Anti Rabies Vaccine

Disease Overview

• Zoonotic disease accounts for estimated 59,000 global deaths annually.
• India records 18,000 to 20,000 deaths annually, with dogs responsible for majority of cases.
• Incubation period typically spans 2 to 3 months.
• Disease remains uniformly fatal once clinical signs appear.

Wound Categorization And Management

Category	Exposure Type	Prophylaxis Required
Category I	Licks on unbroken skin, touching animals.	None.
Category II	Minor scratches, nibbling without bleeding.	Local wound care, Rabies vaccine.
Category III	Transdermal bites, scratches with bleeding, mucosal licks, wild animal bites.	Local wound care, Rabies vaccine, Rabies immunoglobulin or Monoclonal antibodies.

Initial Wound Care

• Cleansing requires flushing under running water with soap for 10 minutes.
• Apply virucidal agent such as 70 percent alcohol or povidone-iodine.
• Avoid suturing; if unavoidable, infiltrate wound with rabies immunoglobulin prior to suturing.

Vaccine Types And Characteristics

• Modern tissue or cell culture vaccines include purified duck embryo vaccine, purified chick embryo cell vaccine, human diploid cell vaccine, and purified vero cell rabies vaccine.
• Nerve tissue vaccines remain obsolete due to poor efficacy and severe neuroparalytic adverse effects.
• Vaccine potency must exceed 2.5 International Units per intramuscular dose.
• Administration involves intramuscular injection into deltoid or anterolateral thigh, or intradermal injection.
• Gluteal injection remains strictly contraindicated.

Immunization Schedules

Postexposure Prophylaxis

• Intramuscular route: Five doses administered on days 0, 3, 7, 14, and 28.
• Intradermal route: Two-site administration on days 0, 3, 7, and 28.
• Recombinant nanoparticle vaccine: Three-dose intramuscular schedule on days 0, 3, and 7.

Preexposure Prophylaxis

• Recommended for high-risk individuals including veterinarians, laboratory personnel, and animal handlers.
• Administered as two doses on days 0 and 7 via intramuscular or intradermal route.

Re-exposure Prophylaxis

• Re-exposure within 3 months of complete prophylaxis requires only wound hygiene.
• Re-exposure beyond 3 months requires two vaccine doses on days 0 and 3.
• Rabies immunoglobulin administration remains contraindicated during re-exposure.

Passive Immunization

• Indicated for Category III exposures and Category II exposures in immunocompromised individuals.
• Administer by infiltrating thoroughly into and around wounds.
• Human rabies immunoglobulin: 20 International Units per kilogram.
• Equine rabies immunoglobulin: 40 International Units per kilogram.
• Rabishield monoclonal antibody: 3.33 International Units per kilogram.
• Twinrab monoclonal antibody cocktail: 40 International Units per kilogram.