Anti-rabies Vaccine Research Articles

Electrostatic Mapping of Rabies Anti-idiotype Antibody Compared to Rabies Virus Glycoprotein

Rabies is a lethal viral animal disease that assaults the central nervous system. Its glycoprotein is a viral protein that is essential for viral pathogenicity. Initially, the rabies vaccine was produced from nerve tissue, but it is no longer recommended since it causes adverse effects and is less effective. The anti-idiotype antibody vaccination is one option that functions as homologous artificial antigens to the glycoprotein of the rabies virus. The CDR is the structure of anti-idiotypic antibodies that play a role in mimicking epitopes. It may resemble or be identical to epitopes seen in rabies virus glycoproteins. The objective of this study is to determine the affinity of the CDR anti-idiotype antibody for the rabies virus glycoprotein epitope by studying the CDR electrostatic value. This electrostatic value was analyzed by bioinformatics approaches using a webPIPSA server. The findings revealed an electrostatic resemblance between the structure of anti-idiotype antibodies and the rabies virus glycoprotein. Further study will be aimed at collecting electrostatic values from each structure to create an anti-rabies vaccine. Keywords: anti-idiotype antibodies, CDR, electrostatic, rabies, glycoprotein, webPIPSA

Safety assessment of the world’s first novel cocktail of two monoclonal antibodies in WHO category-III animal-bite patients

ABSTRACT Background: Rabies, a zoonotic disease, poses a significant global public health challenge, and post-exposure prophylaxis (PEP) is crucial for prevention. Monoclonal antibodies (mAbs) have emerged as a promising alternative to rabies immunoglobulins due to their high efficacy and standardized manufacturing process. Materials and Methods: A prospective, open-label post-marketing surveillance study was conducted with patients of WHO category-III suspected rabid animal bites. TwinRab™, a novel cocktail of docaravimab and miromavimab, was administered at a dosage of 40 IU/kg in and around the wound, along with the anti-rabies vaccine, which was administered intradermal as per Thai Red Cross regimen. Results: In this study, 200 subjects received TwinRab™ with a 100% completion rate. Three (1.5%) patients showed solicited local AEs, and two (1%) patients showed solicited systemic AEs, which were resolved after appropriate treatment intervention. The overall tolerability assessment showed positive ratings from doctors (94%) and patients (74%). Conclusion: The post-marketing surveillance study demonstrated the safety of TwinRab™ in patients who experienced category-III suspected rabid animal bites, thereby supporting its potential as an alternative option for PEP in the management of animal bite for the prevention of rabies.

Epidemiological Profile and Awareness Regarding Animal Bite Management in an Urban Area.

The most common way for people to contract the deadly zoonotic disease rabies is through animal bites. This study was designed because there is a shortage of community-based data to determine the true extent of rabies infection and a lack of understanding regarding patient misconceptions in urban areas. The objective was to determine the scope of the issue and the epidemiological features of animal bite incidents. This was a facility-based cross-sectional study conducted at the field practice area (Urban Health Training Centre) under the Department of Community Medicine, Government Medical College. The study duration was one year (May 2023 to April 2024). Consecutive patients (accompanied by an attendant) attending the Urban Health Training Centre were included in the study. A purposive sampling technique was used, and around 400 animal bite cases were recorded in one year at the Urban Health Training Centre. Out of 1503 male cases at the Urban Health Training Centre, around 255 were dog bite cases (50.6%), whereas out of 1302 females visiting the Urban Health Training Centre, around 145 were dog bite cases (48%). The majority (35%) belonged to the age group of 11 to 20 years for both males and females. The mean age of the cases was 19.4 ± 3.4 years. The study found a male preponderance (64%), with females constituting 36%. The right lower limb (49.5%), left lower limb (39%), and upper limb were the most frequently bitten sites. Fifty-one percent of the cases fell into Category II. According to local data, the most popular home management practices were ghee oil and cold treatments. Although Category III is the most severe bite, only 35% had taken the anti-rabies vaccine (ARV), and 8.75% had received rabies immunoglobulin. The public and medical community need to be made aware of the importance of wound care and the prudent use of the anti-rabies vaccine.

