CHENNAI: After instructing the Deputy Director of Health Services to ensure adequate stock of anti-rabies vaccine, the Directorate of Public Health and Preventive Medicine issued the rabies management protocols and updated vaccine regimen at Primary Health Centre (PHC) level.
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1) The protocols highlight four components, including wound management, vaccination, rabies immunoglobulin (RIG) infiltration and counselling.
2) As part of the treatment, it is very imperative the virus is removed from the wound and thus prevents rabies infection. Hence, it is important that wound washing facilities comprising running tap water and liquid soap are provided for animal bite victims to wash their wounds.
3) All animal bite victims have been advised to thoroughly flush the wounds with running tap water, when appropriate for 15 minutes to remove the traces of saliva from the wound.
4) Then wash the wound/s with soap so that the virus, if still present is inactivated. All closures of wounds should only be done after careful infiltration of RIG.
5) On the vaccine, the protocols require Intradermal Rabies Vaccination (IDRV) and the vaccine supplied shall be reconstituted only with the diluent provided with it.
6) Disposable Insulin syringe with fixed needle or a suitable alternative 1 ml syringe provided shall be used for ID vaccination.
7) As per the protocols issued by the DPH, the recommended regimen consists of injecting one dose of 0.1mL of the reconstituted vaccine at two sites on days 0, 3,7 and 28 (2-2-2-0-2). This is known as the updated "Thai Red Cross (TRC) " regimen.
8) The common side effects of IDRV are soreness, redness, itching, occasionally slight pain, etc. and these are self-limiting and no medication is ordinarily needed.
9) Spirit swabs shall not be used before ID vaccination.
The role of RIG in passive immunization is to provide readymade rabies neutralizing antibodies at the site of exposure before patients start producing their own antibodies as a result of vaccination.
10) RIG administration is recommended after category III exposures of individuals who have not been previously vaccinated against rabies.
11) Human Resource Immune Globulin will provide immediate antibodies until the body can respond to the vaccine by actively producing antibodies of its own.
12) The protocols also require counselling as it can be distressing for few. A word of advice and comforting the patient by the doctor, informing the patient to comply with the series of vaccination apart from regular follow up on medication and dietary habits during the course of vaccination are to be given.
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