Post-exposure prophylaxis for rabies with ERIG and IDRV in children

To assess the clinical safety of equine rabies immunoglobulin (ERIG) and purified vero cell rabies vaccine (PVRV) administered intradermally in children for post-exposure prophylaxis against rabies, a study was carried out among 1494 children < 15 years of age having category III exposure to animal bite at the antirabies clinic of community medicine department of MKCG Medical College Hospital, Berhampur, Orissa from 1st May 2007 to 31st March 2008. The patients received 0.1 ml of PVRV intradermally at two sites on days 0, 3, 7 and 28. The PVRV (Abhayrab) supplied by Government of Orissa had an antigen content of > or = 2.5 IU per 0.5 ml vial. ERIG (Equirab) was also given on day 0 as per WHO guideline. As much of the immunoglobulin as possible was infiltrated around the wounds after skin test. Side effects were monitored during the follow up visits on days 3, 7 and 28. One hundred & eight children (7.2%) showed positive reaction to the skin test dose of ERIG. These patients could not afford HRIG and were administered ERIG after premedication with oral antihistamine (Levocetrizine). There were no serious systemic side-effects but local side-effects like induration, erythema, pruritus are due to the intradermal rabies vaccination (IDRV) and pain, induration due to ERIG. Low grade fever and malaise were the only systemic side effects observed. None of the children had anaphylaxis or regional lymphadenopathy. Only 3% of children had mild serum sickness like symptoms by days 5 & 7 which subsided with oral analgesics and antihistamines. Our study showed that administration of ERIG & PVRV by intradermal route in children with WHO category-III rabies exposure is safe.