Rabies - viral disease, which affects the human nervous system. In the absence of timely treatment, it ends in death. Emergency immunoprophylaxis plays a decisive role in preventing the development of the disease after contact with an infected animal. For this purpose, anti-rabies immunoglobulin is used from human blood serum to prevent rabies.

Immunoglobulin from human blood serum for the prevention of rabies: composition and release form

Anti-rabies immunoglobulin produced in the People's Republic of China from the blood serum of donors who have been immunized with rabies vaccine. The rabies vaccine contains the gamma globulin fraction of proteins. These are exactly the substances that are necessary to neutralize the rabies virus. In the production of the drug, purification methods are used. These are cold extraction with ethanol, purification, ultrafiltration. One milliliter of product contains:

• 150 IU (international units) of specific antibodies to the rabies virus.
• Stabilizer in the form of glycine.
• Sodium chloride.
• Water for injections.

Rabies immunoglobulin is available in bottles of 300 and 150 IU. The vaccination does not contain antibiotics, which significantly reduces the risk of allergic reactions. Externally, the drug has a uniform, light yellow consistency.

Pharmacological action of vaccination

To understand how immunoglobulin works in the human body, you need to find out what kind of substance it is and why it is needed. Immunoglobulins (antibodies) are substances of protein nature. They are synthesized in the human body by special immune cells - plasma cells. Antibodies are a universal way to fight human body with bacterial, viral and other infections. In all infectious diseases, immunoglobulins are produced in response to the penetration of a foreign agent into the body. These proteins bind to antigens carried by infectious agents and neutralize them. The time required for the production of antibodies is two to three weeks from the moment of infection. This period is quite long. Unfortunately, with rabies, complications occur much faster, which leads to 100% mortality without emergency immunoprophylaxis.

Important! Emergency rabies immunoprophylaxis should be started as soon as possible after infection.

Indications and preparation for drug administration

Rabies vaccination is indicated for all patients suspected of being infected with the virus. It is carried out:

• For any damage to the skin or mucous membranes, which were caused by wild or domestic animals with signs of rabies.
• For damage caused by animals that are under veterinary supervision.
• If the saliva of an infected animal gets on the damaged skin.

The drug is used in parallel with the rabies vaccine. In case of a repeated bite by an infected animal, the drug is not prescribed if the first time the patient received a full dose of immunoglobulin.

Doctor's advice. In case of bites from pets (cats, dogs), even if they do not have obvious symptoms of rabies, it is necessary to show the animal to a veterinarian and establish supervision. If signs of rabies appear in a pet, the patient should consult a doctor.

Method of administration of the vaccine and dose

Before using rabies immunoglobulin, you must consult a doctor and perform primary surgical treatment of the wound. It is carried out to prevent wound infection and restore the integrity of the skin. The surgical treatment is performed by a surgeon. It must be done as soon as possible from the moment of suspected infection. If necessary, stitches are applied.

After surgical treatment, immunoprophylaxis is immediately started. To do this, the health worker takes a bottle of immunoglobulin and checks its integrity. Pays attention to color, consistency and presence of impurities. If signs of unsuitability of the drug are detected, its use is prohibited. After checking the drug under sterile conditions, open the bottle and inoculate.

Important! When administering human rabies immunoglobulin, unlike a drug made from horse blood serum, a skin test is not required

The dose of the administered drug is calculated individually. For every kilogram of the patient's body weight, 20 international units of the drug must be administered. When administering immunoglobulin, the following rule is observed: most of the dose should be injected into the soft tissue around the perimeter of the wound, the remainder of the drug is administered intramuscularly. For adults this is the gluteal region, for children - the front surface of the thigh.

Doctor's advice. Rabies immunoglobulin is administered strictly before the rabies vaccine (10-15 minutes before)

Prescribing the drug is possible only if no more than 7 days have passed since the bite. Administration of immunoglobulin a week after infection or after rabies vaccine is not allowed.

