Rabies Prophylaxis Research Articles

A Case of a Serum Sickness-Like Reaction After Postexposure Rabies Prophylaxis

BackgroundSerum sickness secondary to rabies postexposure prophylaxis is not well documented in the medical literature. Our case describes serum sickness after exposure to human-derived rabies immunoglobulin (HRIG) and three human diploid rabies vaccines (HDCV) in a young adult male. Case ReportA 30-year-old previously healthy male patient presented to the Emergency Department with complaints of fever, rash, and jaundice, and had a hospital course complicated by biliary stenosis likely secondary to reactive periportal lymphadenopathy. His initial laboratory values demonstrated obstructive jaundice and slightly elevated complement component 4 levels. These symptoms likely are due to the course of HRIG and HDCV vaccines the patient completed after being exposed to a rabies-positive bat in his home. The patient was hospitalized for 8 days, during which he underwent an endoscopic retrograde cholangiopancreatography with sphincterotomy and biliary stenting. He had one repeat hospitalization for acute blood loss anemia attributed to sphincterotomy, which did not require transfusion or further intervention. Liver biopsy showed cholestatic hepatitis. Why Should an Emergency Physician Be Aware of This?Medical literature describing serum sickness or a serum sickness-like reaction occurring from exposure to HRIG or HDCV is sparse despite the commonality of postexposure rabies prophylaxis in health care. It is important to educate practitioners on this potential complication and highlight next potential consultations and treatments.

Mid-Cheek Reconstruction after a Dog Bite: Case Report and Literature Review

The incidence of animal bite injuries affecting the anatomical regions of the head and neck is notably prevalent, particularly among individuals within the younger demographic. Canine species have been identified as the primary source of the majority of bite injuries in the human population, the spectrum of injuries encompasses a range of traumatic manifestations, which may encompass uncomplicated lacerations or punctures, as well as more complex avulsions characterized by the presence or absence of accompanying tissue. The anatomical regions most frequently affected by the condition under investigation include the buccal region, nasal area, and labial region. The acquisition of comprehensive data regarding the vaccination status of both the animal and the patient is of paramount significance in the realm of medical research. Furthermore, it is imperative to duly administer prophylactic measures such as tetanus or rabies prophylaxis, contingent up on the presence of any indications warranting such interventions. The aforementioned wounds necessitate comprehensive assessment, meticulous cleansing, and, on occasion, surgical debridement or reconstruction within the confines of the operating theater. The selection of the appropriate reparative intervention is contingent upon a comprehensive assessment of the precise anatomical site and magnitude of the inflicted trauma, thereby encompassing a spectrum of potential modalities including primary closure, microsurgical replantation, dermal grafting, tissue flaps, and in rare instances, facial allograft transplantation.

Antiviral mechanisms of two broad-spectrum monoclonal antibodies for rabies prophylaxis and therapy.

Rabies is an acute and lethal encephalomyelitis caused by lyssaviruses, among which rabies virus (RABV) is the most prevalent and important for public health. Although preventable through the post-exposure administration of rabies vaccine and immunoglobulins (RIGs), the disease is almost invariably fatal since the onset of clinical signs. Two human neutralizing monoclonal antibodies (mAbs), RVC20 and RVC58, have been shown to be effective in treating symptomatic rabies. To better understand how these mAbs work, we conducted structural modeling and in vitro assays to analyze their mechanisms of action, including their ability to mediate Fc-dependent effector functions. Our results indicate that both RVC20 and RVC58 recognize and lock the RABV-G protein in its pre-fusion conformation. RVC58 was shown to neutralize more potently the extra-cellular virus, while RVC20 mainly acts by reducing viral spreading from infected cells. Importantly, RVC20 was more effective in promoting effector functions compared to RVC58 and 17C7-RAB1 mAbs, the latter of which is approved for human rabies post-exposure treatment. These results provide valuable insights into the multiple mechanisms of action of RVC20 and RVC58 mAbs, offering relevant information for the development of these mAbs as treatment for human rabies.

