Immunization regimen with IDRV

Today is our topic of discussion Immunization regimen with IDRV

Immunization regimen with IDRV

 

 

Vaccine                             Day                                   Dosage 

1 st dose                            DO                          0.1ml * 2 (0.1 ml into each deltoid region)

2 nd dose                           D3                          0.1ml * 2 (0. ml into each deltoid region)

3 rd dose                            D7                          0.1ml * 2 (0.1 ml into each deltoid region)

4 th dose                            D 28                       0.1 ml x 2 (0.1 ml into each deltoid region)

Immunization regimen of ARV (IM injections)

One dose of vaccine (1 ml):

Same for all ages on days 0, 3, 7, 14, 28 (5-doses schedule) or 

Two dose of vaccine :

(right & left deltoid muscle) on day 0, and one dose is applied into the deltoid muscle on days 7 and 21 (2-1-1 regimen). In small children the vaccine is to be given into the thighs.

[The vaccine given by intramuscular injection into the deltoid muscle, or into the anterolateral region of thigh in small children; it must not be given by intragluteal injection]

Type of anti-rabies vaccine:

• Tissue culture vaccine (TCV) or cell culture vaccine (Rabipur, VerorabⓇ & Rabix-VC) 
• Nerve tissue vaccine (NTV): Prepared from crushed brain of inoculated rabid goat or sheep. Previously 14-21 periumbilical injections (5 ml per injection) were practiced, which is now obsolete.

[The brand names should not be written in the examination paper. These are modern vaccines & can be used intramuscularly (IM) or intradermally (ID) according to it’s WHO recommended regimen, doses & site. 

IDRV (intradermal rabies vaccine):

Recently WHO recommended the same TCV vaccines for government hospitals of Bangladesh according to site, doses & regimen mentioned above. Pregnancy is not a

contraindication for post-exposure prophylaxis]

 

 

Features of nerve tissue vaccine:

1. Manufactured by local producers and sub-standardized .
2. Low efficacy & immunogenicity and short-lasting 
3. Safety and patient tolerability low due to high incidence of reactions and painful multi-dose injections.
4. Low product stability and temperature sensitive. 
5. WHO position: Discontinuation and should replaced by cell culture vaccine.

Complication of nerve tissue vaccine:

Encephalopathy and ascending paralysis.

Merits of cell culture vaccine/TCV:

1. High efficacy and immunogenicity
2. Long lasting
3. Less chance of encephalopathy and paralysis
4. Product stability is high 
5. Can be used as IDRV

Demerit/complication of cell culture vaccine (IDRV):

1. Local reactions:
2. Pain at the injection site, Dot noitane b. Redness,
3. Swelling and induration de combon
4. Systemic reactions (less common): Headache, fever, myalgia, nausea, and weakness

Question: Why IDRV used in government hospitals? 

• Requires less vaccine volume than IM dose; appropriate for our country due to shortage of vaccine/money. 
• Marking of each IDRV is obvious on the injection site, demonstrating previous immunization.
• To switch from NTV to modern cell culture vaccine.

 

 

Fig: A) Characteristic bleb after IDRV, B) & C) marking of IDRV-1,2,3

Pre-exposure prophylaxis:

Primary immunization:

In previously unvaccinated persons, an initial course of pre-exposure prophylaxis consists of three doses I/M inj. administered on days 0.7 and 21 or 28.

Booster doses:

In persons with ongoing risk of rabies exposure, booster doses are offered.

See also :

• Cord Blood Banking Kit