Side effects, complications, reactions to vaccination

The administration of the drug in some cases is accompanied by the occurrence of adverse reactions. They manifest themselves in the form of swelling and redness of the skin at the injection site. Sometimes there is a slight increase in body temperature and general weakness. These symptoms go away on their own and do not require drug treatment.

Complications associated with improper injection technique very rarely occur. The first group is purulent processes. This is the formation of an abscess at the injection site or the development of local purulent lymphadenitis. Such complications arise when the conditions of asepsis and antisepsis are violated. Purulent processes are treated under the supervision of a surgeon. Treatment is often performed surgically. The abscess is opened and the purulent contents are evacuated.

Abscess - a purulent complication of vaccination (photo: www.commons.wikimedia.org)

Second group: damage to the neurovascular bundle when performing an injection. A needle entering a nerve is accompanied by a characteristic acute pain along the nerve endings. When a vessel is damaged, bleeding occurs infrequently. More often accompanied by a small hematoma.

Contraindications to drug administration

Rabies is a disease that, in the absence of treatment and immunoprophylaxis, leads to 100% mortality. In this regard, rabies immunoglobulin and vaccine are administered for health reasons. There are no contraindications to vaccination.

Interaction with other drugs for immunoprophylaxis

The drug is allowed to be administered in parallel with drugs for the prevention of tetanus. All other immunobiological preparations are used only three months after the end of the rabies vaccination.

Important! Immunoglobulin and rabies vaccine must be injected into different areas of the body. A separate syringe is used for each drug.

Vaccine storage conditions

The drug is stored in specially designed refrigeration equipment. Temperature ranges from two to eight degrees above zero. Freezing of the drug is not allowed. The maximum shelf life is two years.

Analogues of the drug

There are two types of rabies immunoglobulin. The first is obtained from human blood serum. To do this, healthy people are immunized, and then rabies antibodies are isolated from their blood. The second type is made from the blood serum of immunized horses. Antibody preparations from human blood serum have a number of advantages:

• The dosage of human immunoglobulin is half as much.
• The preparation from the blood serum of immunized horses must be heated to 37⁰ C before administration.
• The introduction of antibodies obtained from humans is not accompanied by the risk of developing sensitization (allergic reactions).
• Before administering immunoglobulins obtained from horses, a skin test must be performed, and after vaccination, antihistamines must be prescribed.

A drug made from human blood serum similar in composition to rabies immunoglobulin is Rebinolin. It is produced in Israel.

Filterable list

Active substance:

Instructions for medical use

Instructions for medical use - RU No.

Last modified date: 18.12.2015

Dosage form

Injection.

Compound

Composition per 1 ml of the drug:

Active ingredient:

Specific antibodies - at least 150 IU;

Excipients:

Sodium chloride - 9 mg, glycine (glycocol) - 22.5 mg, water for injection up to 1 ml.

Produced complete with anti-rabies immunoglobulin from horse blood serum diluted 1:100.

Description of the dosage form

Rabies immunoglobulin is a clear or slightly opalescent liquid from colorless to slightly yellow in color.

Rabies immunoglobulin diluted 1:100 is a transparent or slightly opalescent liquid from colorless to slightly yellow in color.

Characteristic

Rabies immunoglobulin from serum, blood, horse liquid is a gamma globulin fraction of horse blood immune serum obtained by the rivanol-alcohol method.

Pharmacological group

MIBP-globulin.

Indications

Used in combination with rabies vaccine (on the same day as the first dose of rabies vaccine) to prevent people from developing hydrophobia after severe bites from rabies or suspected rabies

animals.

Contraindications

There are no contraindications. If the test for intradermal administration of rabies immunoglobulin diluted 1:100 is positive, as well as if the victim has a history of strong allergic reactions to the administration of antitetanus serum or other horse serum preparations, it is recommended that the administration of rabies immunoglobulin be carried out in a hospital environment equipped with resuscitation facilities.