Expert consensus on the clinical application of ormutivimab injection for use against the rabies virus

ABSTRACT Background There are no local or international guidelines or consensus on the use of mAbs against the rabies virus. Research design and methods An expert group in the field of rabies prevention and control formulated the consensus presented in this paper. Results Class III exposed persons to rabies for the first time; Identify type II exposed persons with immune deficiency; those who are first exposed to Class II and re-exposed to Class III within 7 days. They can use ormutivimab injection after completing the PEP wound treatment. In the case of injection restrictions or a wound that is difficult to detect, it is recommended that the entire Ormutivimab dose be infiltrated close to the wound. For severe multi-wound bites, the recommended dosage of ormutivimab is 20 IU/kg. If the recommended dose cannot meet all of the wound infiltration requirements, appropriate dilution can be conducted at a dilution ratio of 3 ~ 5 times. If the requirements for infiltration cannot be met after dilution, it is recommended that the dosage be increased with caution (maximum dosage, 40 IU/kg). The use of Ormutivimab is safe and effective without any contraindications by all age groups. Conclusions This consensus standardizes clinical use of Ormutivimab, improves post-exposure prophylaxis of rabies in China, reduces infection rate.

Hyperimmune Globulins for the Management of Infectious Diseases

This review is focused on the use of hyperimmune globulin therapy to treat some infectious diseases of viral or bacterial origin. Despite the introduction of antibiotics and vaccines, plasma immunoglobulin therapy from whole blood donation can still play a key role. These treatments provide passive transfer of high-titer antibodies that either reduces the risk or the severity of the infection and offer immediate but short-term protection against specific diseases. Antibody preparations derived from immunized human donors are commonly used for the prophylaxis and treatment of rabies, hepatitis A and B viruses, varicella-zoster virus, and pneumonia caused by respiratory syncytial virus, Clostridium tetani, Clostridium botulinum. The use of hyperimmune globulin therapy is a promising challenge, especially for the treatment of emerging viral infections for which there are no specific therapies or licensed vaccines.

Assessment of the level of knowledge of rabies and prophylaxis for rabies among medical senior students

Objective: Rabies is a zoonotic disease with acute, progressive viral encephalitis that affects both human and animal health. In our study, it was aimed to measure the level of knowledge about rabies and prophylaxis of senior students of the faculty of medicine. 
 Methods: The study population was 163 students in their final year during the academic year 2019–2020. The participants were interviewed face to face and filled the required questionnaire. The questionnaire was developed based on the Guide for Rabies Prophylaxis published in 2019 by the Republic of Türkiye Ministry of Health.
 Results: In our study, 88.34% (n=114) of the participants did not have sufficient knowledge about rabies pre-contact indications. It was determined that 64.4% (n= 105) of the participants had insufficient knowledge about the effectiveness of post-exposure prophylaxis. In addition, it was determined that indications for starting antibiotics after rabies exposure of 66.24% (n=108) of the participants and 29% (n=) rabies vaccine/ human rabies immunoglobulin (HRIG) application indications and 46% (n=75) did not know the method of application and the area where it was applied.
 Conclusion: It was determined that the senior students of the faculty of medicine did not have sufficient information about rabies and prophylaxis.

Mass Human Exposures to One Rabid Kitten

On October 22, 1994, a State public health laboratory diagnosed rabies in a kitten that had been purchased from a pet store in the State capital. On October 19, the animal developed seizures, then died of unknown causes during the night of October 20–21. Approximately 665 persons received rabies postexposure prophylaxis because of exposure to this kitten and other cats from the same pet store. This case is intended to walk the reader through the situation as it actually happened and identify potential opportunities for interventions that would have resulted in fewer people exposed, fewer rabies prophylaxis administrations, lower costs, and reduced community concern.© The Author 2023

Knowledge of Rabies Prophylaxis among Junior Doctors in a Tertiary Hospital in Manipur – A Cross-sectional Study

