in rabies - libdoc.who.int - World Health Organization

LABORATORY TECHNIQUES IN RABIES
mentioned under "Laboratory precautions" is applied. Suturing of gaping wounds
should be delayed for as long as possible (from several hours up to 3 days).
Puncture wounds should be probed gently with an appropriate chemical disinfectant,
taking care to minimize further trauma, Local infiltration of wounds with
human or animal antrabies irnniunoglobulin (or serum) should also be employed.
if the wounded area so permits; this procedure is used particularly in puncture
wounds where adequate cleansing and disinfection are not feasible. Additional
measures, such as administration of antimicrobials or antitetanus procedures.
when indicated, should follow the local treatment.
Pre-exposure immunization
Various schedules have been tried for pie-exposure immunization of laboratory
personnel. The course of action recommended in the eighth report of the WHO
Expert Committee on Rabies (1992) should be followed (11). The report states:
Pre-exposure immunization should be offered to persons at high risk of
exposure, such as laboratory staff working w~th rabies virus veterinarans
animal handlers and wildlife officers, and other individuals who are living in or
travelling to areas where rabies is endemic
Such immunization should preferably consist of three full intramuscular doses
of tissue-culture rabies vaccine of potency at least 25 IU per dose given on
days 0 7 and 28 (Afew days variation is not important ) The presence of virusneutralizing
antibodies in vaccinated individuals should be ascertained where
feasible using serum samples collected 1-3 weeks after the last dose For
adults the vaccine should always be administered in the deltoid area of the
arm For young children the anterolateral area of the thigh is also acceptable
The guteal area sliould never be used for vaccine injections since administrat~on
in this area results in lower neutralizing antibody titres
Tissue-culture or purified duck-embryo rabies vaccines of potency at least
2.5 IU per dose have been shown to induce adequate antibody titres when
carefully administered intradermally in 0.1 ml volumes on days 0, 7 and 28. After
reconstitution of the vaccine, the entire volume should be used as soon as
possible. Separate syringes and needles must be used for each dose. lntradermal
application of the vaccine is of special interest in areas where economic
constraints limit vaccine availability. However, pre-exposure vaccination with
human diploid cell (HDC) vaccine administered intradermally should, whenever
possible, be performed before starting antimalarial prophylaxis, since
virus-neutralizing antibody hires have been shown to be lower in patients
receiving chloroquine phosphate. When this is not feasible, HDC vaccine
should be administered intramuscularly.
Periodic booster injections are recommended for persons at continuing risk of
exposure to rabies. The following guidelines are recommended for determining
when boosters should be administered:
All persons who work with live rabies virus in a diagnostic, research or vaccine
production laboratory should have a serum sample tested for rabies virusneutralizing
antibodies every 6 months and a booster administered when the