APCRI

Association for Prevention and Control of Rabies in India

Everything About Rabies

  1. Why a person does not acquire immunity against rabies natural infection, as it occurs in other viral infection?
  2. Can rabies be transmitted from man to man?
    1. Are there any survivors of Rabies/hydrophobia?
    2. Does Kissing of a hydrophobia patient require PET immunization?
    3. Can rabies be transmitted through Sexual intercourse?
    4. A pregnant woman develops hydrophobia. What should be done?
    5. What are contraindications to PET?
    6. Can a rabies vaccine be given to a pregnant woman?
    7. Can a Pregnant woman be given Pre-exposure vaccination?
    8. Can a lactating mother be given anti-rabic vaccine?
    9. What is the criteria for “Protection” after immunization ?
    10. Is it essential to perform an antibody test on the patient following ARV ?
    11. Is there a one shot ARV? Is there a ARV to protect life long ?
    12. A person who started NTV wants to change over to TCV and vice versa. What is the guideline of schedule?
    13. Is there any dietary restriction during PET?
    14. Do the new-born or neonates or infants require lesser dosage of ARV ?
    15. What is the efficacy of NTV v / s TCVs ?
    16. How are TCVs safer than NTV?
    17. Can ARV be given along with other vaccines?
    18. Can ARV be given to a child with chicken pox or Measles?
    19. Can ARV be given to HIV or AIDS patient ?
    20. If a person is on antimalarials or steroids or taking Immunosuppresant drug, what is the schedule ?
    21. What is “Potency” of ARV ?
    22. Is it true that potency of NTVs of different institutes vary ?
    23. Can ARV be given to a patient with jaundice ?
    24. Beta Propiolactone (BPL) used for inactivation of vaccine is a known carcinogenic. How is it safe to inject with vaccine?
    25. What is the treatment of neuroparalytic complaints?
    26. Continuos cell lines (like Vero cells) originate from malignant cells. Then the PVRV (Verorab) produced from verocells (African green monkey kidney cell line), Can it cause malignancy?
    27. SV40 (Simian virus 40) is known to be common contaminant of monkey derived cell lines , which produce cancer in some lower animals. Is it a contaminant of verocell also?
    28. What is intradermal (I.D.) schedule of vaccination?
    29. What is abbreviated multisite schedule?
    30. Can TCVs be diluted with tetanus toxoid or water for injection or any other diluent and administered?
    31. Accidentally the TCV was kept in the freezer. Can it be used?
    32. Is it essential to perform an antibody test on the patient following ARV?
    33. A person started with HDCV wants to change to PVRV or PCEC. What should be done?
    34. A dog/cat became unavailable or disappeared for observation from day 4 and the patient was given TCV on day 7 (3rd dose). Subsequently from day 8 it became reavailable (reappeared). What should be done?
    35. A patient received two doses of TCV (day0,3) and the dog was well on day 5 and 7 (3rd injection due, not given). However, the dog dies on day 8 to 15 (any day). What should be done?
    36. Of the currently available TCVs viz HDCV, Rabipur, Verorab, and Verovax-R, Which is the best?
    37. If PET is required for a person bitten by a vaccinated dog, then why vaccinate the dog at all?
    38. How safe is ARS (equine)? Can adverse reactions occur after negative skin tests?
    39. How adverse effects to ARS are managed? Does it influence subsequent vaccine therapy?
    40. If a skin test is positive in a class III rabid animal bite, what should be done?
    41. If ERIG / ARE is inadequate to infilltrate extensive wounds what should be done ?
    42. What if HRIG is inadequate ?
    43. How to calculate the total dose of ARS /HRIG ?
    44. Can ARS / HRIG be given locally to a healed wound ?
    45. Can ARS/HRIG be given after starting vaccination ?
    46. If HRIG is not available can human normal immunoglobulin (polyvalent) be given ?
    47. How is ARS (Equine) or HRIG lifesaving ?
    48. Is Bat Rabies Present in India ?
    49. Is hydrophobia (fear of water) a sing in rabid animals ?
    50. What should be done to persons who have consumed milk of a rabid cow/buffalo/goat?
    51. What is the truth about carrier state of rabies in dog ?
    52. Is 10 days duration of observation of dog (and cat) adequate and valid ?
    53. What should be done to a pet dog / dog which is bitten by a stray dog ?
    54. Are there reports where the patient died of rabies but the biting dog is alive ?
    55. A person has handled (or eaten) the raw meat of a rabid animal; what should be done ?
    56. Can a vaccinated dog transmit rabies ? How effective is dog vaccine ?
    57. A pet vaccinated dog died of sudden unexplained death. What should be done ?
    58. Whether treatment of provoked bites differ from unprovoked bites ?
    59. Can Human ARVs viz. NTV or TCVs (PCEC, PVRV, HDCV) be given to animals?
    60. An unvaccinated or partially vaccinated pet dog/cat is bitten by a dog. What should be done ?
    61. Can unvaccinated pet dog/cat pose danger to the family ?
    62. If PET is required for a bite by a vaccinated dog then why vaccinated the dog at all ?
    63. A vaccinated pet dog is bitten by a rabid animal. What should the owner do ?