Directions for use and doses

The opening of the ampoules and the procedure for administering the drug are carried out in strict compliance with the rules of asepsis and antiseptics.

AIH should be administered exclusively in combination with rabies vaccine, the first administration of which is carried out no more than 30 minutes after administration of AIH in a dose of 1 ml. The treatment regimen for AIH and rabies vaccine is shown in Table 1.

AIH is administered at a dose of 40 IU per 1 kg of body weight of an adult or child. The volume of administered AIH should not exceed 20 ml.

Example: the victim’s body weight is 60 kg; AIH activity (indicated on ampoules and packs of the drug), for example, 200 IU in 1 ml. In order to determine the dose of AIH required for administration, you need to multiply the weight of the victim (60 kg) by 40 IU and divide the resulting number by the activity of the drug (200 IU), that is:

Before administering AIH, to identify sensitivity to a foreign protein, an intradermal test with anti-rabies immunoglobulin diluted 1:100 (ampoules are marked in red), which is located in a box with undiluted drug (ampoules are marked in blue), is mandatory.

Immunoglobulin diluted 1:100 is injected in a volume of 0.1 ml intradermally into the flexor surface of the forearm.

The test is considered negative if after 20-30 minutes there is no swelling or redness at the injection site or less than 1 cm. The test is considered positive if swelling or redness reaches 1 cm or more.

If the reaction is negative, 0.7 ml of rabies immunoglobulin diluted 1:100 is injected subcutaneously into the shoulder area. If there is no reaction, after 30 minutes, the entire calculated dose of AIH, heated to (37±0.5) °C, is administered in 3 divided doses with an interval of 10-15 minutes, taking the drug for each portion from previously unopened ampoules.

The calculated dose of AIH should be infiltrated around the wounds and deep into the wound. If the anatomical location of the injury (fingertips, etc.) does not allow the entire dose to be administered around the wounds, then the remainder of the AIH is injected intramuscularly into a location other than. vaccine administration (buttock muscles, upper outer thigh, shoulder).

Administration of AIH and rabies vaccine should not be administered to the same shoulder.

The entire dose of AIH is administered within one hour.

The most effective administration of the drug is on the first day after injury, but no later than three days.

If the intradermal test is positive (swelling or redness of 1 cm or more) or in the event of an allergic reaction to the subcutaneous injection, AIH is administered with special precautions. First, it is recommended to inject immunoglobulin diluted 1:100 into the subcutaneous tissue of the shoulder in doses of 0.5 ml, 2.0 ml, 5.0 ml with an interval of 15-20 minutes, then inject 0.1 ml of undiluted immunoglobulin and after 30-60 minutes inject intramuscularly the entire prescribed dose of the drug, heated to (37±0.5) °C, divided into 3 doses with an interval of 10-15 minutes. Before the first injection, parenteral administration of antihistamines (suprastin, diphenhydramine, etc.) is recommended. In order to prevent shock simultaneously with the administration of AIH, subcutaneous administration of a 0.1% solution of adrenaline or a 5% solution of ephedrine in an age-specific dosage is recommended.

When administering AIH, solutions of adrenaline, ephedrine, diphenhydramine or suprastin should always be ready.

After the administration of AIH, the patient must be under medical supervision for at least 1 hour. The first vaccination with rabies vaccine is carried out on the day of administration of AIH after the administration of the last one. The vaccination performed is recorded in the established registration forms, indicating the dose, date, manufacturer of the drug, batch number, reaction to administration.

