which they send the victim to the trauma center. Emergency tetanus prophylaxis is carried out in accordance with existing schemes.

At present, rabies vaccine and rabies immunoglobulin are used for vaccine -serum prophylaxis of rabies . Instead of the previously used brain vaccine, which has a high reactogenicity, the culture is used. At present, the most widely used antirabic kulgural concentrated purified purified inactivated dry vaccine (COCAV). Cultural vaccines only in isolated cases cause reactions of a local and general nature. In case of severe multiple bites of dangerous localization, along with the vaccine, an antirabic immunoglobulin is introduced - heterologous (horse) or homologous (human), neutralizing rabies virus. Antibiotic immunoglobulin must be administered in the first hours after the bite (no later than 3 days) in order to create passive immunity. To prepare the rabies immunoglobulin used in practice, the serum of immunized animals (horses, mules, sheep, etc.) is used, therefore, when introducing it for the purpose of preventing an anaphylactic reaction, certain rules must be observed (introduction to Besideka). The dose of an antirabies immunoglobulin is determined from the calculation of 40 IU / kg when heterologous and 20 IU / kg are administered with the administration of a homologous immunoglobulin. To determine the dose of immunoglobulin required for administration, the weight of the victim should be multiplied by 40 (20) ME and divided by the immunoglobulin activity, also measured in ME (indicated on the label). The calculated dose of immunoglobulin is infiltrated around the wounds and into the depth of the wound. If the anatomical location of the wound does not allow the entire dose to be introduced around the wound, the immunoglobulin residue is administered intramuscularly to other sites. Anti-rabies immunoglobulin is not used after the introduction of rabies vaccine. COCAV is injected 6 times in a dose of 1 ml into the deltoid muscle (children - in the muscles of the thigh) at 0, 3, 7, 14. 30 and 90th day.

[1], [2], [3], [4], [5], [6], [7],

Determination of indications for therapeutic and prophylactic immunization against rabies

When examining a person who has suffered from a bite, in each case it is necessary to solve the issue of post-exposure prophylaxis of rabies. Every effort should be made to catch the animal that attacked the person. Destroy all wild animals that bite a person, and from domestic animals - sick, unvaccinated, stray, committed an unprovoked attack on a person behaving unusually or having other signs of rabies. The head of the animal is immediately sent for examination to a specialized laboratory for immunofluorescent staining of the brain in order to determine the antigens of the rabies virus. If the result is negative, the animal's saliva can not contain an agent and it is not necessary to prevent it. If a person has been bitten by a wild animal, which can not be caught, both active and passive immunization are carried out simultaneously. In an area where rabies is not common among domestic animals, apparently healthy dogs and cats are isolated and observed for 10 days. When symptoms of the disease appear or when behavior changes, the animal is destroyed, and its head is sent to a specialized laboratory for immunofluorescent staining of the brain for antigens of the rabies virus. If the animal did not get sick for 10 days, at the time of the bite, its saliva could not contain a rabies virus. In this case, the initiated immunization is stopped (the patient has time to receive three injections of the vaccine - on the 0, 3 and 7 days after the bite). In an area where rabies is common among dogs, an immediate study of the animal's brain is justified, especially in cases of severe bites. The scheme of therapeutic and prophylactic vaccinations of COCAV and anti-rabies immunoglobulin is given in the instructions to these drugs. Persons who received a previous full course of preventive or preventive vaccinations, from the end of which was no more than 1 year, are prescribed three injections of a 1 ml vaccine on the 0 th, 3 rd, 7 th day; if 1 year or more has passed or if an incomplete immunization schedule has been performed, then the vaccine is administered at a dose of 1 ml at 0, 3, 7, 14, 30 and 90 days. According to the indications, anti-rabies immunoglobulin and a vaccine in combination are used.

Glucocorticoids and immunosuppressants can lead to failure of vaccine therapy, so in cases of vaccination against the background of taking these drugs, it is necessary to determine the level of virus neutralizing antibodies. In the absence of viral neutralizing antibodies, an additional course of treatment is necessary.

The vaccinee must know: he is not allowed to drink any alcohol during the course of vaccination and 6 months after his graduation. It should also avoid overwork, hypothermia, overheating.

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

Damage Categories	Nature of contact	Data on the animal	Treatment
1	There are no damages and dislocation of the skin, there is no direct contact	A patient with rabies	Not assigned
2	Inflammation of intact skin, abrasions, single superficial bites or scratches of the trunk, upper and lower extremities (except for the head, face, neck, hands, feet, genitals) caused by domestic and farm animals	If during 10 days of monitoring the animal it remains healthy then the treatment is stopped (that is, after the 3rd injection). In all other cases, when it is impossible to observe the animal (killed, died, fled, disappeared, etc.). Treatment is continued according to the scheme	Start treatment immediately: COCAA by 1 ml at 0, 3, 7, 14, 30 and 90 days
3	Any mucus membranes, any bites of the head, face. Neck, hand, fingers, hands and feet. Genitals, multiple bites and deep single bites of any location caused by domestic and farm animals. Any damnation and damage caused by wild carnivorous animals, bats and rodents	In cases where it is possible to observe the animal and it remains healthy for 10 days, the treatment is stopped (that is, after the 3rd injection). In all other cases, when it is impossible to observe the animals, the treatment is continued according to the indicated scheme	Initiate a combination treatment immediately: an antirabies immunoglobulin at day 0 + COCAA by 1 ml at 0, 3, 7, 14, 30 and 90 days

Doses and immunization schedules are the same for children and adults. Treatment of rabies is prescribed regardless of the victim's treatment for help, even several months after contact with a patient suspected of rabies or unknown animals.

[8], [9], [10]