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Enhanced Rabies Surveillance Using a Direct Rapid Immunohistochemical Test
Published on: April 30, 2019
Post-exposure prophylaxis for rabies with ERIG and IDRV in children
T R Behera1, D M Satapathy, A K Pratap
1Department of Community Medicine, MKCG Medical College, Berhampur, Orissa, Pin -760004. trbehera@rediffmail.com
Insights
Equine rabies immunoglobulin (ERIG) and purified vero cell rabies vaccine (PVRV) administered intradermally are safe for children with category III rabies exposure. This study found minimal local side effects and no serious systemic reactions.
Area of Science:
- Immunology
- Vaccinology
- Public Health
Background:
- Rabies post-exposure prophylaxis (PEP) is crucial for preventing rabies, a fatal zoonotic disease.
- Intradermal administration of rabies vaccines and immunoglobulins offers a potential cost-effective alternative for PEP.
- Equine rabies immunoglobulin (ERIG) and purified vero cell rabies vaccine (PVRV) are used in PEP, but their safety in children via intradermal route requires assessment.
Purpose of the Study:
- To evaluate the clinical safety of intradermally administered ERIG and PVRV in children (<15 years) with WHO category III rabies exposure.
- To monitor for local and systemic side effects following intradermal rabies post-exposure prophylaxis in pediatric patients.
- To assess the feasibility of using ERIG in children unable to afford human rabies immunoglobulin (HRIG).
Main Methods:
- A prospective study involving 1494 children with category III rabies exposure was conducted.
- Patients received 0.1 ml of PVRV intradermally at two sites on days 0, 3, 7, and 28.
- ERIG was administered intradermally on day 0 after a skin test, with premedication for positive reactors.
Main Results:
- 7.2% of children had a positive skin test reaction to ERIG; these patients received ERIG with antihistamines.
- Local side effects included induration, erythema, and pruritus from PVRV, and pain and induration from ERIG.
- Systemic side effects were limited to low-grade fever and malaise; 3% experienced mild serum sickness-like symptoms that resolved with treatment. No anaphylaxis or lymphadenopathy occurred.
Conclusions:
- Intradermal administration of ERIG and PVRV is clinically safe for children with WHO category III rabies exposure.
- The intradermal route for rabies PEP in children is well-tolerated with manageable local and mild systemic side effects.
- ERIG can be a viable alternative for rabies PEP in resource-limited settings when HRIG is unaffordable.
Abstract:
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.