Context: Rabies, a zoonotic disease caused by Lyssavirus genus rabies virus, is 100% fatal yet preventable. Appropriate and timely management of rabies cases will help in reducing and preventing mortality. Health-care personnel, especially the junior doctors who are at the threshold of their public health service, need to be equipped with adequate knowledge to be able to provide effective care. Aims: The aims of the study are to assess the knowledge about rabies and to assess the association between knowledge with sociodemographic characteristics among the junior doctors of a tertiary care hospital, Imphal. Settings and Design: A cross-sectional study was conducted among 520 junior doctors of a tertiary care hospital including interns, house officers, and postgraduate trainees from June 2018 to July 2019. Subjects and Methods: Data collection was done by questionnaire method. Statistical Analysis Used: The data were analyzed using IBM SPSS for Windows, Version 21.0. Armonk, NY, USA. Results: Only 17.5% of the junior doctors had adequate knowledge about rabies. Those who had come across and those who had treated rabies were 35.4% and 23.7%, respectively. Only around half of the respondents knew the management of the WHO Category I and III animal bite exposure. Conclusions: In the present study, it was seen that the overall knowledge of the junior doctors was poor. Only 2 out of 10 of the participants had adequate knowledge of rabies. One-fourth of the participants had treated rabies in their clinical practice and those who had treated rabies had better knowledge compared to those respondents who had never treated.

Modelling modifiable factors associated with the probability of human rabies deaths among self-reported victims of dog bites in Abuja, Nigeria.

Canine-mediated rabies kills tens of thousands of people annually in lesser-developed communities of Asia, Africa, and the Americas, primarily through bites from infected dogs. Multiple rabies outbreaks have been associated with human deaths in Nigeria. However, the lack of quality data on human rabies hinders advocacy and resource allocation for effective prevention and control. We obtained 20 years of dog bite surveillance data across 19 major hospitals in Abuja, incorporating modifiable and environmental covariates. To overcome the challenge of missing information, we used a Bayesian approach with expert-solicited prior information to jointly model missing covariate data and the additive effects of the covariates on the predicted probability of human death after rabies virus exposure. Only 1155 cases of dog bites were recorded throughout the study period, out of which 4.2% (N = 49) died of rabies. The odds for risk of human death were predicted to decrease among individuals who were bitten by owned dogs compared to those bitten by free-roaming dogs. Similarly, there was a predicted decrease in the probability of human death among victims bitten by vaccinated dogs compared to those bitten by unvaccinated dogs. The odds for the risk of human death after bitten individuals received rabies prophylaxis were predicted to decrease compared to no prophylaxis. We demonstrate the practical application of a regularised Bayesian approach to model sparse dog bite surveillance data to uncover risk factors for human rabies, with broader applications in other endemic rabies settings with similar profiles. The low reporting observed in this study underscores the need for community engagement and investment in surveillance to increase data availability. Better data on bite cases will help to estimate the burden of rabies in Nigeria and would be important to plan effective prevention and control of this disease.

Trends of Animal Bite Cases and Comparison of Cases Reported during Pre-COVID-19 and COVID-19 Period in a Dedicated Anti-Rabies Clinic from a Tertiary Care Hospital, Hassan, Karnataka, India: A Retrospective Cohort Study

