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2025 May 29th Rabies TOT MP NCDC Dr Khan Amir Maroof.pptx
- 1. Rabies Epidemiology, Animal Bitemanagement and Pre-& Post Exposure Prophylaxis for Rabies Prevention Dr Khan Amir Maroof Director Professor, Community Medicine UCMS and GTB Hospital, Delhi
- 2. Learning Objectives Understand the burdenof rabies in India Review the transmission and risk factors • Pre-Exposure • Post-Exposure Prophylaxis • Re-exposure in previously vaccinated persons Rabies prophylaxis – NCDC guidelines
- 3. Rabies Overview 100% fatal, 100% preventable Causedby Lyssavirus Reservoir: Mainly dogs (96% cases)
- 4. India-specific epidemiology 18,000-20,000 deaths/year(2002) Reduced to around 5800 deaths/year (2025) 36% of global deaths Rural areas most affected Incidence of dog bites per 1000 population per year • National level: 2025 report – 5.6 • Delhi slum area: 2016 data – 25.2 • Dog owners : 2024 report – 124
- 5. Fig. (A) Rabiescases and incidence by year, 2005–2020. (B) Joinpoint trend analysis of rabies incidence in India, 2005–2020. (C) Incidence of rabies by states, India, 2020. National Health Profile data.
- 6. High-Risk Groups Children under15 years Animal handlers, vets, healthcare workers Rural areas Slum areas
- 7. Transmission Modes of transmission •Bites (most common) • Scratches • Saliva on mucosa or broken skin Animals transmitting rabies • Warm blooded animals (mammals) • Dogs, cats, monkeys • Cattles, squirrels, rabbits • Wild rats, bats (not reported in India)
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- 9. High risk groups Animal handlers Lab staff workingin rabies labs Wildlife personnel Travellers to rabies endemic areas Children living in endemic areas
- 10. Intramuscular schedule -PrEP • Dose : HDCV, PCEC & PDEV - 1 ml • PVRV - 0.5ml & 1ml (PII Coonoor) • Site : Deltoid or anterolateral thigh Route : Intra Muscular • Schedule : • Day 0 - 1st dose • Day 7 - 2nd dose • Day 21 or 28 - 3rd dose
- 11. Intradermal schedule -PrEP • Dose : 0.1 ml at one site • Site : Deltoid Route : Intradermal • Schedule : • Day 0 - 1st dose • Day 7 - 2nd dose • Day 21 or 28 - 3rd dose
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- 14. Category of bites(WHO)
- 15. Recommended management Exposure torabbits, rodents and hares seldom require PEP for rabies Exposure to bats does not warrant PEP for rabies in India
- 16. Local Rx ofwounds • By mere washing of wounds and application of antiseptics ½ the Risk of Rabies Suturing should be avoided • If severe bleeding, infiltrate RIG and minimum stay sutures • If suturing for cosmetic purposes, done 2 wks after starting vaccination
- 17. Rabies Immunoglobulin Equine RIG(ERIG) dose : 40 IU per kg body weight of patient • The ERIG produced in India contains 300 IU per ml Human RIG (HRIG) dose : 20 IU per kg body weight • HRIG preparation is available in concentration of 150 IU per ml. Rabies monoclonal antibodies (Rmab): • Rabishield – 3.33 IU/Kg Body weight • Twinrab – 40 IU/Kg Body weight
- 18. The RIG shouldbe brought to room temperature (25ºC to 30ºC) before administration to the patient As much of the calculated dose of RIG as is anatomically feasible should be infiltrated into and around the wound/s Multiple needle injections into the wound(s) should be avoided. If calculated dose is insufficient, then can dilute with sterile normal saline. The dose should not exceed the calculated dose.
- 19. Rabies Immunoglobulin shouldnever be administered in the same syringe or at the same anatomical site as vaccine. RIG to be administered within 24 hrs and no later than seven days of administering ARV. Animal bite victim should be kept under observation for at least half–an–hour after administration of ERIG. There is no need to admit the patient. Physicians administering ERIG should always be ready to treat anaphylactic reactions with adrenalin. The dose is 0.5 ml of 0.1 percent solution (1 in 1000, 1mg/ml) for adults and 0.01ml/kg body weight for children, injected subcutaneously or IM.
- 20. Intramuscular regimen Essen regimen– five doses on days 0, 3, 7, 14, 28 (also k/a – 1-1-1-1-1 regimen) Day 0 (zero) is the date of the administration of the first dose of vaccine 1 ml per dose Site: Deltoid region for adults and anterolateral aspect of mid thigh in children. Gluteal region not recommended.
- 22. Intradermal regimen Updated Thairegimen – on days 0, 3, 7, 28 Day 0 (zero) is the date of the administration of the first dose of vaccine A total of 0.2 ml to be administered on each day of the administration of vaccine. 0.1ml in one arm AND 0.1 ml in the other arm Site: An inch above the insertion of the deltoid muscle
- 23. Wound washing andRIG Pics courtesy: Dr Anurag Agarwal, Hony Secretary, Consortium Against Rabies
- 24. RIG administration –video 1 Discretionary viewing advised
- 25. RIG administration –video 1 Discretionary viewing advised
- 26. ARV (Anti Rabiesvaccine) administration
- 27. Special cases Pregnant orlactating mother • Immunosuppressants • Chloroquine • HIV/AIDS Immunocompromised conditions
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- 29. Re-exposure prophylaxis schedule If thepatient has previously received and documented full pre- or post-exposure prophylaxis (either by IM or ID route) with a cell-culture vaccine or PDEV Only two booster doses intramuscularly (0.5ml/1ml) or CCVs intra-dermally (0.1 ml at 1 site) on days 0 and 3. Proper wound toilet should be done. Treatment with RIG is not required.
- 31. Acknowledgem ent • NCDC,MoHFW, GoI