Estimates of the burden of human rabies deaths and animal bites in India, 2022–23: a community-based cross-sectional survey and probability decision-tree modelling study

Reliable and recent data of human rabies deaths and animal bites are not available in India, where a third of global cases occur. Since there is a global target of eliminating dog-mediated human rabies by 2030, understanding whether the country is on track is essential. We aimed to estimate the animal-bite burden and the number of human rabies deaths in India. We conducted a community-based nationwide cross-sectional survey with a multistage cluster-sampling design from March 2, 2022 to Aug 26, 2023, covering 60 districts in 15 Indian states. The head of the household or an adult family member was interviewed to collect information about animal-bite history in family members, receipt of anti-rabies vaccination (ARV), and death following animal bite in the family. Annual animal-bite incidence along with 95% CIs were estimated after applying the sampling weights and adjusting for clustering. We estimated annual human rabies deaths using a decision-tree probability model with parameters from the community survey and laboratory data on rabies positivity among suspected rabid dogs. Of the 337 808 individuals residing in the 78 807 households surveyed, 2052 gave a history of animal bite, mostly (1576 [76·8%]) due to dogs in the past 1 year. The weighted and adjusted annual incidence of animal bite was 6·6 (95% CI 5·7-7·6) per 1000 population, translating into 9·1 million bites nationally. Annual dog-bite incidence was 5·6 (4·8-6·6) per 1000. Among people who had been bitten by a dog, 323 (20·5%) did not receive ARV, and 1043 (66·2%) received at least three doses. Nearly half (615 [49·1%]) of the 1253 individuals who received one dose did not complete their full course of vaccination. We estimated 5726 (95% uncertainty interval 3967-7350) human rabies deaths occurring annually in India. Although there was a substantial decline in human rabies deaths over the past two decades, to eliminate dog-mediated human rabies by 2030, India needs to fast-track its actions by adopting a focused one-health approach. Integrating human and animal surveillance, ensuring timely administration of full course of post-exposure prophylaxis, and accelerating dog vaccination across the country are crucial steps towards this goal. Indian Council of Medical Research.

Characterization and treatment protocol of injuries inflicted to humans by synurbic European wild boars (Sus scrofa).

Wild boar (Sus scrofa) has spread and colonized urban areas. The closer contact with humans can lead to wild boar-inflicted injuries. The objectives of this study are: 1) to systematically review the literature on wild boar-inflicted injuries; 2) to describe our wild boar-inflicted wound management protocol; and 3) to analyse the features, outcomes and complications of our case series. First, a systematic search of the literature was performed using the PubMed (MEDLINE) electronic database. Then, our evidence-based wild boar-inflicted wound management protocol was described. Finally, a retrospective case series study including all the patients with wild boar-inflicted injuries attended in our Emergency Department (2020-2022) was analysed. Fourteen studies (twelve case reports and two case series) were selected for the literature review. Our case series included 34 patients: 50.0% of them presented superficial wounds and 38.2% penetrating wounds. Most of the wounds occurred in the lower limbs (71.9%). Following our protocol, 30.0% of the wounds were primarily closed, the 70.0% of the patients received antibiotics (92.3% in penetrating injuries) and the 26.7% received an antitetanic vaccine. Only one patient (2.9%) presented a complication. This study reports the first specific wild boar inflicted-wound management protocol, which led to a low complication rate. Open wounds affecting the lower limbs were the most common lesions. Care should be taken with penetrating tusk injuries. Wide-spectrum antibiotic and antitetanic treatments are recommended. Decisions on wound management should be taken case-by-case, while antirabies vaccination depends on the local status of the disease.