    1. Why a person does not acquire immunity against rabies natural
    infection, as it occurs in other viral infection?

    From the site of bite the virus enters a nerve and via axoplasm reaches the central
    nervous system (CNS). Thus, there is no viremia and the virus is not accessible to the
    normal immune mechanism of the body. Only after travelling efferently from CNS via mostly
    autonomic nerves to different (target) organs the antibody production starts. But by that
    time the patient’s brain stem neuronal cells are destroyed and he dies in a day or
    two either due to respiratory paralysis or due to cardiac arrest.

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    2. Can rabies be transmitted from man to man?

    Theoretically the saliva of a hydrophobia patient is infectious and occasionally such
    transmission is reported. But the well documented transmission is through corneal
    transplantation. Hence, confirmation of cause of death, particularly in neurological cases
    is very important before corneal transplantation. Besides it is also important to avoid
    contact with saliva and secretions of a rabies patient.

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    3. Are there any survivors of Rabies/hydrophobia?

    There are 3 recorded survivors of rabies, 2 from USA (1970and1977) and 1 from Argentina
    (1972). All had received some immunoprophylaxis and they recovered following intensive
    care. No specific drug/therapy is responsible for their recovery (Kaplan, et. Al.). In
    India, 2 Survivors are reported from AIIMS, Delhi (1988) but they are not well acclaimed
    due to lack of laboratory evidence in diagnosis.

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    4.Does Kissing of a hydrophobia patient require PET immunization?

    The saliva of a hydrophobia patient contains the rabies virus and is infective. If there
    is suspicion about contact with saliva of hydrophobia patient during kissing the contact
    person requires 5 doses of TCV or class II schedule of NTV. If there are ulcers in the
    mouth of the contact then even serum or HRIG must be given.

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    5. Can rabies be transmitted through Sexual intercourse?

    Rabies virus is present in the semen and to some extent in vaginal secretions. In some
    patients, priapism, increased sexual libido and indulgence is seen (both in men and women
    patients). Hence, in the contact (exposed) person 5 doses of TCV as PET (or class II of
    NTV schedule) should be given. If there is doubt of class III exposure viz. Abrasion on
    penis or in vagina then even serum or HRIG must be given.

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    6. A pregnant woman develops hydrophobia. What should be done?

    In humans, rabies virus is not known to cross the placental barrier and consequently the
    foetus  is safe. Hence, the hydrophobia pregnant woman should be clinically managed
    and if induction of pregnancy / caesarian section is possible the obstetrician shall do it
    with due “personal precautions” and immunoprophylaxis (3doses of TCV usually or
    if any accidental negligible exposure/doubt 5 doses of any TCV).

    The newborn has to be given 5 doses of any TCV as PET or if the hydrophobia mother (who
    will invariably die) is poor then class I PET schedule of NTV should be given.

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    7. What are contraindications to PET?

