Evaluation of a new premedication protocol for administration of equine rabies immunoglobulin in patients with hypersensitivity.

OBJECTIVES: The present study was undertaken to standardize skin testing and to develop a safe and effective premedication protocol for administration of ERIG in those with skin test positivity/hypersensitivity. METHODS: A method of grading of skin testing was developed using injection histamine as a positive control. This was evaluated by using it on 517 subjects who had severe (WHO category III) exposure to rabies. A premedication protocol consisting of injections pheniramine, ranitidine, hydrocortisone and adrenaline was evaluated by using it on fifty one subjects who were skin test positive/hypersensitive to ERIG. RESULTS: The premedication protocol was safe and effective as all the S1 subjects could be administered the full dose of ERIG despite being skin test positive/hypersensitive to ERIG. Besides the premedication drugs/protocol did not affect the immune response to vaccine and ERIG therapy.

Boosting effect of purified chick embryo cell rabies vaccine using the intradermal route in persons previously immunized by the intramuscular route or vice versa.

BACKGROUND: At present, in the event of re-exposure to rabies, 2 booster doses are recommended for people who have been previously vaccinated with cell culture rabies vaccines by the conventional intramuscular route. As the intradermal route of vaccination is likely to be introduced in the future, we investigated the immune response to a cell culture rabies vaccine after crossing over from the intramuscular to the intradermal route and vice versa. METHODS: Twenty healthy adult volunteers who had received a primary course of rabies vaccination with purified chick embryo cell rabies vaccine by either the intramuscular (n = 10) or intradermal (n = 10) route received booster vaccination with the same vaccine by the alternative route. The regimen used was 0.1 ml of vaccine by the intradermal route at two sites (deltoid area) for the intramuscular group, or 1 ml of vaccine by the intramuscular route (deltoid muscle) to the intradermal group on days 0 and 3. RESULTS: There was a 15-fold rise in the rabies virus neutralizing antibody response both by the intradermal and intramuscular routes of booster vaccination (p < 0.0001). Thus, the change of route of purified chick embryo cell booster vaccination did not alter the anamnestic immune response to the vaccine. No side-effects were observed after vaccination with either of the routes. CONCLUSION: Purified chick embryo cell vaccine was found to be safe and immunologically efficacious following booster vaccination after cross-over from the intradermal to the intramuscular route and vice versa.

An epidemiological study of animal bites in India: results of a WHO sponsored national multi-centric rabies survey.

This was a WHO sponsored national multi-centric rabies survey and one of its objectives was to find out the incidence of animal bites, anti-rabies treatment practices, Pet dog population and their care. Twenty-one medical colleges chosen with geoscatter representation conducted the survey during February-August, 2003. The survey was conducted in 18 states, covering a population of 52,731 chosen randomly from 8500 households. The annual incidence of animal bites was high, 1.7% and it was more in rural areas (1.8%), children (2.6%) and poor/low income group (75%). The main biting animal was dog (91.5%), mostly stray (63%), followed by cat (4.7%). A high proportion of bite victims did not wash their wounds with soap and water (39.5%), preferred Government hospitals (59.9%) and nerve tissue vaccine (46.9%). The use of rabies immunoglobulin was low (2.1%). A single animal bite episode led to a loss of 2.2 man-days and the cost of medicines including anti-rabies vaccine was Rs.252 (US$6). The recourse to indigenous treatment (45.3%) and local application to wound (36.8%/) was quite prevalent. About 17% of households reported having a pet/domesticated dog and the pet dog: man ratio was 1: 36. Pet dog care/management practices were not satisfactory with a low veterinary consultation (35.5%) and vaccination (32.9%). The situation was slightly better in urban areas. The people also reported the presence (83%) and menace (22.8%) of stray dogs. It is recommended to initiate appropriate community awareness and dog vaccination campaigns and effective stray dog control measures.

An assessment of rabies free status of the Island of Andaman, Nicobar and Lakshadweep: results of the WHO sponsored national multicentric rabies survey.

The Islands of Andaman and Nicobar and Lakshadweep have been reported to be rabies free from time immemorial. Recently, a survey of the islands of Andaman and Nicobar & Lakshadweep was done between July and August 2003 to assess their rabies free status. It was revealed that these islands continue to remain rabies free. However, in Andamans the increasing dog population, poor vigil on import of dogs and lack of laboratory surveillance for rabies posed a threat to this status. The Lakshadweep islands, which are free of dogs, however, faced a threat from the lack of vigil on the entry and presence of cats and poor surveillance for rabies in them.

A community survey of dog bites, anti-rabies treatment, rabies and dog population management in Bangalore city.

This survey was conducted by using a 30 cluster random sampling technique to comprehensively study the nature and magnitude of rabies and its related problems in human and dog population. The city has an estimated dog population of 3.25 lakhs of which 2 lakhs (61.5%) are stray dogs and 1.25 lakhs (38.5%) are pet dogs. The dog:man ratio was about 1:12 and the pet:stray dog ratio of 1:2. The awareness about Animal Birth Control (ABC) programme was low (34%) and only 20% had faith in it. The annual incidence of dog bites was 1.9% persons. It was more in males (64%) and mostly from stray dogs (64%). About 86% of them received anti-rabies vaccination and none received life saving Anti-Rabies Serum (ARS). The annual incidence of human rabies was 15 and dog rabies 58 resulting in a ratio of 1:4 approximately as a rabies contagion index. The implementation of ABC programme was weak (10.4% coverage) and is recommended for acceleration and improvement. Similarly modern anti-rabies immunization, including anti-rabic serum, shall replace the outdated sample (sheep brain) vaccine.

Post-exposure prophylaxis with purified vero cell rabies vaccine during pregnancy--safety and immunogenicity.

This study was conducted with the main objective of determining the safety and immunogenicity of purified vero cell rabies vaccine (PVRV) during pregnancy. Twenty nine pregnant women exposed to rabies were vaccinated with PVRV as per the Essen regimen advocated by World Health Organization. None of the women experienced any adverse side effects to the vaccine. The intrauterine growth and development monitored by ultrasound examination was found to be normal and the outcome of pregnancy was satisfactory. There were no congenital anomalies in any of the infants born and they were healthy and had normal growth and development during the one year follow-up period. The rabies neutralizing antibody titers from day 14 to day 365 following vaccination in these women was adequate and well above the minimum protective level of 0.5 iu/ml of serum. Protective levels of antibodies were also present in serum of some of the babies tested, for up to 3 months of age. The mothers and infants followed for one year period were doing well at the end of the study period. Consequently, PVRV was found safe and immunogenically efficacious during pregnancy.

Post exposure rabies prophylaxis with Purified Verocell Rabies Vaccine: a study of immunoresponse in pregnant women and their matched controls.

The present controlled clinical trial evaluates the immunoresponse to Purified Verocell Rabies Vaccnine (PVRV) by Essen schedule of vaccination during Pregnancy. Seventeen Pregnant women with history of animal bites who received PVRV as per Essen regimen were matched for the confounding variables of age, socio-economic status and doses of PVRV received with seventeen "Non-pregnant women". The mean age was about 24 years, majority (70.6%) belonging to middle socio-economic group and received 3 doses of PVRV. Contrary to the expectations the rabies neutralizing antibody titres were slightly higher in pregnant women (except day 180) but the difference was not significant (P > 0.2). Both the groups of women had antibody titres above protective level (0.5 IU/ml) from day 14 till day 365 thus indicating immunogenic efficacy of PVRV by Essen regimen during Pregnancy.