Rabies

rabies
acute and deadly disease caused by a viral infection of the central nervous system. The rabies virus is most often spread by a bite and saliva from an infected (rabid) animal (e.g., bats, raccoons, skunks, foxes, ferrets, cats, or dogs)

Rabies
The number of deaths that rabies causes each year is estimated to be at least 40,000, and as high as 70,000 if higher case estimates are used for densely populated countries in Africa and Asia where rabies is epidemic

Types of rabies
Human diploid cell vaccine (HDCV for pre or post-exposure) Purified chick embryo cell vaccine (PCEC for pre or post-exposure)

Who should receive the vaccine pre-exposure?

Vaccination before exposure (preexposure) should be offered to people in high risk groups such as veterinarians, animal handler/caretakers, or laboratory workers who may be exposed to the rabies virus.

 Pre-exposure vaccination may be considered for:

People whose activities bring them into frequent contact with rabies virus or potentially rabid animals (e.g., bats, raccoons, skunks, ferrets, cats, dogs). Travelers who will spend more than one month in countries with a high rate of rabies infection, if they are likely to come in contact with rabid animals and immediate access to appropriate medical care is limited.

Who should receive the vaccine post-exposure?

Vaccination after exposure (post-exposure) is recommended for all individuals who have had contact with an animal (e.g., bites or abrasions) that they believe may be, or which is proven to be, rabid. Vaccination should be initiated as soon after exposure as possible and should be accompanied by proper wound management and the administration of Rabies Immune Globulin, human (HRIG).

 Pregnant women who are exposed to rabies may receive the vaccine.

Who should not receive the vaccine?

The rabies vaccines are not recommended for routine use. People who are moderately or severely ill should consult with their physician before receiving any vaccine.

 Pre-exposure rabies vaccines are administered by a series of three injections:

The first dose may be given at any time The second dose should be given seven days later The third dose should be given 21 or 28 days after the first dose Booster doses of vaccine are recommended every two years for those individuals who continue to be at increased risk of contracting rabies to maintain protective antibody levels. People that work with live rabies virus in laboratory settings should be tested every six months to ensure that they have adequate antibody levels, and receive boosters as necessary.

 When post-exposure rabies vaccines are administered:

Previously unvaccinated people
should receive the vaccine IM at 0, 3, 7, and 14 days. For adults the vaccine is given in the deltoid area; for children, it may be given in the anterolateral aspect of the thigh. In addition to rabies vaccine, these people should also receive rabies immune globulin (HRIG) at the same time as the first dose of the vaccine to provide rapid protection that persists until the vaccine works. should receive two doses of the vaccine IMthe first immediately, the other three days later. RIG is unnecessary and should not be given. An immunized person is anyone who has received a complete series of vaccine, or a person who has received a pre-exposure or post-exposure series of any rabies vaccine who has an adequate rabies antibody level.

Previously vaccinated people

Effectiveness of the Vaccine

There are no controlled trials of rabies vaccine. Among persons who had been bitten by an animal that was proven to be rabid and who received both HRIG and a full course of one of these modern rabies vaccines there have been no cases of rabies. Previously immunized people still must receive two additional doses of the vaccine if exposed to the virus, and the vaccine is almost 100% effective in these cases as well.

Side effect
Mild reactions
pain, redness, swelling, or itching at injection site are reported among 30%-74% of those vaccinated. Headache, nausea, abdominal pain, muscle aches, and dizziness are reported in 540% of those vaccinated.

Severe reactions
allergic reactions including swelling and mild difficulty breathing developed in 6% of patients who received booster doses of Human Diploid Cell Rabies Vaccine. In addition, three cases of neurologic illness resembling Guillain-Barr Syndrome, a progressive disorder affecting the nervous system, have been reported in people who received the Human Diploid Cell Rabies Vaccine. In these cases, all patients recovered within three months.