Professional Documents
Culture Documents
Rabies Vaccination
Alan C. Jackson, MD
Professor of Medicine (Neurology)
and of Medical Microbiology
Head, Section of Neurology
University of Manitoba
Winnipeg, Manitoba, Canada
Rabies virus structure
Matrix protein
Envelope
Glycoprotein
Nucleocapsid protein
Source: http://www.cdc.gov
Human rabies
paralytic = dumb
~ 20%
Encephalitic rabies
prodromal symptoms
paresthesias/pain/pruritus at site of bite
episodes of generalized arousal or
hyperexcitability separated by lucid
periods
autonomic dysfunction
hydrophobia
Paralytic rabies
paresthesias/pain/pruritus at site of bite
early flaccid muscle weakness
often begins in bitten extremity
progresses to produce quadriparesis
bilateral facial weakness
sensory examination is usually normal
sphincter involvement
fatal outcome
often misdiagnosed as Guillain - Barré syndrome
Geographic distribution of rabies - 2000
Tuberculosis 36,040
Leishmaniosis 2.357
Schistosomiasis 1,760
Trypanosomiasis 1,598
Rabies 1,160
Onchocerciasis 987
Dengue 653
Chagas 649
Leprosy 177
Emerg Inf Dis 10, 2004
Human rabies prevention
United States
Recommendations of the CDC’s
Advisory Committee on Immunization Practices
MMWR Recommendations and Reports
January 8, 1999
http://www.cdc.gov/mmwr
Rabies postexposure guide:
exposure to dogs, cats, and ferrets
RabAvert® Imovax ®
Manufacturer Novartis Sanofi Pasteur
(Merck Frosst)
Cell culture primary chick MRC-5 human
embryo lung cell line
fibroblasts
Common
PCECV HDCV
designation
Day 0 7 21 28
• If CHLOROQUINE malaria prophylaxis, give IM only
• If immunosuppressed check neut. Antibody titre ≥ 0.5 IU/ml
HIV positive patients - CD4 counts <300 may be unresponsive
Modified from MJ Warrell, University of Oxford
Photo courtesy of Claudius Malerczyk (Novartis)
Can Comm Dis Rep 31:1, 2005
Intradermal use of rabies vaccine
Gold standard is IM administration of rabies
vaccine
ID regimen is an acceptable alternative
Uses one-tenth the dose
Comparable degree of protection
Economical and widely accepted
Can Comm Dis Rep 31:1, 2005
Intradermal use of rabies vaccine
Pre-exposure = three 0.1 mL doses on days 0,
7, and 21 or 28 intradermally on upper arm
After reconstitution of 1.0 mL dose, may store
at 4 – 8 degrees C for up to 8 hours with
proper aseptic precautions
PCECV shown to be immunogenic 7 days
after reconstitution with storage in a clinic
refrigerator (Khawplod et al. CID 2002)
Can Comm Dis Rep 31:1, 2005
Intradermal use of rabies vaccine
Neutralization titres after ID vaccination are
lower than after IM, but adequate protective
levels
Briggs found that after 2-2.5 years:
79% of IM vs. 51% of ID had satisfactory titres
ACIP, at 2 years:
93-98% for IM vs. 83-95% for ID
Can Comm Dis Rep 31:1, 2005
Intradermal use of rabies vaccine
Manitoba n=488 in 2005
6-12 mo after 3rd dose:
95% >0.5 IU/mL
Median 2.7 IU/mL