Introduction: Rabies causes 100% case fatality in animal bite victims if left untreated, and it ranks as the 10th leading cause of death due to infectious diseases worldwide. India alone reports 20,000 human rabies deaths annually, accounting for one-third of global mortalities related to the disease. However, rabies is 100% preventable. The nationwide lockdown imposed from March 25, 2020, to curb the spread of the Coronavirus Disease-2019 (COVID-19) disrupted various essential health services, including Post-Exposure Prophylaxis (PEP) for rabies. Aim: to describe the socio-demographic profile of animal bite cases and assess the burden of animal bites during the pre and post COVID-19 Pandemic, specifically in patients reporting to the dedicated Anti-Rabies Clinic (ARC) of a tertiary care hospital in Hassan, Karnataka, India. Materials and Methods: A retrospective record-based study was conducted from January 2019 to November 2021 among animal bite cases reporting to the ARC at Hassan Institute of Medical Sciences, Hassan, Karnataka, India. Data on age, gender, locality, and socio-economic status were collected from the records maintained at the ARC. All subjects with complete data in the records were included in the study. All animal bite cases were managed according to the World Health Organisation (WHO) guidelines, with necessary COVID-19 precautions taken. A total of 3,706, 3,303, and 2,144 subjects were considered for the years 2019, 2020, and 2021, respectively. Results: There was a decreasing trend in the reported cases during the pandemic. The proportion of animal bite cases among those less than 19 years old was 1,146 (30.9%), 1,124 (34.1%), and 711 (33.1%) in the years 2019, 2020, and 2021, respectively. The majority of animal bite victims were males: 2,489 (67.2%), 2,240 (67.8%), and 1,173 (54.7%) in the years 2019, 2020, and 2021, respectively. The majority belonged to the rural population, with 2,668 (72.0%), 1,057 (32%), and 1,586 (74%) in the years 2019, 2020, and 2021, respectively. However, there was an increase in the number of victims from the urban population in the year 2020, with nearly 2,246 (68%). Most of them, 2,299 (62%), 2,114 (64%), and 1,441 (67.2%) in the years 2019, 2020, and 2021, respectively, belonged to a lower socio-economic status. Category-III bites made up the majority representation in all the years 2019, 2020, and 2021. Conclusion: The number of animal bite cases reported during the pandemic was lower compared to the pre-pandemic phase. This highlights either missed reporting of cases or a reduction in exposure to animals, which decreased the risk of animal bites.

Implications of the antiviral drug favipiravir on rabies immunoglobulin for post-exposure prophylaxis of rabies in mice model with category III-like exposures

Rabies is a fatal zoonotic disease caused by the rabies virus (RABV), with almost 100% mortality if proper post-exposure prophylaxis (PEP), consisting of rabies immunoglobulin (RIG) and rabies vaccine, is not applied in a timely manner. However, this is challenged by the limited availability of RIG, especially in resource-constrained countries. In this study, we assessed the scope of the antiviral drug favipiravir to treat rabies-infected mice as an alternative to RIG. Category III-like wounds were induced in RABV-challenged mice treated with favipiravir instead of RIG in the PEP regimen. The use of favipiravir followed by rabies vaccine provided complete protection against rabies-related death in 100% of mice, even after RABV propagated to the central nervous system during infection. Additionally, the virus-neutralizing antibody titer in the favipiravir and vaccine group was significantly higher than that of the RIG and vaccine recipients. The use of favipiravir with rabies vaccine seemingly prevents fatal outcomes and even rescues the cases that already express clinical symptoms. A clinical trial of this approach is warranted, especially in countries with low RIG availability.

Profilaxia pós-exposição da raiva humana: uma revisão dos tratamentos envolvendo gatos domésticos

Rabies is an anthropozoonosis that presents approximately 100% lethality and expensive preventive assistance. Many human post-exposure anti-rabies treatments indicated for people at risk of exposure to rabies virus, usually due to some aggression by a mammalian animal, are instituted annually. This study aimed to evaluate the initial care of post-exposure prophylaxis of human rabies in Belo Horizonte between 2007 and 2016, involving accidents with domestic cats. It was found 71.1% agreement between the treatments instituted by health services and the protocol of the Ministry of Health. Treatments classified as insufficient totaled 18.3% and excessive, 10.6%. The animals were healthy in 68% and observable in 68.4% of the cases. Treatments involving the use of anti-rabies vaccine totaled 87.7%. The most frequent treatment adopted by the health services was observing the animals associated with the human anti-rabies vaccination in 56.7% of the cases. Imperfections in the filling of the notifications must be revised to enable improvements for future analyses. As for human prophylactic anti-rabies care, forming a multidisciplinary health team including veterinarians would be well on the way to improving the service offered.