Adherence to the post-exposure prophylaxis among animal bite patients attending rabies clinic at tertiary care hospital – A cross-sectional study

Background: Rabies is an acute and 100% fatal viral disease transmitted to humans through the bite or lick of an infected animal. It can be successfully prevented if a complete course of anti-rabies vaccine (ARV) is taken following an animal bite. The present study reveals the compliance of animal bite victims to post-exposure prophylaxis (PEP). Aims and Objectives: The objectives of the study are as follows:(1) To determine the adherence to PEP among animal bite victims and factors influencing it. Materials and Methods: A retrospective record-based cross-sectional study was conducted at the anti-rabies clinic of VIMS Hospital Ballari. Information regarding sociodemographic variables, animal bite history, category of bite, treatment received, and completion of ARV schedule of all the animal bite cases were collected from the animal bite register and treatment card during the period from July 2023 to December 2023. Results: Out of the total 350 animal bite victims, all of them received the first dose of vaccine, 86.28% completed two doses, 72% completed three doses, and only 51.14% completed the schedule by taking all four doses, 37% of them completed the schedule without any delay, 14% delayed one or more doses, and the rest 49% did not complete the schedule. Conclusion: Adherence to PEP is a dire necessity as rabies is a fatal disease. Counseling the animal bite victims about the importance of adhering to the complete PEP schedule at the time of administering the first dose of vaccine is crucial.

Rabies control in Bangladesh and prediction of human rabies cases by 2030: a One Health approach

Bangladesh is making progress toward achieving zero dog-mediated rabies deaths by 2030, a global goal set in2015. Drawing from multiple datasets, including patient immunisation record books and mass dog vaccination (MDV) databases, we conducted a comprehensive analysis between 2011 and 2023 to understand the effectiveness of rabies control programmes and predict human rabies cases in Bangladesh by 2030 using time-series forecasting models. We also compared rabies virus sequences from GenBank in Bangladesh and other South Asian countries. The estimated dog population in Bangladesh was determined to be 1,668,140, with an average dog population density of 12.83 dogs/km2 (95% CI 11.14-14.53) and a human-to-dog ratio of 86.70 (95% CI 76.60-96.80). The MDV campaign has led to the vaccination of an average of 21,295 dogs (95% CI 18,654-23,935) per district annually out of an estimated 26,065 dogs (95% CI 22,898-29,230). A declining trend in predicted and observed human rabies cases has been identified, suggesting that Bangladesh is poised to make substantial progress towards achieving the 'Zero by 30' goal, provided the current trajectory continues. The phylogenetic analysis shows that rabies viruses in Bangladesh belong to the Arctic-like-1 group, which differs from those in Bhutan despite sharing a common ancestor. Bangladesh's One Health approach demonstrated that an increase in MDV and anti-rabies vaccine (ARV) resulted in a decline in the relative risk of human rabies cases, indicating that eliminating dog-mediated human rabies could be achievable. The study was supported by the Communicable Disease Control (CDC) Division of the Directorate General of Health Services (DGHS) of the People's Republic of Bangladesh.

Public demand of anti-rabies vaccination prophylaxis for contacts of two rabies victims

Public demand of anti-rabies vaccination prophylaxis for contacts of two rabies victims

Treatment seeking behaviour and compliance regarding Anti-rabies vaccine among animal bite patients in Anti-rabies clinic, at District Hospital Amritsar, Punjab

Treatment seeking behaviour and compliance regarding Anti-rabies vaccine among animal bite patients in Anti-rabies clinic, at District Hospital Amritsar, Punjab

Bilateral peripheral ulcerative keratitis and uveitis following co-administration of COVID-19 and anti-rabies vaccines in a teenager

Bilateral peripheral ulcerative keratitis and uveitis following co-administration of COVID-19 and anti-rabies vaccines in a teenager

Assessing the Safety of a Novel Monoclonal Antibody Cocktail for Postexposure Prophylaxis in Category III Animal Exposures.

TwinRab™ is a novel life-saving biological containing two monoclonal antibodies (docaravimab and miromavimab) essential for all age victims of category III animal exposures. It effectively neutralizes rabies and similar viruses at the exposure site until the body generates vaccine-induced antibodies. This postmarketing surveillance study assesses the safety of TwinRab™ in current postexposure prophylaxis (PEP) use and aims to reinforce its safety data for future applications. The prospective, open-label observational study was conducted on patients with the World Health Organization category III animal exposures at a government hospital in a northern region of India, by a suspected rabid animal. The study protocol included administering TwinRab™ (40 IU/kg) and a full course of anti-rabies vaccination as PEP. Out of 405 participants, 404 completed the study as per the protocol. Adverse events (AEs) occurred in 12.35% of cases, with 9.88% local AEs (primarily pain and tenderness) and 2.47% systemic AEs (fever, malaise, and myalgia). All AEs were mild and resolved without complications. Most participants (88.9%) and investigators (89.1%) rated TwinRab™'s tolerability as excellent. The present study demonstrates the evidence of a satisfactory safety profile along with better tolerability of TwinRab™ (40 IU/kg) for category III animal exposures and supports its continued usage.