Table 1. Scheme of therapeutic and prophylactic vaccinations with rabies vaccine (AV) and rabies immunoglobulin (RAI)

	Nature of contact	Animal details
	There is no damage to the skin, no salivation of the skin or mucous membranes.	Sick with rabies.	Not assigned.
	Salivation of intact skin, abrasions, scratches, single superficial bites of the torso, upper and lower extremities (except for bites of dangerous localization: head, face, neck, hand, fingers and toes), inflicted by domestic and farm animals	If within 10 days of observation of the animal it remains healthy, then treatment is stopped (i.e. after the 3rd injection). If the absence of rabies in an animal is laboratory proven, then treatment is stopped from the moment the absence of rabies is established. In all other cases, when it is impossible to monitor the animal for 10 days (killed, died, ran away, etc.), continue treatment according to the specified scheme.	Start treatment immediately: AB 1.0 ml on days 0.3, 7, 14, 30, 90.
	Any drooling of the mucous membranes, any bites of the head, face, neck, hand, fingers and toes, genitals; single or multiple deep lacerations caused by domestic and farm animals. Any salivation and damage caused by wild carnivores, bats and rodents.	If it is possible to monitor the animal and it remains healthy for 10 days, then treatment is stopped (i.e. after the 3rd injection). If the absence of rabies in an animal is laboratory proven, then treatment is stopped from the moment establishing the absence of rabies. In all other cases, when it is impossible to monitor the animal, continue treatment according to the specified regimen.	Start immediately combined treatment with rabies immunoglobulin: AIH on day 0 and rabies vaccine: AB 1.0 ml on days 0, 3, 7, 14,30 and 90.

Side effects

The administration of AIH may be accompanied by the development of allergic reactions, including anaphylactic shock and serum sickness, and therefore vaccination sites must be equipped with anti-shock therapy.

Interaction:

It is possible to administer it on the same day as emergency tetanus prophylaxis, with AIH administered before antitetanus serum. Compatible with antibiotics The use of immunosuppressive drugs during the subsequent course of vaccination is permissible for health reasons.

special instructions

The drug should not be administered after the start of a course of rabies vaccine. In case of hypersensitivity to heterologous immunoglobulins and serums (history), antihistamines should be prescribed orally in an age-appropriate dosage 2 times a day for 7-10 days (careful monitoring of the patient is necessary). Intravenous administration of AIH is contraindicated (due to the risk of shock), so when injecting, you must make sure that the needle does not penetrate a blood vessel.

To avoid possible interactions between several different drugs, you should tell your doctor about any other therapy you are taking.

To a victim who, for some reason, has received anti-tetanus serum within the previous 24 hours, AIH is administered without prior intradermal testing.

Release form

Rabies immunoglobulin - 3 ml, 5 ml or 10 ml in an ampoule.

Rabies immunoglobulin diluted 1:100 - 1 ml per ampoule.

Available as a set: 1 ampoule of immunoglobulin and 1 ampoule of immunoglobulin diluted 1:100.

5 sets are packed in a pack of cardboard for consumer packaging. The pack contains instructions for use and an ampoule knife or ceramic ampoule knife.

Storage conditions

Storage - at temperatures from 2 to. 8°C in a place inaccessible to showers of children. Do not freeze.

Transportation - at temperatures from 2 to 8°C. Do not freeze.

Best before date

2 years. A drug that has expired cannot be used.

Conditions for dispensing from pharmacies

For medical and preventive institutions.

P N016002/01 dated 2015-12-18
Rabies immunoglobulin from horse blood serum liquid - instructions for medical use - RU No.

Rabies immunoglobulin from blood serum

human 150 IU/ml

Unit of measurement: fl.
Country: China
Manufacturer: FC Sichuan Yuanda Shuyang LLC
Release form: 2 ml bottle

Instructions for the use of rabies immunoglobulin from human blood serum,

injection solution 150 IU/ml Registration number: LSR-010494/08-241208.

GROUP NAME Anti-rabies immunoglobulin. Rabies immunoglobulin

from human blood serum, solution for injection, is a concentrated

solution of purified gamma globulin fraction of human blood serum isolated by the method

Cold extraction with ethanol and subjected to a process of ultrafiltration, purification and viral

Inactivation at a pH value of 4.0 and a temperature of 23-25 ​​° C for 21 days.