Cross sectional study to assess knowledge, attitude and practices (KAP) towards animal bite management and vaccination against rabies, amongst interns in a tertiary care hospital of Kolhapur, Maharashtra

Background: Rabies disease continues to be most feared of all communicable diseases. Rabies is a zoonotic disease & transmitted by animal bites, mainly dogs. India accounts for 59.9% of rabies deaths in Asia and 35% of deaths globally. One of the important factors associated with successful treatment is the knowledge of the care giver in the correct management of animal bites and vaccination against rabies. Objectives: i) To assess the knowledge towards animal bite management, and (ii) To study the knowledge, attitude & practices regarding pre and post-exposure prophylaxis (PEP) of rabies amongst interns in a D. Y. Patil Medical College, & Hospital, Kolhapur, Maharashtra, a tertiary care teaching hospital. Material and Methods: i) Study design - An observational - cross sectional, knowledge, attitude & practices (KAP) study. ii) Tools used - Predesigned, pretested, structured questionnaire based survey in interns on animal bite wound management and pre & post-exposure prophylaxis for rabies. iii) Study population – Interns working in D. Y. Patil Hospital, Kolhapur during study period, iv) Statistical tests – mean, percentage and other statistical analysis was conducted by using Microsoft- Excel.

A Study of Adverse Effects Following Administration of Anti-Rabies Vaccination - A Hospital Based Study

Rabies is an acute viral zoonotic disease that affects all warm-blooded animals including mammals and occurs in more than 150 countries and territories. Although rabies is a 100% fatal disease, it can be prevented by the use of potent anti-rabies vaccines (ARV). The present study was a hospital based descriptive longitudinal study conducted during February 2019 to July 2020 amongst the animal bite patients attending the Anti -Rabies clinic (ARC) of Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC & SJH), New Delhi, to study the adverse events (vaccine reactions) if any following administration of the ARV. The age of the study participants ranged from 2 to 65 years and the mean age was (29.3±15.2) years. No severe or serious adverse events were reported. Of the minor reactions, the most commonly reported symptom was pain at the injection site (34; 9.4%) followed by occurrence of tingling sensation (29; 8.1%), headache (22; 6.1%) and itching at the injection site (19; 5.3%). These findings corroborate with those found in previous studies in the literature. It was concluded that although there are possible local or mild or systemic adverse reactions to rabies vaccination, but once initiated, rabies prophylaxis should not be interrupted or discontinued.

Safety and immunogenicity of a simian-adenovirus-vectored rabies vaccine: an open-label, non-randomised, dose-escalation, first-in-human, single-centre, phase 1 clinical trial

Rabies kills around 60 000 people each year. ChAdOx2 RabG, a simian adenovirus-vectored rabies vaccine candidate, might have potential to provide low-cost single-dose pre-exposure rabies prophylaxis. This first-in-human study aimed to evaluate its safety and immunogenicity in healthy adults. We did a single-centre phase 1 study of ChAdOx2 RabG, administered as a single intramuscular dose, with non-randomised open-label dose escalation at the Centre for Clinical Vaccinology and Tropical Medicine, Oxford, UK. Healthy adults were sequentially allocated to groups receiving low (5 × 109 viral particles), middle (2·5 × 1010 viral particles), and high doses (5 x 1010 viral particles) of ChAdOx2 RabG and were followed up to day 56 after vaccination. The primary objective was to assess safety. The secondary objective was to assess immunogenicity with the internationally standardised rabies virus neutralising antibody assay. In an optional follow-up phase 1 year after enrolment, we measured antibody maintenance then administered a licensed rabies vaccine (to simulate post-exposure prophylaxis) and measured recall responses. The trial is registered with ClinicalTrials.gov, NCT04162600, and is now closed to new participants. Between Jan 2 and Oct 28, 2020, 12 adults received low (n=3), middle (n=3), and high doses (n=6) of ChAdOx2 RabG. Participants reported predominantly mild-to-moderate reactogenicity. There were no serious adverse events. Virus neutralising antibody concentrations exceeded the recognised correlate of protection (0·5 IU/mL) in three middle-dose recipients and six high-dose recipients within 56 days of vaccination (median 18·0 IU/mL). The median peak virus neutralising antibody concentrations within 56 days were 0·7 IU/mL (range 0·0-54·0 IU/mL) for the low-dose group, 18·0 IU/mL (0·7-18·0 IU/mL) for the middle-dose group, and 18·0 IU/mL (6·0-486·0 IU/mL) for the high-dose group. Nine participants returned for the additional follow-up after 1 year. Of these nine participants, virus neutralising antibody titres of more than 0·5 IU/mL were maintained in six of seven who had received middle-dose or high-dose ChAdOx2 RabG. Within 7 days of administration of the first dose of a licensed rabies vaccine, nine participants had virus neutralising antibody titres of more than 0·5 IU/mL. In this study, ChAdOx2 RabG showed an acceptable safety and tolerability profile and encouraging immunogenicity, supporting further clinical evaluation. UK Medical Research Council and Engineering and Physical Sciences Research Council.

