Administering a Rabies vaccine

Administering a Rabies vaccine

General considerations:

The combination of local treatment of the wound, passive immunization with Rabies lmmunoglobulin (RIG) and vaccination is recommended for all severe exposure (category 111) to rabies. Prompt and thorough cleansing of the wound, and administration of purified Equine or Human Rabies lmmunoglobulin (ERIG or HRIG) and cell culture rabies vaccine immediately after exposure virtually guarantee complete protection, and the risk of post-exposure treatment complications is much lower than with brain-tissue vaceines.

Intramuscular schedule:

All intramuscular injections must be given into the deltoid region or,

in small children, into the anteriolateral area of the thigh muscle.

The vaccine should never be administered in the gluteal region.

The most widely used WHO scheme calls for a single 1.0 ml dose IM, administered in the upper deltoid (anteriolateral area of thigh for children) on day 0, 3, 7, 14 and 30 with an optional further dose on day 90.

Often the day 90 dose is omitted except in those also given passive immunisation with RIG (usually categ III bite).

The gluteal region is not recommended on account of high fat content in this region which retards the absorption of the vaccine.

Age and/or weight & dose:

Neonates can be given the anti-rabies vaccine without any additional side effects vis-a-vis older children or adults. Modern tissue culture rabies vaccine should not be given in reduced dosage  irrespective of the age and/ or weight.

The dosage schedule for the modern tissue culture vaccine remains same for all age groups.

Important considerations while administering Rabies lmmunoglobulin(RIG)

Depending on how severe the bite is, Human or Equine Rabies lmmunoglobulin (HRIG or ERIG) is administered on day 0. If possible, RIG should be administered on the day of injury / contact, at the same time as the f irst dose of the vaccine.

If such simultaneous prophylaxis was not given,i.e. if only the vaccine was given at the prescribed interval, then it is only meaningful to administer RIG up to the 8th day after the first injection of the vaccine. The prescribed dosage of RIG must not be exceeded even if commencement of simultaneous prophylaxis is delayed.

Dosage: Human Rabies lmmunoglobulin (HRIG) is given as 20 I.U./ kg.

Equine Rabies lmmunoglobulin (ERIG) is given as 40 I.U./ kg.

Both are injected into and around the wound with any surplus given by deep IM injection. If the calculated volume is inadequate for the injections of all wounds, dilute it in normal saline to make up a sufficient volume.

Disregard the old recommendation that half of the calculated volume of RIG should be injected into the wounds and half I.M.

Site of injection:

Wound infiltration is the most important part of RIG administration. If any of the dose remains after infiltration, it can be given IM into the anteior thigh, and if necessary divided between the two thighs. Injections should not be given into the gluteal region.

Method of wound infiltration:

Caution is needed if injecting into a tissue compartment, e.g. fingerpulp. Excess fiuid can result in increased compartmental pressure and lead to necrosis. Care is needed to avoid RIG seeping out of wounds during infiltration. If such a loss does occur, the volume should be estimated and replaced.

The use of intradermal skin tests before ERIG treatments:

The ID skin test detects lgE mediated Type 1 hypersensitivity, a reaginic response to previous exposure into the antigen .

Rabies Vaccination

This entry was posted in Diseases & Conditions and tagged by Manbir & Gurpreet. Bookmark the permalink.

About Manbir & Gurpreet

Gurpreet Kaur’s journey in this world .... Gurpreet Kaur was a Musician. She was a singer and a composer of music. Her interest was composing and singing Gurbani Shabads in Indian Classical style. She sang Shabads in All the Raags mentioned in Sri Guru Granth Sahib Ji. She also taught Gurmat Sangeet at Gurmat Gian Missionary College, Jawadi, Ludhiana. Elder child to Pushpinder Kaur and Dr. Brig. Harminder Singh, was born in Amritsar on 13th Jan 1962. She attended various convent schools as a child because her father would get frequent Army postings as a dental surgeon. She graduated with Music Honors from Govt. College for Women, Chandigarh. Music was her hobby and she composed and sang Raag based Gurbani Shabads. Doing Kirtan was part of growing up nurtured by her parents. She learned music from her father Dr. Brigadier Harminder Singh who was a dental surgeon in Indian Army and a very good singer himself. Gurpreet’s Bhua (father’s sister), Ajit Kaur retied as a Head of Department of Music from Govt. College for Women Ludhiana, and was a renounced Punjabi singer of her time. Gurpreet Kaur also learned nuances of Indian Classical Music from Pandita Sharma. She was a mother of three children, and a grandmother. Her daughter Keerat Kaur is a Computer Engineer. Her two sons Gurkeerat Singh and Jaskeerat Singh are doctors in USA. Her daughter Keerat Kaur too was part of her group ~ Gurmat Gian Group. Gurpreet Kaur left this world at the age of 54yrs on 12th Sept 2016 in Baltimore USA. She had recorded around 25 cds of Gurbani Keertan. 'Raag Ratan' Album (6 CDs) is a Compilation of Shabads in All the 31 Sudh Raags of Sri Guru Granth Sahib Ji. 'Gauri Sagar' Album (3 CDs) is a Compilation of All forms of Raag Gauri in Sri Guru Granth Sahib Ji. 'Nanak Ki Malhaar' ~ ((3 CDs) is an album of Raag Malhar Shabads in various forms of Malhar. 'Gur Parsaad Basant Bana' ~ (3 CDs) is an album of Shabads in Raag Basant sung in various forms of Raag Basant. Har Ki Vadeyai Sarni Aayea Sewa Priya Kee Preet Piyaree Mohan Ghar Aavho Karo Jodariya Mo Kao Taar Le Raama Taar Le Tere Kavan Kavan Gun Keh Keh Gawan Mera Baid Guru Govinda Saajanrraa Mera Saajanrraa

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s