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.