Effect of telephone reminders on adherence to anti-rabies vaccine amongst animal bite patients in North India: A randomised, single-blind, parallel-group, single-centre, interventional superiority trial

ObjectivesRabies is a highly infectious viral zoonotic disease of the central nervous system with a near 100% fatality rate. Vaccine adherence is an integral part of achieving effective treatment. India accounts for 27% of the global deaths from rabies yearly. Rabid dog bites are responsible for 99% of these deaths. This study aimed to assess the effect of reminder calls on compliance with the anti-rabies vaccine among animal bite patients. MethodsAn interventional, randomised, single-blinded, parallel-group, single-centre study was conducted at the Anti Rabies Clinic, Rajindra Hospital, Government Medical College, Patiala, a city located in Punjab, India, with a population of approximately 19 lakhs. A sample of 400 patients was enrolled and divided into two groups by lottery method. After obtaining written and informed consent from patients, data were collected using a validated pre-tested, semi-structured proforma. The intervention group received reminder calls before each dose. At the end of the study, complete information regarding compliance was obtained from both groups and analysed. ResultsThe median age group of the animal bite patients was 21-40 years, with most being male (69.50%). Most of the bites were on the lower extremities (64.0%), followed by the upper extremities (29.0%) and the face (3.25%). Out of 153 patients who delayed the dose, 137 (89.54%) delayed a single dose. The 4th dose on the 28th day was the most frequently delayed dose (75.16%). Reminder calls increased the vaccine compliance rate from 53.5% in the non-intervention group to 70% in the intervention group (adjusted odds ratio=2.28; P=0.0002). There was no effect of gender, area, educational qualification, or marital status on the compliance. ConclusionsReminder calls were found to have significant effect on the adherence to the anti-rabies vaccine. This simple, cost-effective, and patient-friendly intervention must be integrated within the health care system to ensure timely and complete administration of the anti-rabies vaccine to reduce the risk of rabies.

Adjuvant properties of chitosan derivatives administered to mice with anti-rabies vaccine

Adjuvant properties of chitosan derivatives administered to mice with anti-rabies vaccine

Cutaneous Small Vessel Vasculitis Following Anti-Rabies Vaccine.

Cutaneous Small Vessel Vasculitis Following Anti-Rabies Vaccine.

Rabies death in a prisoner: necessity for medical history documentation

Rabies is a zoonotic illness with a high mortality rate that attacks mammals' central nervous systems. It is a viral illness that may be avoided with immunization. Up to 99% of the human rabies transmissions occur in dogs, making them the primary cause of rabies mortality in humans. It is a case-report of rabies death in a 55-years old male, a prisoner from Phulbani Jail (Kandhamal), who was presented to MKCG Medical College and Hospital casualty with with chief complaints of difficulty in breathing and difficulty in drinking water since last night on 17 July 2023, at 11:19 pm. The patient had a history of dog bite exposure four years ago, for which he had not received any post-exposure prophylaxis. The patient was identified as having a likely case of rabies based on his previous history of animal bite and clinical manifestations. Patient was declared dead on 18 July 2023 at 10:30 am. Rabies diagnosis was confirmed by pathological examination of brain sample which showed presence of Negri bodies. This case-report focuses on the importance of proper medical history information including any animal bite exposure especially for convicts before admitting in prison so as to avoid later morbidity and its legal consequences. Such kind of incident also shows that there is lack of awareness regarding rabies in community. In this instance, mortality may have been prevented if the patient had finished the anti-rabies vaccine regimen and made it to a higher center in time for immunoglobulin. Increasing rabies vaccination awareness among the general public can help reduce rabies-related deaths.

Lack of documentation in animal bite cases and its impact on rabies biologicals utilization.

