One clinic visit for pre-exposure rabies vaccination (a preliminary one year study).

We performed an abbreviated prospective study of rabies pre-exposure (PREP) vaccination in 109 volunteers. Group 1, the control group, received the conventional 3 intradermal injections on days 0, 7 and 21. Group 2 received one rabies vaccine injection (0.1 ml intradermally) at 2 sites on a single day. Group 3 was given one full ampule intramuscularly. One year later, all 3 groups received booster injections (0.1 ml at 4 sites) intradermally at one time or 2 injections intramuscularly on days 0 and 3. All subjects achieved a vigorous anamnestic antibody response 7 days after the boosters. These data suggest that one time immunization of one full dose intramuscularly or 2 site injections of 0.1 intradermally on a single day are adequate to prime immune memory and obtain an accelerated immune response one year later.

A 4­site, single­visit intradermal postexposure prophylaxis regimen for previously vaccinated patients: experiences with >5000 patients.

We previously demonstrated that 4‐site, intradermal, single‐visit rabies booster vaccination provides immunogenicity greater than that provided by the standard 2‐booster, 2‐visit regimen. The regimen has been routinely used in 5116 patients since 1998 without any treatment failure. It is not only effective but also saves vaccine costs and transportation expenses and improves compliance.

Is injecting a finger with rabies immunoglobulin dangerous?

Treating potentially rabies virus infected wounds requires the injection of rabies immunoglobulin into and around the wounds, followed by vaccination with an approved tissue culture rabies vaccine. A significant number of such bite wounds involves fingers where there is little space for expansion. Injecting immunoglobulin into such areas under pressure may induce a compartment syndrome caused by compromising circulation. We carried out a retrospective review and a prospective study of patients seen with digital bite injuries and found that it is a safe procedure if carried out with care by experienced staff.

Adverse reactions to human rabies immune globulin manufactured by the Thai Red Cross Society.

Rabies Immunoglobulins (RIG) are an essential part of optimal management of rabies exposures [World Health Organization (WHO)]. They provide protection against the virus during the critical initial 7 days before adequate endogenous vaccine induced antibodies are formed. Even though Human Rabies Immune Globulin (HRIG) is the ideal product for post-exposure rabies treatment it, like most biological, can cause very rare adverse reactions. A retrospective review of a series of 8737 patients, who received HRIG at one institution, revealed that only 15 (0.183 %) reported transient mild adverse reactions.

Common dilemmas in managing rabies exposed subjects.

Health care staff managing rabies exposures in a canine endemic or epidemic environments are often faced with having to make treatment decisions where there are no firm guidelines from WHO or local public health authorities. We have made an attempt to identify several common events that presented to a busy animal bite clinic in a rabies endemic country. Leading experts in this field have been queried about their management opinions in such situtions. They have revealed little uniformity. It appears that there is still much controversy and lack of evidence-based approach from international authorities, and that more research and data collection is needed to resolve some of these issues and provide better guidelines in this field.