Post Exposure Immunization

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RABIES VACCINE – Post Exposure Immunization

Indication

Individuals who have been exposed to rabies virus through suspected/infected rabid animal bites/scratches/licks come under this group.

Important facts in management

  • Immediate and thorough cleansing of wounds with copious soap and water.
  • Preferably, the wound should not be sutured.
  • Tetanus vaccine as per prior immunization status.
  • Anti Rabies vaccine to be given.

The number of doses required is determined by the previous anti-rabies immunization status of an individual.

Immunized person is one who has:

  • received prior complete post-exposure vaccination with HDCV, PCEC
  • previously been immunized with any other type of rabies vaccine with a documented blood report of adequate antibody response (0.5 IU/ml or greater)

Unimmunized person is one who has:

  • received incomplete or no anti-rabies vaccines in the past.

Recommended Schedule

Grade of Exposure determines the schedule. So, it becomes important that you provide correct information to your health care provider & let him make the decision.

Exposure Grade Type of Exposure Immunisation Schedule
1 Touching/feeding animals with no contact with their saliva; with undamaged skin. No immunisation necessary.
If there is risk of further exposure, vaccinate on day 0, 7, 28. But if in doubt, give the complete course on day 0, 3, 7, 14 and 30.
2 Animal has nibbled or licked exposed skin Immediately start immunization. Give the complete course.
Contact of broken skin with infected animals saliva Also give simultaneous prophylaxis with human rabies immune globulin (readymade antibody).
Superficial, non- bleeding, scratches made by the animal with the exception of scratches on the head, neck, scapular region, arms, hands If the animal later is proved to be healthy, it is recommended to continue with schedule on day 0, 7, 28.
3 All bites Immediate administration of immune globulin and start the immunization- complete course as mentioned above.
Bleeding scratches and all scratches on the head, neck, scapular region, arms, hands If the animal later is proved to be healthy, it is recommended to continue with schedule on day 0, 7, 28.
Contact of mucus membrane with saliva as in licking

Re-Exposure Schedule

If one has already taken the full course of vaccines once and is re- exposed, the following schedule is to be followed:

Interval between full course and re-exposure Schedule
Less than 3 years One injection on day 0 and 3
More than 3 years Full course

Post-exposure Immunisation Time Table

Immunization Status   Vaccine / Product Dose Number of Doses Schedule (Days) Route
Not previously immunized Human RIG 20 IU/kg body weight 1 0 50% Infiltrated Subcutaneously at the site of bite/scratch (if possible); remainder Intramuscular in the buttocks.
HDCV 1ml 5 0, 3, 7, 14, 30 Intramuscular
PCEC
Previously immunized*(Within 3 years) HDCV 1ml 2 0, 3 Intramuscular
PCEC
Previously immunized (>3 years back) HDCV 1ml 5 0, 3, 7, 14, 30 Intramuscular
PCEC

Abbreviations: RIG – Rabies Immune Globulin; HDCV – Human Diploid Cell

[rabies] Vaccine; PCEC – Purified Chick Embryo Cell; I.U. – international unit; kg – kilogram; ml – milliliter.

* Prior complete post-exposure vaccination with HDCV, PCEC; or previously immunized with any other type of rabies vaccine with a documented blood report of adequate antibody response.

Remember

  • The dose of the vaccine remains the same in adultsand children.
  • Under no circumstances should the vaccine be given in the buttocks.
  • The pre-exposure vaccines can be given intradermally (ID) in case of HDCV or intramuscularly (IM) but the post-exposure vaccines must be given intramuscularly (IM).