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

SAFETY PRECAUTIONS
titre falls below 0.5 IU/ml. Responsible authorities should ensure that all staff
are properly immunized.
All other persons at continuing risk of exposure to rabies should have a serum
sample tested for I-abies virus-neutralizing antibodies every year; a booster
should be administered when the titre falls below 0.5 U/ml.
Satisfactory antibody responses have been obtained with as little as two or
three doses of vaccine given 3 days apart, and this may be tried if there is a
shortage of time. A booster dose should be given one to several montiis after the
last inoculation. Any potent tissue-cultiire vaccine can be employed either
intradermally (0.2 m1 total dose in two sites in the deltoid reglon of the upper arm,
0.1 ml in each) or subcutaneously or intramuscularly (in three doses of at least
2.5 IU per dose). Alternatively, 2 ml of 5% nerve-tissue emulsion or its equivalent
may be given subcutaneously or intramuscularly if cell-culture vaccine is not
available. It is important to determine, as stated above, whether virus-neutralizing
antibody has in fact resulted from the procedure. With pre-existing antibody and
the known rapid recall response elicited by booster doses, if re-exposure occurs a
single inoculation of vaccine can be employed with reasonable confidence. The
development of new, concentrated, and purified vaccines of cell-culture origin,
with greatly increased antgenic content, has considerably improved the antibody
levels now achieved with most conventional antirabies vaccines (12).
Exposed individuals who have not received pre-exposure immunization should
be treated according to the recommendations made in the eighth report of the
WHO Expert Committee on Rabies (11). i.e. local treatment of the wound followed
by a complete post-exposure course of vaccine, including rabies immunoglobulin
if indicated.
References
1. Pal SB et al, eds. Handbook of laboratory health and safety measures
Lancaster, MTP Press. 1985.
2. Miller BM et al , eds. Laboratory safety: principles and practices. Washington,
DC, American Society for Microbiology, 1986.
3, Laboratory biosafety manual. 2nd ed. Geneva, World Health Organization,
1993.
4. Schmidt NH, Emmons RW. Diagnostic procedures for viral, rickettsia1 and
chlamydial infections. Washington. DC, American Public Health Association.
1989.
5. Winkler WG et al. Airborne rabies transinisson in a laboratory worker Journal
of the American Medical Association, 1973, 226: 1219-1 221
6 Kaplan MM et al. An intracerebral assay procedure in mice for chemical
inactivation of rabies virus. Bulletin of the World Health Organization, 1966, 34:
293- 297.