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RABIES, HUMAN - USA: VACCINATION PROTOCOL CHANGE
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Wed 24 Jun 2009
Source: The Boston Herald, Associated Press (AP) report [edited]
<http://www.bostonherald.com/news/national/general/view.bg?articleid=1181023>
Federal advisory panel: just 4 rabies shots needed
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People exposed to rabies need only 4 vaccinations [for post-exposure
prophylaxis - Mod.CP], not the 5 currently recommended, a vaccine
advisory committee said Wednesday [24 Jun 2009]. In the past, rabies
shots were dreaded almost as much as the disease itself. Until the
1970s, an encounter with a rabid animal led to at least 14 shots in
the abdomen. But vaccines have improved, and 5 shots in the arm or
thigh have been the US standard for more than 20 years. The Advisory
Committee on Immunization Practices voted unanimously that 4 shots --
all given within the 1st 14 days after exposure to rabies -- are
sufficient. The panel advises the US Centers for Disease Control and
Prevention, which issues official guidance to doctors.
Committee members made the decision after hearing that out of 20 000
to 40 000 Americans exposed to rabies each year, an estimated 1000
get only 3 or 4 shots and none of them have developed rabies. The
shots cost between USD 100 and USD 200 apiece. Two companies make
rabies vaccine for the US market, Novartis and Sanofi Pasteur.
The committee's recommendations usually harmonize with drug
companies' package insert information about how their product should
be used, but not in this case. A Novartis official, Clement Lewin,
said he disagreed with the panel setting a precedent by making an
off-label recommendation. He said it might confuse doctors who read
company information about the vaccine that calls for 5 doses over 28
days, but see government guidance that says 4 shots are enough.
Rabies is a viral disease transmitted through the bite of a rabid
animal. Most rabies cases occur in wild animals like raccoons,
skunks, bats, and foxes. The virus can infect the nervous system and
can cause symptoms like insomnia, anxiety, confusion, paralysis,
salivating, hallucinations, difficulty swallowing, and fear of water.
Death usually occurs within days of the onset of symptoms. It's a
recurring menace in the developing world, but the number of US deaths
has declined to an average of 2 or 3 each year.
[Byline: Mike Stobbe]
--
Communicated by:
Powell Gammill
Health Professional, retired
Phoenix, AZ, USA
<pgammill@cox.net>
[The current regulations in the USA prior to implementation of this
revision are detailed in the document entitled: Human Rabies
Prevention -- United States, 2008, Recommendations of the Advisory
Committee on Immunization Practices [ACIP], available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e507a1.htm#tab5>.
"ACIP recommends that prophylaxis for the prevention of rabies in
humans exposed to rabies virus should include prompt and thorough
wound cleansing followed by passive rabies immunization with human
rabies immune globulin (HRIG) and vaccination with a cell culture
rabies vaccine. For persons who have never been vaccinated against
rabies, postexposure antirabies vaccination should always include
administration of both passive antibody (HRIG) and vaccine (human
diploid cell vaccine [HDCV] or purified chick embryo cell vaccine
[PCECV]). Persons who have ever previously received complete
vaccination regimens (pre-exposure or postexposure) with a cell
culture vaccine or persons who have been vaccinated with other types
of vaccines and have previously had a documented rabies virus
neutralizing antibody titer should receive only 2 doses of vaccine:
one on day 0 (as soon as the exposure is recognized and
administration of vaccine can be arranged) and the 2nd on day 3. HRIG
is administered only once (that is, at the beginning of antirabies
prophylaxis) to previously unvaccinated persons to provide immediate,
passive, rabies virus neutralizing antibody coverage until the
patient responds to HDCV or PCECV by actively producing antibodies. A
regimen of 5 [now 4] 1-mL doses of HDCV or PCECV should be
administered intramuscularly to previously unvaccinated persons. The
1st dose of the 5-dose [now 4-dose] course should be administered as
soon as possible after exposure (day 0). Additional doses should then
be administered on days 3, 7, 14, and 28 after the 1st vaccination.
Rabies pre-exposure vaccination should include 3 1.0-mL injections of
HDCV or PCECV administered intramuscularly (one injection per day on
days 0, 7, and 21 or 28)."
Currently the 5-dose regime comprises vaccination at 3, 7, 14, and 28
days after the primary vaccination. The proposed timing of the 4-dose
regimen is not revealed in the press report. - Mod.CP]
[see also:
Rabies, canine, human - Indonesia (08): comment on vaccination 20090405.1317
Rabies, canine, human - Indonesia (07): comment on vaccination 20090404.1300]
...................................cp/mj/dk
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