    Rabies is 100% fatal and hence there is no contraindication to PET at all.

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    8. Can a rabies vaccine be given to a pregnant woman?

    All rabies vaccines including Nerve Tissue vaccines are known to be safe during
    pregnancy. Besides pregnant woman with h / o animal bite are susceptible to rabies and
    should be given PET. Under no circumstances MTP should be done following ARV
    administration.

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    9. Can a Pregnant woman be given Pre-exposure vaccination?

    Modern TCVs are considered generally safe during pregnancy (as of
    reports available till now) and no teratogenicity or other adverse effects are reported
    during pregnancy. However, pregnant woman wherever possible may avoid exposure and
    pre-exposure vaccination. As Rabies is a 100% fatal disease, there are no absolute
    contraindications for prophylaxis and post exposure prophylaxis must be started even in
    pregnant and lactating women.

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    10. Can a lactating mother be given anti-rabic vaccine?

    All anti-rabic vaccines are inactivated vaccines and can safely be
    given to lactating mothers and it has no effect on the breast fed baby.

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    11. What is the criteria for “Protection” after
    immunization?

    Rabies Neutralizing Antibody titre of > 0.5 IU / ml of serum in the vaccine is
    considered protective. The facilities for this test are available at select centres like
    CRI, Kasauli, Himachal pradesh; Pasteur Institute, Coonoor, Tamilnadu; NICD, Delhi NIV,
    Pune; NIMHANS, Bangalore and few other centres.

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    12. Is it essential to perform an antibody test on the patient
    following ARV ?

    Antibody tests viz., Rapid Fluorescent Focus Inhibition Test (RFFIT), Mouse Neutralization
    Test (MNT), etc., are some sophisticated tests and are done only at select few reference
    centres in the country. Besides ARVs, whether NTV or TCVs with proper cold chain
    maintenance if given according to the approved schedule, no testing of antibody is
    required on a routine basis.

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    13. Is there a one shot ARV? Is there a ARV to protect life long
    ?

    No where in the world is there a single shot ARV [including the often mistaken notion
    about expensive HDCV] nor is there a ARV which gives lifelong immunity.

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    NERVE TISSUE VACCINE

    14.A person who started NTV wants to change over to TCV and vice versa.
    What is the guideline of schedule?

    If a person has started NTV then if he shifts to TCV full course of TCV (5 or 6 doses)
    should be given irrespective of doses of NTV received earlier. If a person who started TCV
    has received minimum 3 doses (day 0, 3 and 7) then the remaining injections of NTV as per
    schedule should be given. If he has received 1 or 2 doses of TCV then full course of NTV
    as per schedule should be given.

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    15.Is there any dietary restriction during PET?

    It is generally advisable to abstain from alcohol during the ARV administration as it may
    affect the immune response.

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    16.Do the new-born or neonates or infants require lesser dosage
    of ARV ?

    In case of TCVs (HDCV/PVRV/PCEC) the dosage is same for all age groups. However, in case
    of NTVs it is lesser quantity for younger age groups (lower body weight) according to
    manufacturer.

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    17.What is the efficacy of NTV  v/s  TCVs ?

    The efficacy (ability to protect against rabies) of NTV is known to produce neuroparalytic
    accident after 5-7 injections in 1 in 4000 to 11,000 persons. Besides the local and other
    systemic side effects of NTV is about 50-70% and often lead to defaults, mostly local
    pain, itching, redness, occasionally fever and in about 2-8% persons. Hence, TCVs are
    safer.

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    18. How are TCVs safer than NTV?

    The myelin residue (of sheep brain) in the NTV is known to produce
    neuroparalytic accident after 5-7 injections in 1 in 4000 to 11,000 persons. Besides the
    local and other systemic side effects of NTV is about 50-70% and often lead to defaults,
    wheras in TCVs adverse events are mild, transient, mostly local pain, itching, redness,
    ocasionally fever and in about 2-8% persons. Hence, TCVs are safer.

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    19.Can ARV be given along with other vaccines?

