National Guidelines for Rabies Prophylaxis and Intra-dermal ...

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16 Materials required � A �vial A of vial rabies of rabies vaccine vaccine approved approved for for IDRV and its diluent. IDRV and its diluent. � 2 ml disposable syringe with 24 G � 2 ml needle disposable for reconstitution syringe of with vaccine. 24 G needle for reconstitution � Disposable 1 of ml vaccine. (insulin) syringe (with � Disposable graduations 1 ml upto (insulin) 100 or syringe 40 units) (with with graduations a fixed (28 G) needle (Fig.1) upto 100 or 40 units) with a fixed (28 G) needle � Disinfectant swabs (e.g. 70% ethanol, (Fig.1) isopropyl alcohol) for cleaning the top Fig.1 : 1ml syringe � Disinfectant of the vial swabs and the patients’ (e.g. 70% skin. ethanol, isopropyl Fig.1: 1ml with syringe hypodermic with needle (Insulin hypodermic syringe) needle alcohol) for cleaning the top of the vial and the (Insulin syringe) ID injection technique patients’ skin. Materials Using aseptic required technique, reconstitute the vial of freeze-dried vaccine with the diluent supplied Materials � A vial by required the of manufacturer. rabies vaccine With approved 1 ml syringe for draw 0.2 ml (up to 20 units if a 100 ID units injection �syringe IDRV A vial technique and is of used its rabies diluent. or upto vaccine 8 units approved if a 40 for units syringe is used) of vaccine needed for Using one � patient aseptic 2 IDRV ml (i.e. disposable and technique, 0.1 its ml diluent. per syringe ID reconstitute site with X 2 sites) 24 the G and vial expel of freeze-dried the air bubbles vaccine carefully with from the the syringe � diluent needle 2 thereby ml supplied for disposable removing reconstitution any syringe dead by the manufacturer. of vaccine. with space 24 in the G syringe. Using With 1 ml syringe draw 0.2 ml (up to 20 � Disposable the needle technique for reconstitution 1 ml of (insulin) BCG inoculation, of syringe vaccine. (with stretch the surface of the skin and insert the tip units of the �if a 100 units syringe is used or upto 8 units if a 40 units syringe is used) graduations needle Disposable with upto 1 bevel ml 100 (insulin) upwards, or 40 units) syringe almost with (with parallel a to the skin surface (Fig.2) and slowly of inject vaccine fixed half graduations needed the (28 volume G) needle upto for of one 100 vaccine (Fig.1) or patient 40 in units) the (i.e. syringe with 0.1 a ml (i.e. per 0.1mL; ID site either X 10 2 sites) or 4 units) and into expel the the uppermost air � bubbles Disinfectant fixed dermal (28 G) carefully swabs layer needle of from (e.g. (Fig.1) skin, 70% the over syringe ethanol, the deltoid thereby area, removing preferably any an dead inch space above the in insertion � the syringe. isopropyl Disinfectant of deltoid alcohol) swabs muscle. for (e.g. cleaning If 70% the the ethanol, needle top is correctly placed inside the dermis, considerable of isopropyl the vial resistance and alcohol) the is patients’ felt for while cleaning skin. injecting the top the Fig.1 vaccine. : 1ml A raised syringe papule with hypodermic should begin to appear immediately causing a peau d’ orange (orange needle Fig.1 : peel) (Insulin 1ml syringe appearance syringe) with hypodermic of the vial and the patients’ skin. needle (Insulin syringe) (Fig.3). Inject the Using ID remaining injection the technique half technique the volume of BCG of vaccine inoculation, (i.e. 0.1ml; stretch either the 10 surface or 4 units) of on the the skin opposite and deltoid ID injection area. technique insert Using the aseptic tip of technique, the needle reconstitute with bevel the upwards, vial of freeze-dried almost parallel vaccine to with the skin the diluent surface If Using the vaccine aseptic is technique, injected too reconstitute deeply into the the vial skin of (subcutaneous), freeze-dried vaccine papule with is not the seen. diluent supplied by the manufacturer. With 1 ml syringe draw 0.2 ml (up to 20 units if a 100 Then (Fig.2) the supplied needle and by should slowly the manufacturer. be inject withdrawn half With the and 1 volume ml reinserted syringe of vaccine at draw an 0.2 adjacent in ml the (up site syringe to and 20 units the (i.e. ID if a 0.1ml; vaccine 100 units syringe is used or upto 8 units if a 40 units syringe is used) of vaccine needed for either given units 10 syringe once or more. 4 is units) used or into upto the 8 units uppermost if a 40 units one patient (i.e. 0.1 ml per ID site X 2 sites) and dermal syringe expel the layer is used) air bubbles of skin, of vaccine carefully over the needed from deltoid for the one patient (i.e. 0.1 ml per ID site X 2 sites) and expel the air bubbles carefully from the area, syringe preferably thereby removing an inch any above dead space the insertion in the syringe. syringe thereby