Pre-Exposure and Post Exposure Prophylaxis of Rabies virus
Introduction
Rabies is fatal Viral disease that affects the central nervous system of mammals,
including humans. It is caused by the Rabies lyssavirus and is primarily transmitted
through the bite of op scratch an infected animal. once symptoms appear, rabies is
almost always fatal, making Prevention through prophylaxis crucial. The are two
main preventive approaches Pre exposure
Prophylaxis (PrEP) and Post-exposure Prophylaxis (PEP)
Pre-Exposure Prophylaxis (PrEP) for Rabies
PrEP is recommended for anyone who is at continual, frequent or increased risk for
exposure to the rabies virus, as a result of their occupation or residence such as:
• GROUPS of Persons at high-risk exposure to live of rabies virus (laboratory
staff veterinarians animal handlers, and Wildlife officers)
• Children living in or visiting rabies-affected areas may be immunized
voluntary individual Preventively on a basis or in mass Campaigns when
there are no economic, Programmatic or logistical obstacles.
• Travellers to rabies - affected areas according to the level of risk in that area.
• In Bangladesh, an estimated 166.590 People suffer from animal bites
annually, leading to approximately 2,100 reported human rabies deaths each
year. The majority of these cases occur in rural areas, with children being
Particularly vulnerable. Dogs are the Primary reservoir and transmitter of the
rabies virus in the country.
,Pre-Exposure Prophylaxis Schedule
The rabies PrEP regimen consists of three doses of rabies vaccine administered as
follows:
• Day o-First dose
• Day 7- second dose
• Day 21 Or 28- Third dose
Pre-exposure rabies Prophylaxis regimens (PrEP) with vaccines
fulfilling WHO requirements:
Intramuscular:
• one each intramuscular dose is given on days 0, 7, 28 or 21.
• site of injection: deltoid area of the fore adults; anterolateral area arm of the
thigh is recommended for Children aged less than 2 years.
Intradermal:
• one intradermal injection of 0.1 ml is given 21 op 28. on each of days 0,7
and 21 or 28.
• If antimalarial chemoprophylaxis is applied concurrently intramuscular
injections must be used.
The vaccination series listed above must be Completed at the stipulated times.
However, there is no need to restart the series if the doses are not given on the
exact Schedule.
,Booster vaccination and monitoring of Previously immunized persons
• Persons working with live rabies virus. In diagnostic laboratories, research
laboratories vaccine Production laboratories at Permanent risk of exposure to
rabies should have:
o one serum sample taken every Six months.
o A booster dose when the titer falls below 0.5 IU/ml.
• Others Professions (veterinarians, animal handlers, wildlife officers etc.)
working in rabies endemic areas should have:
o one serum sample taken every two years.
o A booster dose When the titer falls below 0.5 IU/ml.
Post- Exposure Prophylaxis (PEP) for Rabies
Post-exposure Prophylaxis is given to individuals who have Scratched, or exposed
of a been bitten, to the saliva Potentially rabid animal. Immediate treatment is
essential to Prevent virus from spreading to the nervous system.
Top 10 General considerations in Rabies PEP
1. Wounds must be immediately Washed/flushed for 15 minutes and disinfected.
2. Rabies PEP should be instituted immediately. PEP consists of a course of Potent,
effective rabies vaccine that meets WHO recommendations and administration of
rabies immunoglobulin.
3. PEP must be applied using vaccine regimens and administration routes that have
been proven to be safe and effective.
4. PEP does not have contraindications Purified rabies immunoglobulin and
vaccine are used. Pregnancy and infancy are not contraindications to PEP.
, 5. If rabies immunoglobulin is not available on first visit, use can be delayed by up
to date of the 7 days from the first vaccine dose.
6. Initiation of PEP should not await the results of laboratory diagnosis or be
delayed by dog observation when rabies is Suspected.
7. When suspect rabid animal contacts (excluding bats) occur in areas free
cornivore-mediated rabies and of Where there is adequate surveillance in Place,
PEP may not be required. The decision must be based on expert risk assessment.
8. Patients Presenting for rabies PEP even months after having been bitten should
be treated as if the Contact had recently occurred.
9. PEP Should be administered even if the Suspect animal is not available for
testing or observation. However, vaccine and immunoglobulin administration may
be discontinued if animal involved: is a vaccinated the dog (cat or ferret) that
following Observation for 10 days, remains healthy or is humanely killed and
declared negative for rabies by WHO Prescribed laboratory test.
10. In areas enzootic for (canine and wildlife) rabies; PEP should be instituted
immediately unless adequate laboratory surveillance and data indicates that the
species involved is not vector of rabies.
Administration of Rabies Immunoglobulin (RIG)
Administration of rabies immunoglobulin (RIG) to wounds classified as category
III exposure, is of upmost importance in wound management.
• Bites to the head, neck, face, hand and genitals are category III exposures.
• Infiltrate RIG into the depth of the Wound and around the wound.
• RIG Should be infiltrated around the wound as much as anatomically
feasible.