COMPOSITION (per 1 ml) Specific antibodies to the rabies virus, not less than 150 IU; stabilizer glycine (glycocol)

from 20 to 25 mg; sodium chloride 7 mg; water for injections. The drug does not contain antibiotics. HBsAg,

antibodies to HIV-1, HIV-2 and hepatitis C virus are absent.

DESCRIPTION Transparent or slightly opalescent liquid, colorless or light yellow.

IMMUNOLOGICAL PROPERTIES The drug contains specific antibodies that can

neutralize the rabies virus.

PHARMACOKINETICS The maximum concentration of antibodies is achieved 2-3 days after

intramuscular injection of antirabic immunoglobulin. Antibody half-life

is from 3 to 4 weeks.

PURPOSE Used in combination with rabies vaccine to prevent the disease

people with hydrophobia with severe multiple bites from rabies or suspected rabies

animals. In case of repeated multiple bites by a patient with rabies or suspected of rabies

Anti-rabies immunoglobulin is not prescribed to animals if the victim received

DOSAGE AND ADMINISTRATION Immediately or as soon as possible after the bite or injury

carry out mandatory local treatment of the wound. Wounds are washed generously with soap and water or any

Detergent and treated with 40-70% alcohol or tincture of iodine. In cases where there is evidence,

surgical treatment of the wound is performed. After local treatment of the wound,

specific treatment. Before injection, check the integrity of the bottle and the presence of markings on it.

The drug is unsuitable for use in bottles with damaged integrity, markings, or when

changing it physical properties(color, transparency, etc.), when the expiration date has expired, when

Storage violations. The opening of the bottles and the procedure for administering the drug are carried out

With strict adherence to the rules of asepsis and antiseptics. Performing a skin test before administration

not required. The drug is administered as much as possible early dates after treatment once in a dose

20 IU/kg body weight of an adult or child. An example of calculating the dose of immunoglobulin Body weight

victim - 60 kg. For example, the actual activity of the immunoglobulin of a given series, indicated

on the bottle label or on the packaging is 200 IU/ml. In order to determine the required

To administer a dose of immunoglobulin in ml, you need to multiply the weight of the victim (60 kg) by 20 IU and

divide the resulting number by the activity of the drug (200 IU/ml), i.e.: 60x20/200 = 6 ml How can

the majority of the calculated dose should be infiltrated around the wound if possible

anatomically. The rest should be injected intramuscularly into the external superior gluteal

area for adults, or in the anterolateral area of ​​the thigh for children. In children (especially those who have

multiple wounds) a dose of anti-rabies immunoglobulin from human blood serum can

be diluted 2-3 times with 0.9% sodium chloride solution for injection to a volume that provides

complete infiltration of the affected areas of the body. Administration of rabies immunoglobulin from

human blood serum should be carried out 10-15 minutes before the rabies vaccine.

The sequence of administration of anti-rabies drugs must be strictly observed.

In cases where the victim seeks anti-rabies help late, anti-rabies

immunoglobulin from human blood serum can be administered no later than 7 days after contact

with an animal suffering from rabies or an animal suspected of rabies. Introduction of anti-rabies

Immunoglobulin in more late dates, and also after the administration of rabies vaccine is not allowed.

The dosage of immunoglobulin should not be exceeded under any circumstances, since the administration

An increased dose of immunoglobulin may partially suppress the production of antibodies. Immunoglobulin

Rabies and rabies vaccines should be administered to different areas of the body using

various syringes. If emergency tetanus prophylaxis is necessary, this is carried out

after the administration of rabies immunoglobulin and the first vaccination of rabies vaccine.

INTERACTIONS WITH DRUGS Administration of rabies immunoglobulin may

be carried out simultaneously with emergency tetanus prophylaxis. Introduction of others

combined anti-rabies treatment.

