Rabies

What to do when bitten/ contact with a dog?
All areas of the body and all wounds should be immediately and thoroughly cleaned with soap, water and an antiseptic preparation should be applied.

• The wound is not to be sutured.
  
  
• In case of a bite, after immediate treatment take the person to a hospital for required cleaning and assessment for requirement of rabies immunoglobulin.

When to get immunized for Rabies?

• Post Exposure:- After contact with animals, which are rabid or suspected to be rabid.
  
  
• Pre Exposure:- Required for high risk people like veterinary surgeons, hunters, animal keepers, butchers or before going to an area in which rabies in endemic.

Are there any conditions when the rabies vaccine should not be taken?
All persons must receive the vaccine after exposure. If a person is known to be hypersensitive to any of the constituents of the vaccine, then the vaccine is to be administered under supervision with ready measures for managing anaphylactic shock.

• Avoid prophylactic use in children, adolescents, pregnant women & adults on treatment for any acute illness.
  
  
• Avoid pre exposure vaccine if person is known to be allergic to any constituents of the vaccine.
  
  
• Avoid further immunization of once a complication has occurred with the vaccine.
  
  

What is the Immunization schedule?
Rabies immunization depends on the severity of the exposure:

Grade of exposure	Type of exposure		Immunization schedule
I	Contact with a rabid or suspected rabid animal	Contact with an inoculated animal
	Touching/feeding animal, but no contact with saliva; and skin undamaged prior to and during contact	Touching inoculated lure, skin intact	No immunization necessary If uncertainty exists than schedule B is to be followed.
II	a) Animal has nibbled or licked exposed skin. b) Contact with saliva c) Superficial, non- bleeding scratches made by the animal	Touching inoculated lure, skin damaged.	Immediate immunization according to schedule B. In case of uncertainty concomitant prophylaxis as specified in schedule C. If animal is examined & found to be non-rabid then continue as in schedule A
III	a) All bites b) Bleeding scratches c) All scratches on the head, neck, scapular region, arm & hands d) Contact of animal saliva with mucous membrane of patient	Contact of inoculated lure with mucous membrane or fresh skin wound	Immediate concomitant prophylaxis per schedule C. If animal is proved non-rabid it is adjustable to continue treatment as in schedule A.

Table 2:- Immunization schedule for subjects with no or inadequate immunity
Schedule A	Schedule B	Schedule C
Prophylactic immunization prior to exposure.	Immunization after exposure.	Concomitant prophylaxis after exposure.
One injection IM on days 0,7,28 and 365	One injection IM on days 0,3,7,14,30 & if necessary on day 90.	Rabipur® as in schedule B + 1 X 20 I.V./kg body wt. human rabies immunoglobulin concomitantly with injection of Rabipur or on day 7 after the first injection of Rabipur® at the latest.

Important
People who have received vaccine of doubtful potency or who have not completed the course of injections as required have to receive the entire course according to exposure. In case of re-exposure after 5 yrs., entire course should be taken according to grade of exposure.

Dosage and administration of vaccine
The dose is same for children & adults . 1ml. of vaccines given by intramuscular injection in the deltoid muscle (arm) or in the thigh in small children. The recommended schedule is followed strictly, even if some time has passed since the exposure.

What are the side effects?
These are generally mild and non serious.

• Mild pain, redness and swelling may occur at injection site.
• Occasionally arthritis, gastrointestinal disorders or lymph node swelling may occur.
• Other rare undesirable effects like anaphylactic shock may occur in exceptional cases.