    ARV can be given with other EPI vaccines. However, TCV should be given at the recommended
    site (deltoid or thigh, IM) and at a site different from EPI vaccine.

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    20.Can ARV be given to a child with chicken pox or Measles?

    It can be given.

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    21.Can ARV be given to HIV or AIDS patient ?

    TCVs are preferred to NTV and the Day 0 dose (1st injection) should preferably be doubled
    and given at two sites (deltoids or thighMI) in young children. However, if facilities for
    antibody titres estimation are available it should be done. Rabies immunoglobulins are
    life saving in AIDS patients when the CD4 counts are low and sero conversion is
    compromised.

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    22.If a person is on antimalarials or steroids or taking
    Immunosuppresant drug, what is the schedule ?

    TCVs are preferred to NTVs and the Day 0 dose (1st injection) should preferably be doubled
    and given at two sites (deltoids thigh IM in young children). However, if facilities for
    antibody titres estimation are available it should be done.

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    23.What is “Potency” of ARV ?

    The “potency” is the capacity or antigenic value of the vaccine to
    induce immune response. NTVs it is a minimum of 0.3 antigenic value and for TCVs it is
    >2.5 IU / dose.

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    24.Is it true that potency of NTVs of different institutes vary ?

    Yes. Hence, their dosage and schedules viz., number of injection, boosters, etc.,
    also vary.

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    25.Can ARV be given to a patient with jaundice ?

    If PET vaccination is required TCVs are to be preferred. If facilities permit antibody
    titre estimation is recommended. Serum or RIG (Equine or Human) if required (class III)
    should be used.

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    26. Beta Propiolactone (BPL) used for inactivation of vaccine is
    a known carcinogenic. How is it safe to inject with vaccine?

    No. BPL loses its carcinogenicity because of its hydrolysis during the process of
    inactivation of rabies virus where it is used in final concentration of 1:4000.

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    27. What is the treatment of neuroparalytic complaints?

    NTV should be immediately replaced with TCV. Patients should be put on absolute
    bed rest. Corticosteroids in highest tolerable doses are given parentally. Supportive
    therapy with vitamin B complex, Vitamin C and calcium may be given. After recovery,
    steroids are tapered off. The dose of TCV should be doubled during this period and if
    possible antibody titre estimation must be done.

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    TISSUE CULTURE VACCINES

    28. Continuos cell lines (like Vero cells) originate from
    malignant cells. Then the PVRV (Verorab) produced from verocells (African green monkey
    kidney cell line), Can it cause malignancy?

    The verocell lines are thoroughly tested for their capability of inducing malignancy in
    most susceptible animals even in that passage (subculture) which is beyond the passage
    used for production of vaccine. Verocell lines have been shown not to produce any
    malignancy in both in vivo and in vitro systems, The verocell line used for production of
    PVRV has been approved by WHO and is part of American type culture collection (ATCC) which
    is accepted worldwide. The same cell line is now used for production of even polio
    vaciine.

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    29. SV40 (Simian virus 40) is known to be common contaminant of
    monkey derived cell lines , which produce cancer in some lower animals. Is it a
    contaminant of verocell also?

    Vero line used for PVRV (Verorab and verovax-R) is free of any SV40 virus

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    30. What is intradermal (I.D.) schedule of vaccination?

    One dose of 0.1 ml of PVRV (Verorab or Verovax-R) should be given at each of two
    sites, either the forearm or the upperarm, on the days 0, 3, 7, and one dose at one site
    ondays 30 and 90. It is to be administered in specialised centres and by trained personnel
    only with adequate laboratory facilities (for antibody titre estimation facility in the
    patients vaccines).

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    31. What is abbreviated multisite schedule?

    In the abbreviated multisite schedule, (also known as Zagreb schedule), the 2-1-1
    regimen, one dose (of HDCV or PVRV or PCEC) is given in the right arm and one dose in the
    left arm (IM) on day 0 and one dose applied intramuscularly in the deltoid region on day 7
    and 21. Though this is WHO approved it is not approved by drug controller of India and
    hence should not be used by medical practitioners in India.

