A 5-year-old boy presents to the hospital with bleeding wound from bite of his pet dog which was fully vaccinated. He previously had completed anti rabies immunization on December 2018. What post exposure prophylaxis against rabies is recommended for the patient now?
Ans. (B) Single site 2 doses on day 0 and 3(Refer: WHO vaccination 2018)As it is difficult to know whether the vaccinated dog is adequately seroconverted/protected against rabies. Hence, even in such individuals it is recommended to start the PEPThis case is classified under WHO- Category-III.Individuals with WHO category II or III exposures should receive PEP without delay.One ID dose is 0.1 mL of vaccine and one IM dose is an entire vial of vaccine, irrespective of the vial size.Should a vaccine dose be delayed for any reason, the PEP schedule should be resumed (not restarted)Rabies Immunoglobulin (RIG)RIG provides a passive immunization and is administered only once, as soon as possible after the initiation of PEP and not beyond 7 days after the first dose of vaccine.Vaccines should never be withheld regardless of the availability of RIG.Max dose: hRIG- 20IU/kg, eRIG- 40IU/kgAll of the rabies immunoglobulin, or as much as anatomically possible (but avoiding possible compartment syndrome), should be administered into or around the wound site or sites. The remaining immunoglobulin, if any, should be injected intramuscularly at a site distant from the site of vaccine administration. Rabies immunoglobulin may be diluted to a volume, sufficient for all wounds to be effectively and safely infiltrated.Prioritization of RIG allocation:#Multiple bites > Deep wounds > Bites to head, neck and hands > Patients with severe immunodeficiency > The biting animal is confirmed or probable rabies > Bites, scratches, and exposure of mucous membranes caused by a bat.Immunodeficient individuals: In the event of exposure a complete PEP course, including RIG is recommended irrespective of the PrEP status.(PrEP) Pre-exposure prophylaxis:#PrEP considered in remote, rabies- endemic areas where access to PEP is difficult, the dog bite incidence is 5% per year or vampire bat rabies is known to be present.#2 sites ID or a 1-site IM vaccine administration on days 0 and 7.#A routine PrEP booster or serology for neutralizing antibody titers is recommended only if a continued, high risk of rabies exposure remains.#Individuals with documented immunodeficiency should be evaluated on a case-by-case basis and best receive an ID or IM PrEP schedule as above, plus a third vaccine administration between days 21 to 28.
No ARV required
Single site 2 doses on day 0 and 3
Single site 4 doses on day 0, 3 7 and 28
Rig and 4 doses regime
Communicable Diseases