removing any dead space in the syringe. of deltoid muscle. If the needle is correctly Using the placed technique inside of BCG the inoculation, dermis, considerable stretch the surface resistance of the skin is felt and while insert injecting the tip Using the technique of BCG inoculation, stretch the surface of the skin and insert the tip of the needle with bevel upwards, almost parallel to the skin surface (Fig.2) and slowly the of inject vaccine. the needle half the A with volume raised bevel of papule upwards, vaccine should almost in the syringe begin parallel to (i.e. appear to the skin 0.1mL; immediately surface (Fig.2) either 10 or 4 causing and slowly units) into a peau inject half the volume of vaccine in the syringe (i.e. 0.1mL; either 10 or 4 units) into the the d’ uppermost uppermost orange (orange dermal dermal layer peel) layer of appearance of skin, skin, over over the (Fig.3). the deltoid deltoid Inject area, area, the preferably preferably remaining an an half inch inch the above above volume the the of insertion insertion vaccine of (i.e. of deltoid deltoid 0.1ml; muscle. muscle. either If 10 If the or the 4 needle needle units) is on is correctly correctly the opposite placed placed deltoid inside inside area. the the dermis, dermis, considerable considerable resistance resistance is is felt felt while while injecting injecting the the vaccine. vaccine. A raised raised papule papule should should begin begin to to appear appear immediately immediately causing causing a a peau peau d’ d’ orange orange (orange (orange peel) peel) appearance appearance (Fig.3). (Fig.3). Inject Inject the the If remaining the vaccine half is the injected volume too of vaccine deeply (i.e. into 0.1ml; the skin either (subcutaneous), 10 or 4 units) on papule the opposite is not remaining half the volume of vaccine (i.e. 0.1ml; either 10 or 4 units) on the opposite seen. deltoid deltoid Then area. area. the needle should be withdrawn and reinserted at an adjacent site If the vaccine is injected too deeply into the skin (subcutaneous), papule is not seen. Then and If the vaccine ID vaccine is injected given too once deeply more. into the skin (subcutaneous), papule is not seen. Then the the needle needle should should be be withdrawn and and reinserted at at an an adjacent site site and and the the ID ID vaccine given given once more. Fig.2 once Insertion more. of needle for ID Fig. 3 Bleb raised on ID inoculation inoculation Fig.2: Insertion of needle for ID inoculation Fig. 3: Bleb raised on ID inoculation Fig.2 Insertion of of needle for ID Fig. 3 Bleb raised on ID inoculation inoculation inoculation National Guidelines for Rabies Prophylaxis and Intra-dermal Administration of Cell Culture Rabies Vaccines
Anti-rabies treatment centres which meet the following criteria may use ID administration : � Have adequately trained staff to give ID inoculation of anti-rabies vaccine � Can maintain cold chain for vaccine storage � Ensure adequate supply of suitable syringes and needles for ID administration � Are adequately well versed in management of open vial and safe storage practices. 2.3 Post-Exposure Prophylaxis for previously vaccinated persons Managing re-exposure following post-exposure treatment with TCV: If reexposed, persons who have previously received full post-exposure prophylaxis (either by IM or ID route) with a potent cell-culture vaccine should now be given only two booster doses, intramuscularly (0.5ml/1ml)/intra-dermally (0.1 ml at 1 site) on days 0 and 3. Proper wound toilet should be done. Treatment with RIG is not necessary. Managing exposure following pre-exposure prophylaxis with TCV: If after recommended pre-exposure prophylaxis, a vaccinated person is exposed to rabies, a proper wound toileting should be done and two IM/ID (0.1 ml at 1 site) doses of Cell Culture Vaccine be given on days 0 and 3. Treatment with RIG is not necessary Managing re-exposure following post-exposure treatment with NTV: Persons who have previously received full post-exposure treatment with NTV should be treated as fresh case and may be given treatment as per merits of the case. National Guidelines for Rabies Prophylaxis and Intra-dermal Administration of Cell Culture Rabies Vaccines 17
Page 1: National Guidelines for Rabies Prop
Page 4 and 5: Contents 1. Introduction 5 2. Post-
Page 6 and 7: 4 Preface Rabies continues to be a
Page 8 and 9: 2 6 Post-Exposure Prophylaxis (PEP)
Page 10 and 11: 8 local infiltration of rabies immu
Page 12 and 13: 10 Local infiltration of rabies imm
Page 14 and 15: 12 Cell Culture Vaccine with double
Page 16 and 17: 14 2.2.3.2 Intra-dermal (ID) Regime
Page 20 and 21: 3 18 Pre-exposure Vaccination Pre-e
Page 22 and 23: 20 Formulation of National Guidelin
Page 24 and 25: 22 Finalisation of Draft of Nationa

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