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    32. Can TCVs be diluted with tetanus toxoid or water for
    injection or any other diluent and administered?

    Since mixing of biological products can lead to physical or chemical interaction and in
    the absence of specific studies the TCVs which are costly should not be diluted with any
    other diluent (other than provided with the vaccine.)

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    33. Accidentally the TCV was kept in the freezer. Can it be used?

    As freezing and thawing (liquifying frozen substances) is known to affect the potency of
    the vaccine, it should not be used.

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    34. Is it essential to perform an antibody test on the patient
    following ARV?

    Antibody tests viz., Rapid fluorescent focus inhibition test (RFFIT), Mouse neutralisation
    test (MNT), etc. are some of the sophisticated tests and are done only at select few
    reference centres in the country. Besides ARVs, whether NTV or TCVs with proper cold chain
    maintenance if given according to the approved schedule, no testing of antibody is
    required on a routine basis .

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    35. A person started with HDCV wants to change to PVRV or PCEC.
    What should be done?

    All TCVs viz HDCV, PVRV, AND PCEC are freely interchangeble. This is done in
    practice either for cost reason, or due to sudden non availability of one brand or due to
    allergy to one of the TCVs.

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    36. A dog/cat became unavailable or disappeared for observation
    from day 4 and the patient was given TCV on day 7 (3rd dose). Subsequently from day 8 it
    became reavailable (reappeared). What should be done?

    The dog or cat should be observed till day 10 or wherever possible upto day 15
    and if healthy and alive then the 4th injection due on day 14 is not required. But the
    earlier 3 injections (on day 0,3,&7) may provide protective antibody titres for the
    “pre-exposure schedule duration” of 1 year only.

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    37. A patient received two doses of TCV (day0,3) and the dog was
    well on day 5 and 7 (3rd injection due, not given). However, the dog dies on day 8 to 15
    (any day). What should be done?

    If rabies in the dog cannot be confirmed by postmortem then it is presumed to be
    rabid and the remaining (not to restart fresh) 3 doses of day 7, 14 and 28 (or 30) shall
    be given as close to the original dates of schedule and all the 5 injections completed by
    day 30.

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    38. Of the currently available TCVs viz., HDCV, Rabipur, Verorab,
    and Verovax-R, Which is the best?

    For all practical purposes from safety and sero-efficacy point of view all are
    equally good and approved by WHO. But each vaccine has its own merit which the doctor
    should consider while using it in a given situation/case

    a) HDCV : This is of homologous (human) origin, considered by many as the
    “purest” antigen; the popular vaccine in the developed world and often used as
    “Gold standard” in TCVs. But it is the most expensive TCV (about 930/-) per dose
    and is imported from France to India.

    b) Rabipur (PCEC vaccine) :  It is a thermo stable vaccine, it is
    indigenously produced in India by  Aventis Pharma at Gujarat.  It is also
    approved by the Food and Drugs administration (FDA) of USA. Besides it is exported from
    India to Nepal, Bangladesh, and Srilanka, thus signifying its quality.

    c) Verorab (PVRV) : It is a thermo stable vaccine, has a dose of 0.5 ml
    and is the WHO reference vaccine for intra-dermal regimen. It  is imported from
    France.

    d) Verovax-R (PVRV) :It is a thermo stable vaccine, has a dose of 0.5 ml
    and is the WHO reference vaccine for intra-dermal regimen. It  is imported from
    France . The diluent is in prefilled syringe and is convenient to use for an otherwise
    busy practitioner

    e) Abhayrab(PVRV) :It is a thermo stable vaccine,
    produced in India by Human Biologicals Ltd., a Government  undertaking.

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    39. If PET is required for a person bitten by a vaccinated dog,
    then why vaccinate the dog at all?

    Vaccinating the pet dog is primarily to protect it against contracting rabies following
    bites by stray rabid dogs/animals. No veterinary vaccine offers 100% protection against
    rabies. Rabies is enzootic in our stray animal/dog population. The facility of protective
    antibody titre test (in vaccinated dog) is available only at a few centres in the country.
    The facility to quarantine the bitten vaccinated pet is limited and difficult. In veiw of
    the above facts and practical realities, rabies being 100% fatal, we take no chances and
    start PET (immunisation) in the bitten person and presume the vaccinated dog to be
    incubating rabies ( and infective) and simultaneously observe the dog.