• Remaining RIG should be injected at an intramuscular site distant from that
of vaccine inoculation (e.g. into the anterior thigh)
Introduction
Rabies is fatal Viral disease that affects the central nervous system of mammals,
including humans. It is caused by the Rabies lyssavirus and is primarily transmitted
through the bite of op scratch an infected animal. once symptoms appear, rabies is
almost always fatal, making Prevention through prophylaxis crucial. The are two
main preventive approaches Pre exposure
Prophylaxis (PrEP) and Post-exposure Prophylaxis (PEP)
Pre-Exposure Prophylaxis (PrEP) for Rabies
PrEP is recommended for anyone who is at continual, frequent or increased risk for
exposure to the rabies virus, as a result of their occupation or residence such as:
• GROUPS of Persons at high-risk exposure to live of rabies virus (laboratory
staff veterinarians animal handlers, and Wildlife officers)
• Children living in or visiting rabies-affected areas may be immunized
voluntary individual Preventively on a basis or in mass Campaigns when
there are no economic, Programmatic or logistical obstacles.
• Travellers to rabies - affected areas according to the level of risk in that area.
• In Bangladesh, an estimated 166.590 People suffer from animal bites
annually, leading to approximately 2,100 reported human rabies deaths each
year. The majority of these cases occur in rural areas, with children being
Particularly vulnerable. Dogs are the Primary reservoir and transmitter of the
rabies virus in the country.
,Pre-Exposure Prophylaxis Schedule
The rabies PrEP regimen consists of three doses of rabies vaccine administered as
follows:
• Day o-First dose
• Day 7- second dose
• Day 21 Or 28- Third dose
Pre-exposure rabies Prophylaxis regimens (PrEP) with vaccines
fulfilling WHO requirements:
Intramuscular:
• one each intramuscular dose is given on days 0, 7, 28 or 21.
• site of injection: deltoid area of the fore adults; anterolateral area arm of the
thigh is recommended for Children aged less than 2 years.
Intradermal:
• one intradermal injection of 0.1 ml is given 21 op 28. on each of days 0,7
and 21 or 28.
• If antimalarial chemoprophylaxis is applied concurrently intramuscular
injections must be used.
The vaccination series listed above must be Completed at the stipulated times.
However, there is no need to restart the series if the doses are not given on the
exact Schedule.
,Booster vaccination and monitoring of Previously immunized persons
• Persons working with live rabies virus. In diagnostic laboratories, research
laboratories vaccine Production laboratories at Permanent risk of exposure to
rabies should have:
o one serum sample taken every Six months.
o A booster dose when the titer falls below 0.5 IU/ml.
• Others Professions (veterinarians, animal handlers, wildlife officers etc.)
working in rabies endemic areas should have:
o one serum sample taken every two years.
o A booster dose When the titer falls below 0.5 IU/ml.
Post- Exposure Prophylaxis (PEP) for Rabies
Post-exposure Prophylaxis is given to individuals who have Scratched, or exposed
of a been bitten, to the saliva Potentially rabid animal. Immediate treatment is
essential to Prevent virus from spreading to the nervous system.
Top 10 General considerations in Rabies PEP
1. Wounds must be immediately Washed/flushed for 15 minutes and disinfected.
2. Rabies PEP should be instituted immediately. PEP consists of a course of Potent,
effective rabies vaccine that meets WHO recommendations and administration of
rabies immunoglobulin.
3. PEP must be applied using vaccine regimens and administration routes that have
been proven to be safe and effective.
4. PEP does not have contraindications Purified rabies immunoglobulin and
vaccine are used. Pregnancy and infancy are not contraindications to PEP.
, 5. If rabies immunoglobulin is not available on first visit, use can be delayed by up
to date of the 7 days from the first vaccine dose.
6. Initiation of PEP should not await the results of laboratory diagnosis or be
delayed by dog observation when rabies is Suspected.
7. When suspect rabid animal contacts (excluding bats) occur in areas free
cornivore-mediated rabies and of Where there is adequate surveillance in Place,
PEP may not be required. The decision must be based on expert risk assessment.
8. Patients Presenting for rabies PEP even months after having been bitten should
be treated as if the Contact had recently occurred.
9. PEP Should be administered even if the Suspect animal is not available for
testing or observation. However, vaccine and immunoglobulin administration may
be discontinued if animal involved: is a vaccinated the dog (cat or ferret) that
following Observation for 10 days, remains healthy or is humanely killed and
declared negative for rabies by WHO Prescribed laboratory test.
10. In areas enzootic for (canine and wildlife) rabies; PEP should be instituted
immediately unless adequate laboratory surveillance and data indicates that the
species involved is not vector of rabies.
Administration of Rabies Immunoglobulin (RIG)
Administration of rabies immunoglobulin (RIG) to wounds classified as category
III exposure, is of upmost importance in wound management.
• Bites to the head, neck, face, hand and genitals are category III exposures.
• Infiltrate RIG into the depth of the Wound and around the wound.
• RIG Should be infiltrated around the wound as much as anatomically
feasible.
• Remaining RIG should be injected at an intramuscular site distant from that
of vaccine inoculation (e.g. into the anterior thigh)
