Only one antigenic type of rabies virus is known. More than 99% of infections in humans and other mammals that develop symptoms end fatally. Survival after the onset of rabies symptoms is extremely rare. It is therefore essential that individuals at high risk receive preventive immunization, that the nature and risk of any exposure be evaluated, and that individuals be given postexposure pro phylaxis if their exposure is believed to have been dangerous (Table 1). Because treatment is of no benefit after the onset of clinical disease, it is essential that postexposure treatment be initiated promptly. Postexposure rabies pro phylaxis consists of the immediate and thorough cleansing of all wounds with soap and water, administration of rabies immune globulin, and a vaccination regimen.

Table1. Rabies Postexposure Prophylaxis Guide—United States, 2008

A. Pathophysiology of Rabies Prevention by Vaccine

Presumably the virus must be amplified in muscle near the site of inoculation until the concentration of virus is sufficient to accomplish infection of the central nervous system. If immunogenic vaccine or specific antibody can be administered promptly, virus replication can be depressed and virus can be prevented from invading the central nervous system. The action of passively administered antibody is to neutralize some of the inoculated virus and lower the concentration of virus in the body, providing additional time for a vaccine to stimulate active antibody production to prevent entry into the central nervous system. Successful postexposure prophylaxis will therefore prevent the development of clinical rabies.

B. Types of Vaccines

 All vaccines for human use contain only inactivated rabies virus. Two vaccines are available in the United States, although a number of others are in use in other countries. Both rabies vaccines available in the United States are equally safe and efficacious.

1. Human diploid cell vaccine (HDCV)—To obtain a rabies virus suspension free from nervous system and foreign proteins, rabies virus is grown in the MRC-5 human diploid cell line. The rabies virus preparation is concentrated by ultra filtration and inactivated with β-propiolactone. No serious anaphylactic or encephalitic reactions have been reported. This vaccine has been used in the United States since 1980.

2. Purified chick embryo cell vaccine (PCEC)—This vaccine is prepared from the fixed rabies virus strain Flury LEP grown in chicken fibroblasts. It is inactivated with β-propiolactone and further purified by zonal centrifugation. It became available in the United States in 1997.

A recombinant viral vaccine consisting of vaccinia virus carrying the rabies surface glycoprotein gene has successfully immunized animals following oral administration. This vac cine can be used for the immunization of both wildlife reservoir species and domestic animals.

C. Types of Rabies Antibody

1. Rabies immune globulin, human (HRIG)—HRIG is a γ-globulin prepared by cold ethanol fractionation from the plasma of hyperimmunized humans. There are fewer adverse reactions to human rabies immune globulin than to equine anti-rabies serum.

2. Anti-rabies serum, equine—This is concentrated serum from horses hyperimmunized with rabies virus. It has been used in countries where HRIG is not available.

D. Pre-exposure Prophylaxis

This is indicated for persons at high risk of contact with rabies virus (research and diagnostic laboratory workers, spelunkers) or with rabid animals (veterinarians, animal control, and wildlife workers). The goal is to attain an antibody level presumed to be protective by means of vaccine administration prior to any exposure. It is recommended that antibody titers of vaccinated individuals be monitored periodically and that boosters be given when required.

E. Postexposure Prophylaxis

 Although few (0–5) cases of human rabies occur in the United States per year, more than 20,000 persons receive some treatment every year for possible bite wound expo sure. The decision to administer rabies antibody or rabies vaccine—or both—depends on several factors: (1) the nature of the biting animal (species, state of health, domestic, or wild) and its vaccination status, (2) the availability of the animal for laboratory examination (all bites by wild animals and bats require rabies immune globulin and vaccine), (3) the existence of rabies in the area, (4) the manner of attack (provoked or unprovoked), (5) the severity of the bite and contamination by saliva of the animal, and (6) advice from local public health officials (Table 1). Schedules for postexposure prophylaxis involving the administration of rabies immune globulin and vaccine are available from the Centers for Disease Control and Prevention and state public health offices.

اخر الاخبار

اخبار العتبة العباسية المقدسة

دار الكفيل تنهي طباعة كتاب (لمَ لا) تمهيدًا لمناقشته في ملتقى غيث السماء القرآني الثاني

العتبة العباسية المقدسة تطلق مسابقتها الثقافية بذكرى ولادة الإمام زين العابدين (عليه السلام)

العتبة العباسية المقدسة تكرّم 1000 طالبة من المرتديات العباءة العراقية في مدارس الديوانية

العتبة العباسية المقدسة تؤكد أهمية الحجاب كجزء من منظومة الواجبات الشرعية

المزيد

الآخبار الصحية

الخبز الأسمر أم الأبيض.. أيهما أفضل لضبط سكر الدم؟

عقاقير التخسيس و"الانتحار".. الحكومة الأميركية تحسم الجدل

الهرم الغذائي الجديد.. لماذا يعد "انقلابا" في خارطة الطعام؟

لحماية ظهرك وقلبك في آن واحد.. ما وضعية النوم الصحيحة؟

المزيد

الآخبار التكنلوجية

كيف يعزز الضوء الطبيعي تفكيرك وانتباهك خلال اليوم

سابقة.. طاقم من محطة الفضاء الدولية يعود إلى الأرض مبكرا

منصات التواصل تضرّ بنفسية المراهقين… والفتيات الأكثر تأثرا

ابتكار ألماني قد يغيّر مستقبل صناعة البلاستيك

المزيد

مواضيع ذات صلة

PAPILLOMAVIRUSES

General Features of Viral Carcinogenesis

Methods of Antiviral Susceptibility Testing: Influenza

Methods of Antiviral Susceptibility Testing: Genotypic Susceptibility Assays

Methods of Antiviral Susceptibility Testing: Phenotypic Assays

Pathogenesis and Pathology of Rabies Virus

Properties of the Rabies Virus

Coronavirus Infections in Humans

Properties of Coronaviruses

Congenital Rubella Syndrome

Postnatal Rubella

Hendra Virus and Nipah Virus Infections