Rabies has significant health and economic consequences for both humans and animals. Annually, India witnesses 17.4 million dog bites, yet only 3 million individuals receive post-exposure prophylaxis (PEP). There is a shortage of anti-rabies vaccine in India as quoted in many news reports. In India, lack of documentation of previous vaccination against animal bites is there, hence resulting in the re-administration of the anti-rabies vaccine, leading to a significant biological loss (anti-rabies vaccine). A cross-sectional, retrospective study was conducted. Data was collected, and analyzed from June 2021 to June 2023 a period of 2 years. Majority of the patients reported within the first 24 hours after being bitten while approximately one-third reported after 24 hours. Majority were Category 3 bites and unprovoked. Males, lower-middle class, and bites on lower extremities were common among 4291 patients attending the clinic. Out of 217 re-exposure cases, 185 did not have any documentation regarding their previous treatment of animal bites. Among 4291 patients attending the clinic, majority were Category 3 bites on the lower extremities. 85.25% of re-exposure cases had to be administered a full course of treatment due to a lack of documentation leading to rabies as a biological wastage. This avoidable wastage can be a resource for treating more patients.

IJCM_306A: Patient compliance towards Post exposure Prophylaxis with Anti Rabies Vaccine - Hospital based study

Background: Rabies is a deadly viral disease that affects the nervous system. The components of rabies post-exposure prophylaxis involve wound treatment, Rabies Immune Globulin, and the anti-rabies vaccine. Proper compliance with the rabies vaccination schedule is crucial to prevent development of Rabies Objectives: 1) To assess prevalence of non-compliance and delayed compliance towards post-exposure prophylaxis of the anti-rabiess vaccine of GMC, Jammu 2) To study factors associated with and reasons of delayed compliance and non-compliance towards post-exposure prophylaxis of the anti-rabies vaccine of GMC, Jammu Methodology: A cross- sectional study was carried out from September 2022 to July 2023 on 594 animal bite victims presenting to OPD of the anti-rabies clinic of GMC, Jammu for the first time, with category 2 and 3 bites were included Results: Males were about 76.9%, and females, 23.1%. Graduates were 29.3%. Animal bites were mainly from stray dogs (58.2%), with category three wounds (93.8%). Wound washing practices were done by 540 (90.9%), about 58 (9.8%) had used only water and about 482 (81.1%) had used only soap and water for wound washing. 71.7% completed the full course of Anti-Rabies Vaccine (ARV), 24.6% showed delayed compliance, and 3.7% were non-compliant or dropouts. Delayed compliance was observed on the second (35%), third (42.4%), and fourth doses (22.6%). Reasons for delayed compliance included distant residence, loss of wages, and forgetfulness. Non-compliance reasons included negligence and health issues. No socio- demographic factors showed an association with compliance with ARV. Conclusion: The urgent need to increase awareness and counseling for individuals bitten by animals. Special attention is crucial for promptly administering Anti-Rabies Immunoglobulin in severe cases (category 3 bites) to prevent rabies

IJCM_413A: A cross sectional study to find out status of post exposure prophylaxis among animal bite cases in Raipur city Chhattisgarh.

Background: Rabies is a viral zoonosis that occurs in more than 100 countries and territories Although a number of carnivores and bat species serve as natural reservoirs, rabies in dogs is the source of 99% human infections and poses a potential threat to more than 3.3 billion people. In humans, rabies is highly fatal once clinical symptoms have developed. According to the World Health Organization, human rabies can be prevented completely by proper post exposure prophylaxis. In India alone, 20,000 deaths (i.e., about 2/100,000 population at risk) and 2 million bites, mostly by dogs, are estimated to occur annually. India has 36% global and 65% Asian rabies burden in terms of cases. Local treatment of wounds is of maximal value when applied immediately after exposure (within minutes if possible). Animal experiments have shown that local wound treatment can reduce the chances of developing rabies by up to 80%. Objectives: To find out the status of post exposure prophylaxis and associated factors among animal bite cases in Raipur city Chhattisgarh. Methodology: Type of study: A community based cross sectional survey Conducted at: Raipur District. Duration of study: Over a period of 3 months (November 2023- January 2024). Study Subjects: General Population. Inclusion criteria: General population, Raipur. Exclusion Criteria: 1) Patients who do not give consent. 2)Unconscious Very ill patients or patients with Mental illness. Results: Total of 1124 participants 41 had animal bite, 63.41% were males and 36.59% were females. Among the biting animals 83% were dogs, while cats were 15% and 2% were monkeys. Out of 41 cases 90.24% had Category II bite while 9.75% had Category III bite. 33 out of 41 i.e. 80.48% victims took Anti Rabies vaccine, while rest 19.52% preferred treatment from traditional healer. Conclusion: Majority of animal bite were of dog bite and were classified under Category II. Improved awareness, forestalling animal rabies, and better access to affordable and potent human rabies vaccines are essential for the elimination of human rabies.

