Rabies vaccine

Rabies remains one of the most important public health problems. Around 50,000 people die from it every year worldwide, and around 10 million people receive post-exposure prophylaxis. In Russia, there were 17 cases of rabies in 2004 (including 6 children), 14 in 2005 (4 children), and 8 in 2007 (no children); The rabies vaccine is administered to 200,000-300,000 people per year.

The source and reservoir of the virus are wild carnivores, especially foxes and wolves, as well as dogs, cats, and in American countries - bats. A person becomes infected through a bite, through drooling on damaged skin or mucous membranes, rarely through objects contaminated with saliva, when cutting up carcasses, etc. Rhabdovirus appears in the saliva of a sick animal no earlier than 10 days before the development of rabies symptoms, which determines the observation period for a bite by a domestic animal. The incubation period is from several days to 1 year (usually 30-90 days) depending on the infective dose and the site of the bite: the most dangerous bites are to the face, fingers and hands, and genitals.

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The purpose of rabies vaccination

Emergency (post-exposure) rabies prevention is carried out for people who have had contact with the animal, pre-exposure prevention is carried out for people of a number of professions with inactivated vaccines and specific immunoglobulins.

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Contraindications to rabies vaccination

There are no contraindications for post-exposure use of rabies vaccine.

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Doses and methods of administration of rabies vaccine

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COCAV

Before use, 1 ml of solvent is added to the ampoule, the solution should be used within no more than 5 minutes, it is administered slowly intramuscularly in a dose of 1 ml for children over 5 years old and adults in the deltoid muscle, for children under 5 years old - in the anterolateral surface of the thigh. Administration into the buttock is not allowed.

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Rabivak-Vnukovo-32

Add 3 ml of solvent to the ampoule with the vaccine; with vigorous shaking, the time for complete dissolution is no more than 5 minutes. Inject into the subcutaneous tissue of the abdomen, 2-3 fingers away from the midline, at the level of or below the navel (as an exception - in the interscapular region). In case of drooling, superficial bites, scratches of the body or limbs by a domestic animal that fell ill within 10 days after the bite, for children under 8 years of age, the vaccine dose is 2 ml, over 8 years - 3 ml. For more serious injuries by domestic animals and any bites by wild animals, a single dose is 4 and 5 ml, respectively.

Rabipur

The rabies vaccine is diluted with 1 ml of water for injection and administered intramuscularly into the deltoid muscle; for young children, into the anterolateral surface of the thigh at a dose of 1 ml, regardless of age.

Drugs used for the prevention of rabies

Preparation	Content
KOKAV - dry concentrated purified inactivated culture vaccine, Russia	Attenuated rabies virus grown in Syrian hamster kidney cell culture, UV-inactivated, activity >2.5 IU. Contains kanamycin sulfate up to 150 mcg/ml. Store at 2-8°
Rabivac-Vnukovo-32 (KAV) - dry culture vaccine, Russia	The same virus as in KOKAV, but with an activity of 0.5 ME. Contains kanamycin sulfate up to 150 μg/ml and traces (up to 0.5 μg) of bovine albumin. Store at 4-8°
Rabipur - Novartis Vaccines and Diagnostics GmbH & Co., KG, Germany	Flury LEP virus strain grown on chicken fibroblast culture, inactivated with beta-propiolactone. Activity >2.5 IU. Store at 2-8°
Anti-rabies immunoglobulin from human serum - Sichuan Yuanda Shuyang, China	Injection solution 150 IU/ml. Vials 1, 2, 5 ml. (Supplier: OJSC Trading House Allergen)
Anti-rabies immunoglobulin from horse serum, Russia, Ukraine	Activity not less than 150 IU/ml. Ampoules of 5 and 10 ml in; complete with IG in a dilution of 1:100. Store at 3-7

Antirabies immunoglobulin from human serum is administered intramuscularly, to adults and children - 1 dose of 20 IU/kg - but no more, since this can suppress the production of antibodies. Part of the dose - the maximum - is administered by infiltrating the wound, and the remainder - intramuscularly (thigh, buttock) together with the 1st dose of the vaccine - into the deltoid muscle - further from the Ig.

In case of delay, immunoglobulin should be administered no later than the eighth day after the first dose of the vaccine, regardless of the time interval between contact with the virus and the start of therapy. To ensure good infiltration of the affected areas in children (especially with multiple bites), the drug is diluted 2-3 times with 0.9% NaCl solution.