CONTRAINDICATIONS Since immunoglobulin from human blood serum is used for vital

(vital) indications, there are no contraindications to its use.

Persons with hypersensitivity to human blood preparations and pregnant women

Rabies immunoglobulin is a drug that is used to immunize the population against rabies.

About the drug

At its core, this drug is a solution of purified and concentrated gamma globulin fraction of serum. It is released from the blood. The cold ethanol extraction method is used. After this, so-called ultrafiltration is carried out, cleaning from viruses occurs. The drug contains special substances that can fight the common rabies virus, if such activity occurs.

After consuming immunoglobulin for approximately two to three days, highest level antibodies in the blood. Administration should be intramuscular. The half-life of antibodies is approximately a month or a slightly shorter period of time, depending on the characteristic nuances of the individual organism.

A little more valuable information about immunoglobulin:

Release form

The drug is traditionally available in the form of a solution intended for injection. It is predominantly transparent, although it can be slightly opalescent. It is packaged in bottles - 1, 2 or 5 ml.

Indications

The described drug is used in traditional combination with an anti-rabies vaccine, so that people who have been bitten by animals with rabies or, alternatively, with suspected rabies do not develop hydrophobia. If repeated bites occur, there is no need to re-administer the drug if the first treatment was successful. The rabies vaccine, which is used in combination therapy, should be reintroduced.

Contraindications

The drug in question has no significant contraindications; it can be administered to almost everyone. But if a person has a special sensitivity to human blood products, and also if the woman is pregnant, then the drug should be administered in a hospital, under the supervision of exclusively qualified doctors who can take prompt measures if necessary. But this does not mean that these people are prohibited from doing this medicine basically.

Side effects

Sometimes rabies immunoglobulin can cause certain side effects, but, however, not for all people. Often on the first day, hyperemia and swelling may appear. Sometimes body temperature rises. In very rare cases, a severe allergic reaction may occur, in particular:

• anaphylactic shock;
• hives;
• Quincke's edema.

To minimize problems from side effects, it is necessary to remain under the supervision of a specialist for at least half an hour after administering the drug. Then the risk that any, even minimal complications will develop will be almost zero.

Application

The instructions for using the drug are not very complicated, but a number of subtleties must be taken into account. After a bite, you must first wash the surface of the wound. It is best to treat the wound with iodine solution or alcohol. If necessary, surgical treatment may be performed, depending on the severity of the bite. Next, you need to check the vial in which the vaccine is located for integrity, whether it is damaged, or whether the markings are missing.

The drug must be administered as quickly as possible after receiving the wound. The maximum you can wait if an animal has rabies, or there is the slightest suspicion of it, is seven days, no more. The dose is 20 IU per kilogram of a person’s weight, and it does not matter whether we are talking about a child or an adult. It is better to have a qualified doctor calculate the dose. Most of the dose is infiltrated both around the wound and into its depth. The rest must be administered to the person intramuscularly. If we are talking about an adult, what needs to be injected into the buttocks, a child can be injected into the thigh.

If a child has multiple wounds, you can dilute the drug with a solution of sodium chloride until the volume is reached at which the most complete infiltration of the wounds can be achieved.

Sometimes there is a need for combined treatment. Then this drug must be administered first, only then another rabies vaccine is introduced. On the contrary, you cannot do it, as the instructions say, otherwise there may be negative consequences. Moreover, these substances must be administered to different types of locations in the body.

Overdose

There is no information about the negative effects of an overdose of the drug, but another consequence can occur, which is also not very pleasant - partial suppression of antibody production in case of a noticeable excess of the dose. So you must try to comply with it.

Conclusion

When bitten by an animal that causes even the slightest suspicion of rabies, this drug is necessary. Moreover, it is very safe.

Side effects of rabies vaccination in humans Vaccination against rabies in humans prevents death

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Rabies vaccination preparations.