Post-exposure prophylaxis of rabies during pregnancy: safety and other concerns

Rabies is a 100% fatal disease caused mainly due to animal bites but can easily be prevented through timely vaccination in case of its potential exposure. Pregnancy is a special condition in which vaccination against rabies in case of its potential exposure may pose questions on its safety owing to its effect on the growing foetus. Through, this short review, we aim to explain the safety of rabies vaccines during pregnancy and its potential harms. Currently available evidences show that both vaccines and immunoglobulins against rabies are completely safe in pregnancy and adverse effects profile similar to non-pregnant state. Further, both the vaccine and immunoglobulins against rabies have no adverse effect on the growing foetus and therefore may safely be given to pregnant women in case of potential exposure.

Review of Oral Rabies Vaccination of Dogs and Its Application in India.

Oral rabies vaccines (ORVs) have been in use to successfully control rabies in wildlife since 1978 across Europe and the USA. This review focuses on the potential and need for the use of ORVs in free-roaming dogs to control dog-transmitted rabies in India. Iterative work to improve ORVs over the past four decades has resulted in vaccines that have high safety profiles whilst generating a consistent protective immune response to the rabies virus. The available evidence for safety and efficacy of modern ORVs in dogs and the broad and outspoken support from prominent global public health institutions for their use provides confidence to national authorities considering their use in rabies-endemic regions. India is estimated to have the largest rabies burden of any country and, whilst considerable progress has been made to increase access to human rabies prophylaxis, examples of high-output mass dog vaccination campaigns to eliminate the virus at the source remain limited. Efficiently accessing a large proportion of the dog population through parenteral methods is a considerable challenge due to the large, evasive stray dog population in many settings. Existing parenteral approaches require large skilled dog-catching teams to reach these dogs, which present financial, operational and logistical limitations to achieve 70% dog vaccination coverage in urban settings in a short duration. ORV presents the potential to accelerate the development of approaches to eliminate rabies across large areas of the South Asia region. Here we review the use of ORVs in wildlife and dogs, with specific consideration of the India setting. We also present the results of a risk analysis for a hypothetical campaign using ORV for the vaccination of dogs in an Indian state.

Continuing medical education about postexposure prophylaxis of rabies in tribal area medical college hospital of Gujarat, India: One step towards rabies elimination.