Antirabies immunoglobulin from horse blood serum is administered at a dose of 40 IU/kg of body weight after mandatory intradermal testing with the drug diluted 1:100. If the test is negative, 0.7 ml of immunoglobulin diluted 1:100 is injected under the skin of the shoulder, and after 10 minutes, if there is no reaction, the entire dose of the undiluted drug, heated to 37±0.5°, is administered fractionally in 3 doses with an interval of 10-15 minutes. Part of the dose is administered around the bite sites, and the rest is administered intramuscularly. If the skin or subcutaneous tests are positive, the drug is administered according to vital indications with fractional desensitization. Before the first injection, antihistamines are administered intramuscularly; a subcutaneous injection of a 0.1% adrenaline solution in an age-appropriate dose is recommended.

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Rabies Prevention Schemes

Vaccination against rabies provides immunity development in 10-14 days from its onset. In case of severe bites in dangerous locations, the incubation period may be too short, therefore specific immunoglobulin is administered with the vaccine.

Therapeutic and prophylactic (post-exposure) immunization is carried out with or without anti-rabies immunoglobulin. In case of severe injuries or death of the animal from rabies, simultaneously with the first administration of the vaccine, anti-rabies immunoglobulin is administered intramuscularly (if it could not be administered on the first day, it should be administered as soon as possible during the first 3 days after the bite). The vaccine is administered regardless of the time since the bite. In areas free from rabies for 2 years or more, in case of bites inflicted by domestic animals with an unspecified diagnosis or wild animals, immunoglobulin is not administered, but vaccination is carried out. Schemes for prevention with the KOKAV vaccine.

The administration of the vaccine is stopped if the animal remains healthy after 10 days of observation. In case of a bite of a previously vaccinated person, 2 doses of the KOKAV vaccine are administered - on days 0 and 3.

Rabivac (KAV) - the course is from 9 to 25 injections depending on the severity of the damage and information about the animal.

Rabipur is administered 1 dose on days 0, 3, 7, 14 and 28 after the bite to all persons not vaccinated or not fully vaccinated against rabies. In Denmark, bat bites are treated with 6 instead of 5 doses of the vaccine.

Preventive (pre-exposure) immunization is carried out by three intramuscular injections of 1 dose of the vaccine (0, 7, 30 days) with revaccination after 12 months, then every 3 years; similar schemes are used for foreign vaccines. Individuals in risk groups are recommended to have annual monitoring of the level of specific antibodies in the blood: in cases where their level decreases below 0.5 IU/ml, a single revaccination with one immunizing dose is carried out.

Scheme of therapeutic and prophylactic vaccinations with COCAV and anti-rabies immunoglobulin (AIG)

Damage category Contact type*	Animal details	Treatment
1. No damage or saliva deposits on the skin. No direct contact.	Sick with rabies	Not assigned
2. Salivation of intact skin, abrasions, single superficial bites or scratches of the body, upper and lower extremities (except the head, face, neck, hand, fingers and toes, perineum, genitals, inflicted by domestic or farm animals.	If the animal remains healthy for 10 days, the treatment is stopped (i.e. after the 3rd injection). When it is impossible to observe the animal (killed, died, ran away, etc.), the treatment is stopped.	Start treatment immediately: COCAV 1.0 ml on days 0.3, 7, 14, 30 and 90.
Any drooling of mucous membranes, any bites of the head, face, neck, hand, fingers and toes, perineum, genitals; multiple bites and deep single bites of any localization, inflicted by domestic or farm animals. Any drooling and damage caused by wild carnivores, bats and rodents.	If it is possible to observe the animal and it remains healthy for 10 days, the treatment is stopped (i.e. after the 3rd injection). When it is impossible to observe the animal, the treatment is stopped.	Start treatment immediately and simultaneously: AIH on day 0 + COCAV (1 ml) on days 0, 3, 7, 14, 30 and 90.

* - Contact includes bite wounds, scratches, abrasions and drooling areas.

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Vaccination reactions and complications after rabies vaccine

Culture vaccines against rabies do not cause neurological complications and can be used in individuals with an unfavorable neurological anamnesis. Mild reactions may occur at the injection site - soreness, swelling, and compaction. General malaise (fever, enlarged lymph nodes, joint pain, muscle pain) are rare. A 1-2 day break in vaccinations and taking antipyretics usually eliminates the symptoms of the disease. Isolated cases of allergic reactions have been described.

After the use of heterologous antirabies immunoglobulin, the development of immediate-type allergic reactions (rash, Quincke's edema, anaphylactic shock) and serum sickness is possible.