    However, in extremely rare situations exception to the above thumb rule can be made at the
    professional discretion of the treating physician.

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    ANTIRABIC SERUM

    40. How safe is ARS (equine)? Can adverse reactions occur after negative
    skin tests?

    Genarally the currently available ARS (equine) are purified (enzyme refined and pepsin
    digested) and safe and the reported anaphylaxis is 1:40,000 patients. However , in 1-6% of
    the patients, even after a negative skin test there may be adverse reactions ranging from
    serum sickness like reaction to anaphylaxis. Hence, it is always safer to keep emergency
    drugs (like Wysolone, antihistaminics, oxygen etc.) on hand and ARS preferably be given in
    an institutional set up.

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    41. How adverse effects to ARS are managed? Does it influence
    subsequent vaccine therapy?

    The immediate reaction are anaphylactiod type viz. Hypotension, dyspnoea, syncope,
    urticaria. Serious type of quinckies edema or anaphlactic shock is rare (<1%). This is
    treated with adrenaline, oxygen, artificial respiration, hydrocortisone and
    antihistamines. Serum sickness like reactions (1% subjects) may occur after 6 days. They
    consist of an inflammatory reaction due to compliment activation and formation of immune
    complexes (type III hypersensitivity reaction). Clinical symptoms are fever, pruritis,
    rash, urticaria, adenopathy, and arthralgia. This is treated with non steroidal anti
    inflammatory agents and anti-histamines. If steroids are used an extra dose of TCV should
    be used for each remaining schedule of vaccination. Ideally in these situations antibody
    titre estimation is required and if possible this must got done at the nearest centre.

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    42. If a skin test is positive in a class
    III rabid animal bite, what should be done?

    Ideally the patient should be persuaded to buy HRIG which is
    practically safe and no skin test is required. If the patient cannot afford HRIG, as the
    situation is life threatning under signed informed consent a heroic measure of
    desensitisation for horse serum may be considered in a institution set up. Alternatively
    administration of ARS under cover of antihistamines can also be attempted in a institution
    set up.

    As a last resort if HRIG is not affordable and desensitisation for
    ARS (or under cover of antihistamines) is not possible the wounds must atleast be
    thoroughly flushed with povidone iodine or surgical spirit or tincture iodine (to
    neutralise the virus) and the patient should preferably be given atleast TCVs with two
    doses on day 0 (in both deltoids).

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    43.If ERIG / ARE is inadequate to
    infilltrate extensive wounds what should be done ?

    Dilute it with normal saline (upto equal volume) and use it both for
    local infiltration (as much as possible) and any balance given in gluteal IM
    administration.

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    44.What if HRIG is inadequate ?

    Dilute it with normal immunoglobulin (unto rqual volume) and use as
    described above for ARS.

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    45.How to calculate the total dose of ARS
    /HRIG ?

    CRI, kasauli, HP : 5 MI vial, 1500 IU (300 IU per ML)

    1/300 x 40 IU x body wt (kgs)= Dose in ML.

    PM,ARS, France : 5ml vial, 1000 IU (200 IU per ML)

    1/200 x 40 IU x Body wt (kgs)= Dose in ML

    RIG [Berirab, Berirab-p, Imogamrab] = 2 ML (300 IU) ampoul 5ML (750
    IU) ampoule

    1/150 x 20 IU x Body wt (KGS) = Dose in ML

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    46.Can ARS / HRIG be given locally to a
    healed wound ?

    If a wound has healed or healing (scab is formed) if should not be
    disturbed and the total dose should be given IM gluteal only.

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    47.Can ARS/HRIG be given after starting
    vaccination ?

