HDCV | PCECV | HRIG Vaccine Type | Usage | Precautions | Side Effects
- Rabies is caused by Rabies virus, an RNA virus of the Rhabdoviridae family.
- It is a uniformly fatal disease transmitted to humans via contact with saliva of infected mammals including dogs, bats and monkeys.
- Once the signs and symptoms of Rabies appear there is currently no treatment. Prophylaxis (both pre- and post-exposure) via vaccination and immunoglobulin is the only method of preventing this deadly disease.
Vaccine Type
- Inactivated (killed) virus vaccine.
Available as
- Human Diploid Cell Vaccine (HDCV): contains inactivated rabies virus grown in human diploid cell culture, given by IM injection.
- Purified Chick Embryo Cell Vaccine (PCECV): contains inactivated rabies virus grown in chick fibroblasts, also given by IM injection.
- Human Rabies Immunoglobulin (HRIG): It is not a vaccine but neutralizing antibodies against rabies virus, given to certain individuals for post-exposure prophylaxis (passive immunization).
Usage
Pre-exposure Prophylaxis:
This should be offered to people who are at risk of acquiring rabies virus, like animal handlers; rabies lab workers and rabies biologics production workers; veterinarians; and hunters. Three-dose schedule is currently in practice using either HDCV or PCECV, given as: 0, 7 days after first dose, and 21 or 28 days after first dose
Post-exposure Prophylaxis:
Exposure to rabies virus can be divided into bite exposures and non-bite exposures.
- Bite exposure: Any penetration of the skin by teeth constitutes a bite exposure and represents a potential risk.
- Non-bite exposure: contamination of open skin wounds or mucous membranes with saliva or potentially infected material (like neural tissue) of a rabid animal is a form of non-bite exposure. Other cases include human-human transmission via organ or tissue transplant and possibly aerosol transmission from infected bats.
- Non Exposure:Indirect contact and activities (e.g., petting or handling an animal, contact with blood, urine or feces, and contact of saliva with intact skin) do not constitute exposures; therefore, post-exposure prophylaxis should not be administered in these situations.
Recommendations:
- Generally speaking, post-exposure prophylaxis is recommended for both bite and non-bite exposures. Wound cleaning by thorough washing with water significantly reduces the risk of rabies, even without vaccination.
- For persons who have received full course of rabies vaccination previously, 2 doses of vaccine are recommended at 0, and 3 days. HRIG is not required.
- For a person who has not received any previous vaccination of rabies, 4 shots of the vaccine at 0, 3, 7, 14 days and one dose of HRIG at the same time as the first dose of vaccine are recommended.
Precautions
- Once a person is exposed to rabies virus, there are no contraindications to post-exposure prophylaxis.
- Certain drugs and conditions, particularly immunosuppression (either drug induced or otherwise), might interfere with the production of adequate immune response to the vaccine. If possible the respective drug might be stopped during the immunization period.
- Pregnancy is not a contraindication to post-exposure prophylaxis, and if the risk is high enough, pre-exposure prophylaxis can also be given to a pregnant women.
- Persons who had an allergic reaction to previous dose of a rabies vaccine should be revaccinated with caution. If severe allergic reaction occur to one type of vaccine, it may be advised to use another type to complete the course.