What is the choice of drugs based on?

For rabies vaccinations (rabies immunization), two drugs are used:

These drugs have different principles of action.

The rabies vaccine by itself is unable to kill the virus. The task of the vaccine is to provide the body with antigenic information about the virus. The immune system is provided with a non-living model of a real virus for familiarization, devoid of harmful force, but retaining its identifying marks - antigens.

By reading and remembering information about these identification marks, the immune system acquires the ability to produce specific proteins - antibodies. Antibodies recognize the virus by familiar antigens and neutralize it. With the help of a vaccine, so-called “active immunity” is acquired for a period of at least 1 year.

However, this process takes approximately two weeks. All this time, the body remains defenseless against the virus.

What to do? Provide temporary “crutches” - introduce ready-made antibodies.

Where can I get them from? In another organism. The drug containing concentrated antibodies is called “immunoglobulin” (the previously used drug, not purified from foreign protein fractions, was called “serum”). Immunoglobulin is obtained from donor blood. The donor can be a person (homologous immunoglobulin) or an animal, in practice a horse (heterologous immunoglobulin). To ensure that the donor has enough antibodies, he is pre-immunized with an anti-rabies vaccine. Human immunoglobulin is more effective than horse immunoglobulin, which is why the dose is administered at 2 times less. Plus it's safer.

Immunoglobulin, like any protein molecule, itself contains antigens. The more foreign the injected protein is, the more hostile the immune system perceives it. Within a few weeks after administration, immunoglobulin is completely destroyed in the body. This type of immunity is called "passive".

Thus, immunoglobulin provides passive immunity immediately, but for a short time, and the vaccine provides active immunity after two to three weeks, for a long time.

The choice of drugs mainly depends on the expected duration of the incubation period. Its duration is influenced primarily by the location of the bite, as well as the number, depth and extent of the bites.

If there is confidence that vaccinations will have time to create sufficient immunity before the onset of the disease (light bites), vaccinations are given

If it is impossible to wait until active immunity appears (severe and moderate bites, as well as delayed - more than 10 days - treatment for bites of any severity inflicted by an unknown or suspected animal with rabies), a combined course of treatment is carried out - in addition to the vaccine, they also administer

Rabies vaccine.

The first rabies vaccine was proposed in 1885 by Louis Pasteur. He obtained a weakened (called "fixed") strain of the virus by 90 successive passages of the virus through the brain of a rabbit. The Pasteur strain was provided different countries for the production of vaccines. Since then, a large number of vaccines have been developed. For a long time, live vaccines were used (containing live viruses of a fixed strain).

For rabies vaccinations, inactivated (i.e. containing a killed virus) vaccines, produced “in vitro” on tissue cultures, are now used.

Doses and vaccination schedules are the same for children and adults.

After the vaccine has dissolved, it should be used within no more than 5 minutes. The vaccine is administered intramuscularly into the deltoid muscle of the shoulder, and for children under 5 years old - into the upper part of the anterolateral surface of the thigh. Injection of the vaccine into the gluteal region is unacceptable.

The vaccinated person must be under medical supervision for at least 30 minutes.

Indications for vaccine administration:

Preventive immunization - people at high risk are vaccinated “just in case and in advance” - hunters, veterinarians, gamekeepers, employees of laboratories working with the “wild” rabies virus, etc.

Contraindications for preventive immunization:

1. acute infectious and non-infectious diseases, chronic diseases in the acute or decompensation stage - vaccinations are carried out no earlier than one month after recovery (remission)
2. local and systemic allergic reactions to the previous administration of the vaccine (generalized rash, angioedema, etc.)
3. pregnancy

• Therapeutic and preventive immunization - carried out in connection with an already existing bite

  There are no contraindications in this case.

