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Description
& Composition
:-
Its a Sterile 5% infected sheep brain suspension inactivated
with BPL in buffer solution with 0.25 percent phenol as
bactericidal & 0.01% merthiolate as preservative.
Indication
of antirabic treatment :-
Anti-rabic treatment should be started immediately when
a person is bitten, scratched or licked under the following
conditions :-
1. The animal presents clinical signs of rabies.
2. The animal is proved positive for rabies by laboratory
examination.
3. The animal is suspected of being rabid even though laboratory
tests fail to confirm.
4. In endemic areas , following the bite of a stray animal
that can not be apprehended.
5. Following handling of an animal diagnosed as rabid where
abrasions of the skin have been contaminated by saliva.
Note
:- Rabies may be transmitted by rabid animals of
any species; bites by cats or other animals merit
the same preventive measures as for the dog bites.
Treatment
:- Prevention of rabies must start with treatment of
the wound (see wound treatment below). In severe cases,
the use of anti-rabies serum may be considered. This must
be followed by vaccine injections (see use of Anti rabies
serum below).
Dosage
:- The dosage depends upon the classification of the wound
and the age of the bitten person.
Class
I
a) Licks, including indirect contact with saliva, on
definite fresh cuts or abrasions on all parts of the body
except on the head, face, neck or fingers.
b) Licks on the intact mucous membrane of the mouth, nose,
anus or genitals or on the conjunctiva.
c) Bites or scratches which have raise the epidermis but
have not definitely drawn blood, on all parts of the body
except the head, face, neck or fingers.
d) Person who have drunk unboiled milk of rabid animal.
Dose :- 2ml, daily for 7 days.
Class
II
a) Licks on definitely remembered fresh cuts or abrasions
on the fingers.
b) All bites or scratches on the fingers which are not lacerated,
not more than 1cm long have not penetrated the true skin.
c) Bites or scratches on all parts of the body except head,
neck, face or fingers which have definitely drawn blood.
Dose :
Adult
:5ml daily for 10 days
Children below 30kg body weight : 2ml daily for
10 days |
One
booster dose of the same quantity of vaccine 3 weeksafter
the last injection. |
Class
III
a) Licks on definitely remembered fresh cuts or abrasions
on the head, face, neck or hand.
b) All bites or scratches on the head, face, neck or hand.
c) Bites or scratches on the fingers which are lacerated,
more than 1cm long and have penetrated the true skin.
d) All bites penetrating the true skin & definitely
drawing blood when there are more than five in number in
all.
e) All jackal and wolf bites.
Dose :-
Adults : 5ml daily for 10 days
Children below 30 kg body weight: 2ml daily for 10 days
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Two booster doses of the same quantity of vaccine, one
on 7th day & second 3 weeks after the last injection |
Administration
:
The vaccine is given deep subscutaneously usually in the
abdominal wall.
Instructions
to the patient :
The rabies vaccine is not a powerful antigen. Hence anything
which might depress the antibody forming mechanism should
be avoided.
The patient under treatment for about 10 days subsequently,
must be instructed to,
a) Avoid alcoholic drinks. This may interfere with development
of immunity and increase non-specific reactions to treatment.
b) Avoid any strenuous exertion
c) Avoid exposure to cold or chilling.
d) Avoid late nights, mental and physical strain.
e) Take an adequate, light diet, avoiding highly spiced
foods.
f) The bowls be evacuated regularly, if necessary
by the use of mild purgative.
Use
of anti-rabies serum :
In cases of severe bites and in all cases of Jackal, wolf
and fox bites the administration of anti-rabies serum in
addition to vaccine therapy is recommended. The best results
are obtained when serum is administered immediately after
exposure. It may be useful when given 6 days after exposure
beyond which it is of little value. Part of the serum should
be infiltrated into the wound after cleaning thoroughly
& the rest should be administered intra muscularly after
testing the patient for serum sensitivity. The serum must
be immediately followed by a full course of 10, daily injections
of antirabic vaccine followed by two reinforcing doses on
the 24th and 34th day. The booster doses are essential to
counteract any neutralising effect of serum on earlier injections
of vaccine.
Wound
Treatment :
Proper wound treatment can save 50 percent of persons at
risk. Thorough cleaning and cauterisation of wound is therefore
the most important single step in rabies prevention and
must be carried out as early as possible. The wound should
be cauterized with one of the quaternary ammonium compounds
like cetavlon or hexamethonium disinfectants or with pure
carbolic acid or fuming nitric acid or with surgical cautery
. |Cauterization is effective in punctured wounds which
can not be cleaned with soap or detergent. It is inadvisable
to stitch wounds. They should be allowed to heal by granulation
from below.
Side
effects : These are rare. The
local & constitutional disturbances such as erythema,
oedema or pruritis at site or injection some time accompanied
by fever may occur. They subside in a few days. But in severe
cases the treatment is discontinued and restarted after
subsidence of the symptoms. Very rarely neuroparalytic disease
may occur. If the patient complains persistent headache,
pain in the back of neck accompanied by nausea, unsteadiness
of the limbs related to the roots of the spinal cord, malaise,
fever and lymphadenopathy, the injections should be discontinued.
The majority of the cases require no further treatment for
this condition and recover rapidly on stopping the vaccine.
They are advised complete bed rest. There is no specific
treatment though antiallergic drugs may be tried ACTH are
reputed to the help. Corticosteroids must be used only if
essential as they are reputed to potentiate the virus, thereby
increasing the risk of rabies.
Late
cases :
As the length of the incubation period of hydrophobia can
not be predicted, no period after a bite when the treatment
should be refused, can be laid down.
Advice
cases :
In the cases where the biting animal is available for observation
the patient is given appropriate dose of the class to which
assigned, on first, second and third day only. If the animal
remains alive and well for ten days no further treatment
is given. Such cases are called " Advice cases".
If on the other hand, that animal dies of the rabies during
observation for 10 days the appropriate treatment of the
case is completed.
Re-treatment
:
In case of patients who have recently undergone a course
of antirabic treatment
and who have again been exposed to the risk of injection
the following procedure is recommended.
a) Risk not greater than first exposure.
1) Within 3 months of the first course of vaccine no further
treatment is necessary.
2) Between 3 & 6 months, 2 reinforcing doses of vaccine
5cc, for adults and 2cc for children 10 days apart, should
be given.
3) More than 6 months a fresh course of treatment appropriate
to the second exposure should be given.
b) Risk greater than first exposure.
If the patient is estimated to be at greater risk than that
for which he previously received treatment he should undergo
a complete course of treatment appropriate to his recent
exposure.
Storage
:
The vaccine must be stored in a refrigerator at 2oC
to 8oC, it must not be frozen. This vaccine deteriorates
rapidly on exposure to room temp. or with fluctuations of
temperature. Hence storage in an ice box is not suitable.
The expiry date marked on the label is valid only, if vaccine
has been properly stored.
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