IJCM_376A: Time motion study in Anti Rabies Vaccination OPD in tertiary care Hospital of Central India

Background: Outpatient department is considered a doorway to health services. The outpatient department thus requires a systematic study of its services for its efficient management and functioning. Time-motion study in ARV OPD provides information on how much time it takes for management of animal bite patients at each step. Such a study could prove useful to improve efficiency of health care services. Objective: To assess the average time spent in different service delivery points in ARV OPD Methodology: A hospital based cross0sectional study was conducted in ARV OPD from July 2022 to June 2023 on Patients coming to ARV OPD. A total of 960 patients were included in the study using Systematic Random sampling technique. Data was collected using a pre-designed and pre-tested questionnaire for socio-demographic details and case history of patients and time required for each step in management of animal bite. Stopwatch of smartphone was used to record time at each step of patient management. All the collected data was entered in SPSS software (version 20.0) and was analyzed accordingly. Results: Study results showed that out of 960 patients 613 (63.85%) were male and 347(36.15%) were female. 509 (53.02%) were from urban and 451(46.98%) were from rural area. Out of 960 patients 816 (85 %) were of category III bite and 144 (15%) of category II bite. The most common site for animal bite was lower limb 556 (57.9%) followed by 288 (30%) on upper limb, on trunk 38 (3.96 %) and 78 (8.14%) on head and neck region. Total time required for management of animal bite was 35.15+/- 17.92 minutes. Conclusion: The time spent in transit could be reduced with proper management of logistics. Also reframing of strategies at various steps could help reduced average time needed to attend a patients at ARV OPD.

IJCM_365A: A prospective study on the safety and clinical efficacy of rabies monoclonal antibodies for post exposure prophylaxis in suspected animal exposures at the anti rabies clinic of KIMS Hospital and Research Centre, Bangalore

Background: Rabies immunoglobulins will provide timely passive immunity after exposure to suspected rabid animals along with thorough wound wash and full course of anti-rabies vaccination. The products include human derived RIG (HRIG) and equine derived RIG (ERIG), both having certain constraints for usage. In contrast, monoclonal antibodies (mAbs) produced by recombinant technology, have shown superiority in availability, safety and purity. Therefore, RmAb are an alternative to RIG for passive immunity component of post exposure prophylaxis (PEP). Only two products i.e., RabiShield (single human mAb) & Twinrab (cocktail of two mAbs) have been merchandised in Indian market. WHO has recommended monitoring the clinical use and outcomes of RmAb products for rabies PEP Objective: To assess the safety and clinical efficacy of presently available rabies monoclonal antibodies for post exposure prophylaxis Methodology: All the patients with category III exposure visiting the study site and consenting for the study were included. The details pertaining to socio demographic profile, details of biting animal, characteristics of bite wound, wound wash, details of active & passive immunization and details of adverse events following PEP were collected using a case record form. All the study subjects were followed up for the occurrence of any delayed reactions and further upto six months to know the clinical efficacy of PEP. Results: The present study included 475 animal bite victims. Among them 41.2 % were children, 49.6% were adults and 9.01 % were elderly. The ADEs among Rabishield and TwinRab were 3.18 % & 2.12 % respectively and the difference among them were not statistically significant. ADEs among all the patients receiving both RmAbs were mild and subsided without any complications. All the study subjects were healthy and alive after six months after PEP confirming clinical efficacy. Conclusion: The presently available RmAbs are safe and clinically effective in preventing rabies in suspected exposures