    The combined use of ARS/HRIG (passive immunity) and vaccine (active
    immunity) must be carefully adjusted if the effects of one are not to cancel out the
    effects of the other. Hence ideally the serum must be given within 72 hours of starting of
    vaccine. Hewever, where serum is inevitably to be given beyond 72 hours of starting
    vaccine an additional extra dose of vaccine (TCV) is recommended for IM deltiod/thigh
    administration.

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    48.If HRIG is not available can human
    normal immunoglobulin (polyvalent) be given ?

    Human normal immunoglobulin (polyvalent) cannot substitute HRIG.

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    49.How is ARS (Equine) or HRIG lifesaving ?

    The local infiltration of wounds with ARS/HRIG is of paramount
    importance as it neutralises any residual virus still present in wound [after wound
    treatment] and thus prevents entry of virus into a nerve ending at bite site.

    Besides ARS / HRIG also provides readymade rabies antibody before an
    active response to vaccine takes place. The earliest protective level of antibody [>
    0.5 IU / ML] response to modern TCVs is by day 14. However, in severe bites/bites close to
    brain the incubation may be as short as 4-10 days. In these cases HRIG /ARS is lifesaving.
    After ARS HRIG administration the rabies antibody can be detected within 24 hours, with
    HRIG it reaches a level of 0.1 IU / ML at 3 days and declines with half – life of about 21
    days, whereas in ARS (Equine) this is still of a shorter duration. Hence, ARS /HRIG
    provides immediate passive protection before active protection to vaccine is induced by
    day 14.

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    RABIES IN ANIMALS

    50.Is Bat Rabies Present in India ?

    No. Hence bat bites do not require post-exposure Immunisation.

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    51.Is hydrophobia (fear of water) a sing in
    rabid animals ?

    No. Rabid dogs can drink water and even swim in water.

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    52.What should be done to persons who have
    consumed milk of a rabid cow/buffalo/goat?

    If they have heated/boiled the milk the virus is killed at 60’C
    in 30 seconds. They do not require any vaccination.

    However, if they are still very apprehensive and unconvinced or
    unsure about raw milk consumption, they may be advised PET with tissue culture vaccine
    viz. 3 doses in doubtful exposure or 5 doses in possible exposure, at the discretion of
    physician viz. Day 0,7, and 21(or 28) or day 0,3,7,14 and 28 (or 30). However, if they
    have consumed raw milk, full course of PET (5 dose IM, gluteal).

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    53.What is the truth about carrier state of
    rabies in dog ?

    Carrier state in dogs is very rare and are considered freaks of
    nature. Besides these dogs (mostly studied in experimental Laboratories) excrete the virus
    intermittently and sometimes in low titer. Consequently the observation of dog for 10 days
    and appropriate simultaneous immunisation of bitten person is considered valid even by WHO
    (1996).

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    54.Is 10 days duration of observation of
    dog (and cat) adequate and valid ?

    It is valid. However, in Europe (rabies free areas) it is 15 days
    and in india too wherever permissable / feasible this may be considered, only in
    individual cases and on merit.

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    55.What should be done to a pet dog / dog
    which is bitten by a stray dog ?

    Thoroughly wash the wound with a detergent soap. Apply a household
    antiseptic viz. Tr. Iodine, etc. and consult a veterinarian immediately.

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    56.Are there reports where the patient died
    of rabies but the biting dog is alive ?

    Occasional such reports are seen which base their diagnosis of
    rabies in man on clinico-epidemiological basis (no laboratory diagnosis) and the most
    important thing is the laboratory confirmation of rabies virus secretion in the saliva of
    the biting animal (still alive) is not available. Hence, the so called carrier state of
    rabies (otherwise healthy) is yet to be conclusively established; and till such time the
    current practice of simultaneous starting of vaccination and observation of animal shall
    continue.

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    57.A person has handled (or eaten) the raw
    meat of a rabid animal; what should be done ?

    He should receive full course of NTV or 5 doses of TCV. In extremely
    rare cases if a person has eaten raw meat of a provenly (laboratory Diagnosis) rabid
    animal and if he has oral lesions or ulcers or is apprehensive, he may even be given
    ARS/HRIG [full dose in gluteal IM on day o along with first dose of vaccine].