ABSTRACTBackground:Continuing Medical Education (CME) is an essential feature of the clinical practice and helps to improve the health care provider’s ability to provide quality patient care. The World Health Organization has given a global strategic plan to end human deaths from dog-mediated rabies by 2030 known as “Zero by thirty.”Methodology:A CME session was organized for staff nurses working in a tertiary medical care hospital of Valsad district about anti rabies vaccination. Ninety-one participants were administered the questionnaire about antirabies vaccine (ARV) and related practical aspects before and after the CME session.Results:Mean pre- and post-CME Score of the participants was 5.38 and 8.68 out of 10, respectively which was statistically significant. The majority of the participants could score from 5 to 6 (33, 36.2%) before CME which rose to 9 to 10 after CME (58, 63.7%). A total of 52 participants (57%) showed improvement in total score by more than 5 points after attending CME, whereas 13 (14%) showed no improvement. The maximum improvement (52.1%) was found in the fact that currently available vaccine vials are the same for intradermal (ID) and intramuscular (IM) regimes, followed by the need for immunoglobulins in category III animal bites (44.3%).Conclusion:CME showed significant improvement in knowledge regarding rabies and antirabies vaccination. The knowledge regarding the similar schedule for both adults and children needs improvement. Subsequent CME programs should focus on these aspects for the effective management of animal bite patients.

Xperimental Evaluation of the Possibility of using the LAL test to Determine Bacterial Endotoxins in Vaccines for Rabies Prophylaxis

Relevance. The presence of pyrogenic impurities in finished dosage forms of concentrated cultural anti-rabies vaccines produced in the Russian Federation is determined using pyrogenicity tests on rabbits (in vivo). In accordance with the decision of the Board of the Eurasian Economic Commission dated September 7, 2018 N 151 «On the approval of guidelines for drawing up a regulatory document on the quality of a medicinal product», one of the requirements for parenteral drugs is the determination of bacterial endotoxins. This document indicates that the regulatory documentation should include a test and an admissibility criterion for bacterial endotoxins (BE) using the horseshoe crab amoebocyte lysate technique.Aims. Experimental evaluation of the possibility of using the LAL-test to determine bacterial endotoxins in national vaccines for the prevention of rabies.Materials and methods. The research of the drug «Cultural antirabies vaccine concentrated inactivated purified» of national production was carried out in accordance with the National Pharmacopoeia of the Russian Federation, General Pharmacopoeia Monograph OFS.1.2.4.0006.15 in three modifications: gel-clot test: methods A, B; turbidimetric kinetic test: method C; chromogenic kinetic test: method D.Results. Was investigated 6 series of the national vaccines for the prevention of rabies from two national manufacturers (using three pharmacopoeial methods). LAL reagent produced by two companies (Charles River Endosafe® and Lonza). In order to confirm the reproducibility of the method, the gel-clot test was carried out at different time intervals by one or two operators. During the research was determined the possibility of using photometric methods (method C and D).Conclusions. The research proved the possibility of determining bacterial endotoxins by methods: gel-clot test (method A), turbidimetric kinetic test (method C) and chromogenic kinetic test (method D). Method B is recommended for quantitative analysis of vaccine without instrumental methods. During the research all national vaccines for the prevention of rabies was free from bacterial endotoxins (no more 25 EU/ml).

Rabies Exposures in International Travelers: A Review

Up to 2% of international travelers report an animal contact which raises the possibility of rabies exposure. Travelassociated rabies is rare; however, infection is essentially fatal once expressed yet death is preventable by timely postexposure prophylaxis (PEP) -- thorough wound cleansing, local injection of rabies immune globulin (RIG) and a vaccine series. To begin to provide initial guidance if contacted by a patient potentially exposed to rabies while abroad, key questions the clinician should ask in a stepwise fashion are: (1) What animal was involved? (2) What was the actual exposure and in what country did it occur? (3) How many wounds, location (including mucosal surfaces), severity and what wound care performed? (4) Is the traveler immunocompromised? (5) Was either preexposure rabies prophylaxis or PEP previously given? (6) Is rabies PEP clearly indicated and/or is expert advice and guidance needed? (7) Where is the traveler, what level of acceptable care is accessible and how long to access it? And (8) What formulation of rabies immune globulin and vaccine is available and what injection protocol is in-use? Framed here by experience with four travelers, answers to these and additional questions set the stage for the clinician’s initial guidance and action. The goal and clinical relevance of this review is straightforward – to maximize the opportunity for travelers who warrant rabies PEP to promptly receive it.