Side effects of the vaccine:

• local reactions - short-term swelling, redness, swelling, itching, hardening at the injection site
• general reactions - moderate fever, tremors in the limbs, weakness, dizziness, headache, arthralgia (joint pain), myalgia (muscle pain), gastroenterological disorders (abdominal pain, vomiting)
• possible development of immediate allergic reactions (urticaria, Quincke's edema)

Anti-rabies immunoglobulin.

Anti-rabies immunoglobulin is indicated for a combined course of immunization against rabies together with an anti-rabies vaccine:

• in case of delayed treatment (more than 10 days) for bites of any severity inflicted by an unknown or suspected rabid animal

Two types of immunoglobulin are used:

• heterologous (equine) immunoglobulin
• homologous (human) immunoglobulin obtained from donor blood.

Homologous (human) rabies immunoglobulin is prescribed at a dose of 20 MO per 1 kg of body weight.
heterologous (equine) rabies immunoglobulin is prescribed at a dose of 40 MO per 1 kg of body weight.

Example: the patient’s body weight is 60 kg, the immunoglobulin activity is indicated on the package (for example, 200 IU in 1 ml)
60*40/200 = 12 ml should be administered to this patient after determining sensitivity to a foreign protein.

As much of the calculated dose as possible should be infiltrated near the wound and into the depth of the wound. If the anatomical location (fingertips, etc.) does not allow the entire dose of rabies immunoglobulin to be administered into the tissue near the wound, then the remainder is injected intramuscularly (into the upper thigh or into the deltoid muscle, on the side of the body opposite to the site of vaccine administration).

Administration of rabies immunoglobulin is most effective on the first day after the bite. The entire dose of the drug is administered in one day. Only in case of particularly wide and multiple bites inflicted by a rabid wolf or other carnivore, the administration of rabies immunoglobulin can be repeated, in the same dose, after which a course of vaccination is carried out with the obligatory administration of an additional dose of the vaccine on the 60th day from the start of treatment (see) .

Test for sensitivity to foreign protein.

20 minutes before the drug is administered, foreign protein sensitivity test- 0.1 ml of diluted (1:100) immunoglobulin is injected intradermally into the anterior surface of the forearm. An ampoule with diluted (1:100) immunoglobulin is attached to each dose of undiluted drug and is in the same package.

Diluted (1:100) immunoglobulin in a dose of 0.1 ml is injected intradermally into the anterior surface of the forearm.
after 20 minutes - sample evaluation ⇓
The test is negative if swelling or redness at the site of immunoglobulin injection does not exceed 1 cm The test is positive if there is swelling or redness of 1 cm or more at the site of immunoglobulin administration, or there is an allergic reaction
the test is negative ⇓		the test is positive ⇓
0.7 ml of diluted (1:100) immunoglobulin is injected subcutaneously to identify general sensitivity to a foreign protein.	if general reactions occur after 30 minutes ⇒	Injected diluted immunoglobulin (1:100) in doses of 0.5 ml, 2.0 ml, 5.0 ml is injected at intervals of 20 minutes into the subcutaneous tissue of the shoulder
in the absence of general reactions after 30 minutes ⇓		in 20 minutes ⇓
		0.1 ml of undiluted immunoglobulin is injected subcutaneously
		in 30-60 minutes ⇓
		Before the first injection of immunoglobulin, antihistamines (diphenhydramine, suprastin, etc.) are prescribed and are recommended to be taken orally for 10 days. In order to prevent shock, subcutaneous administration of a 0.1% solution of adrenaline or a 5% solution of ephedrine in an age-related dose is recommended.
		⇓
The entire dose of immunoglobulin, heated to 37°C, is administered in fractional doses (in 3 doses at intervals of 15 minutes), taking the drug for each portion from an unopened ampoule. The entire dose should be infiltrated around the wound and into its depth. If anatomical damage precludes this (fingertips, etc.), then the drug can be administered intramuscularly to other places (muscles of the buttock, thigh, shoulder, etc.). The entire dose is administered within an hour.