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    58.Can a vaccinated dog transmit rabies ?
    How effective is dog vaccine ?

    Modern veterinary vaccines (tissue culture) are efficacious. If in
    the last 2 years a dog has received 2 doses it is generally considered protected. Ideally
    its blood should be tested for protective antibody titre level but this is rarely
    practicable/feasible due to scare facilities in our country. Consequently a bite by even a
    vaccinated dog is presumed to be rabid and the bitten person is given post exposure
    immunisation [day 0, 3,. Injections] and after 5 days [day 7 in case of TCVs] if the dog
    is healthy no further vaccination is required. But the dog must be further observed till
    10 days from day of bite (wherever possible up to 15 days) and if it is healthy and alive
    no further vaccination is required. However, 2 doses of TCV [day 0 and 3] received are not
    immunogenically protective and will go waste. Hence, in those who are in constant touch
    with animals, the person may be advised to take the 3rd injection on day 21 or
    28 (3rd dose) which will offer the same benefit of pre-exposure prophylaxis
    with slight modified schedule in this case (day 0,3 and 21 or 28).

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    59.A pet vaccinated dog died of sudden
    unexplained death. What should be done ?

    If facilities are available post-mortem of the dog for confirmation
    of rabies is required. If not possible, (or if the post mortem proves rabies) all those
    who came in contact with the saliva of the animal (directly or through its fomites) should
    be given PET.

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    60.Whether treatment of provoked bites
    differ from unprovoked bites ?

    Provocation is subjective and relative and specific to each dog/cat.
    However, obvious gross prococation viz., stamping, hitting, chasing, etc. Possibly suggest
    that the animal may not be rabid. However, the wound treatment of animal bites is the
    same.

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    61.Can Human ARVs viz. NTV or TCVs (PCEC,
    PVRV, HDCV) be given to animals?

    Though human ARVs may not be harmful to animal, there is no
    dose-weight correlation of immune response nor their efficacy known in animals. Besides
    the incubation period of rabies in animals is long. Hence, it is advisable to reserve
    human vaccines for human use only.

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    62.An unvaccinated or partially vaccinated
    pet dog/cat is bitten by a dog. What should be done ?

    The wound should be immediately washed with a detergent soap and
    Cold water, any household antiseptic like dettol/savlon, Tr.Iodine should be applied. If
    the stray dog is suspected to be rabid then the petdog should ideally be put to sleep. But
    if the owner is not ready or the rabid status of stray dog is not known then postexposure
    vaccination of the pet with tissue culture vaccine and simultaneous for upto 2 months
    (upto 6 months desirable) for possible signs of rabies in it. During this period for any
    sickness in dog, the owner should take the dog to the veterinarian to get rabies ruled out
    at the first instance.

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    63.Can unvaccinated pet dog/cat pose danger
    to the family ?

    As rabies is enzootic (prevalent in stray dogs) if pet unvaccinated
    dog is bitten by a stray rabid dog it will develop rabies and later pose threat at home to
    all family members.

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    64.If PET is required for a bite by a
    vaccinated dog then why vaccinated the dog at all ?

    Vaccination of the dog is to protect it against rabies following
    bite by a (stray) rabid dog. If potent TCV (veterinary) vaccine is given correctly as per
    schedule (preexposure) it will mostly prevent rabies in the vaccinated dog. But in
    enzootic (rabies prevalence in animals) India, where protection status of vaccinated dog
    by antibody estimation (RFFIT/MNT Test) is not possible due to scarce facilities and such
    time rabies is eliminated from the stray dog population in our country, the need for PET
    in exposed persons continues.

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    65.A vaccinated pet dog is bitten by a
    rabid animal. What should the owner do ?

    Ideally such dog should be humanely killed (put to sleep ) by a
    veterinarian since postexposure prophlaxis is not
    very successful. Such dogs pose risk (source of infection) to others and if the owner
    [much against professional advice] goes for postexposure immunisation of the dog, he
    should be informed of this risk.

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