Vaccin de la rage
Rabies is a serious viral disease affecting mammals, including humans. It is caused by a virus causing encephalitis. Zoonosis fairly common, it affects primarily carnivores. The symptoms are nervous and sometimes aggressive although there are also more primitive forms where the patient is particularly quiet. In Europe, rabies has been effectively eliminated in some countries by distributing baits vaccinating dispersed in nature.
Between 40,000 and 70,000 people die of rabies each year in countries of Africa and Asia where the disease is endemic.
CLINICAL
RABIES VACCINE PASTEUR is indicated for the prevention of rabies in children and adults. It can be used before and after exposure, or priming rappel.Prévention of rabies pre-exposure (pre-exposure vaccination) The pre-exposure vaccination should be offered in subjects at high risk of infection with rabies virus .Everyone at constant risk, such as diagnostic laboratory personnel, research or production work on rabies virus should be vaccinated. Serologic testing is recommended every six months (see section 4.4). The pre-exposure vaccination should be considered in individuals at risk of frequent exposure rabies · veterinarians and their assistants, animal caretakers. · The people in contact with their professional or leisure, with species such as dogs, cats, skunks, raccoons, bats and other species that may have rabies. For example, game wardens, hunters, forestry workers and cavers, taxidermists. · Adults and children residing or staying in endemic areas. Serologic testing can be performed every 2 to 3 years for subjects subjected to intermittent exposure.In areas of low rabies enzootic, veterinarians and assistants (including students), Animal and Nature Reserve staff (game wardens) are considered subject to occasional risk of exposure and are primed to receive rabies . serological checks of rabies antibodies should be performed at regular intervals depending on the risk posed by each sujet.Les booster injections will be administered based systematic risk of the subject. The frequency of administration of booster doses is described in section 4.2.Prévention of rabies after exposure (post-exposure vaccination): At the slightest risk of contamination rabies post-exposure vaccination should be done as soon as possible.Dans some countries, vaccination should be performed in a center spécialisé.Le rabies post-exposure treatment includes topical treatment of nonspecific injury, passive immunization with rabies immunoglobulins (RIG) and vaccination according to the nature of the injury and the state of the animal (see Tables 1 and 2). Table 1:To behave according to the state of the animal
(A) In France, the veterinary surveillance has 3 certificates issued on D0, D7, D14 and declaring the absence of signs of rabies. According to WHO recommendations, the minimum duration of observation of veterinary surveillance for dogs and cats is 10 days. (B) The treatment is recommended depending on the severity of the injury: see dessousTableau 2: WHO guide treatment after exposure depending on the severity of the injury
(A) A contact with rodents, rabbits, and hares almost never require for rabies treatment specific. (B) Stop treatment if the animal is healthy after 10 days of observation (for cats and dogs) or after euthanasia, the search for rabies by appropriate laboratory techniques is negative.
RABIES PosologieVACCIN PASTEUR can be administered to adults and children, using the same dosage.The vaccination should be adapted to the circumstances of vaccination and in the condition the immunity of rabies vaccination and pre-sujet.4.2.1 expositionTrois doses of rabies vaccine Pasteur (0.5 ml) are administered on D0, D7 and D28 or J21.Rappel after vaccination pre-expositionUne booster injection of rabies vaccine Pasteur (0.5 ml) will be given one year after primary vaccination, followed by a booster every five years (Table 3). Table 3: Recommendations for priming and recall
* The injection of D28 can be administered to J21.VACCIN RABIES PASTEUR may be administered as a booster after primary immunization with rabies cell culture vaccine (rabies vaccine prepared on Vero cells or human diploid cell (HDCV)). 4.2.2 Post-exposure Vaccination: First Aid: blessureToutes local treatment of bites and scratches should be washed immediately with plenty of water with soap or detergent. This can eliminate effectively the rabies virus at the infection site.A solution of 70% alcohol, tincture (or solution) of iodine, or 0.1% solution of quaternary ammonium can then be applied (provided that no more traces of soap because these two products are neutralized). Depending on the severity of injuries, if rabies immunoglobulin (RIG) should be administered in combination with the vaccine, refer to the conditions of use of the record of IGR.Si necessary, treatment will be completed by the administration of tetanus prophylaxis and / or completely antibiothérapie.Sujets immunisésDeux booster doses of rabies vaccine Pasteur (0.5 ml) are administered on days 0 and J3.L administration of rabies immunoglobulin ( RMI) is not necessary and should not be done in this case, the booster is always followed by a response anamnestique.Les subjects previously immunized should be able to document: • a comprehensive rabies vaccination before or after exposure, a cell culture vaccine or · a documented rabies antibody titer ≥ 0.5 IU / ml.In case of doubt or if the recall goes back more than 5 years if vaccination is incomplete, the patient should not be considered fully immunized, and comprehensive treatment of post-exposure must be instauré.Tableau 4: Recommendations for Post-exposure rabies vaccination in accordance with previous injections
Unimmunized subjects: Five doses of rabies vaccine Pasteur (0.5 ml) are administered on D0, D3, D7, D14 and rabies immunoglobulin J28.Des (RMI) should be administered at the same time as the first injection in case of serious injury ( category III according to the WHO classification of risk of rabies). Equine and human immunoglobulin can be used with RABIES VACCINE PASTEUR.La dosage of RMI is recognized internationally as follows: human rabies immunoglobulin 20 IU / kg equine rabies corporelImmunoglobulines: 40 IU / kg body weight is likely to RMI inhibit partially active production of antibodies, the dose should not exceed the dose recommandée.Le vaccine will be injected contralateral side to the sites of administration RMI.In geographic areas endemic for rabies, the administration of two injections of vaccine at day 0 may be justified, for example, when the lesions are very severe or localized in the vicinity of the nervous system, in case of immunodeficiency of the subject, or when a delay between exposure and consultation of médicale.Mode administrationVACCIN RABIES PASTEUR is administered only intramuscularly in the deltoid in adults or the anterolateral thigh in small children (see also sections 4.4 and 6.6)
4.3.1 Pre-expositionContre-usual indications of any vaccine: in case of fever or acute illness différée.Hypersensibilité vaccination should be known to the active substance, any excipients, polymyxin B, streptomycin, or néomycine.Dans all cases, the risk / benefit ratio must be évalué.4.3.2 Post expositionEn due to changes always fatal rabies infection, there are no cons-indication to vaccination post exposure.
The recommendations relating to the scheme of administration should be scrupulously followed. Particularly in post-exposure, it is imperative to administer treatment according to the state of the animal, the circumstances of contact and the nature of the wound (see section 4.2) As with all injectable vaccines, it is recommended to have a proper medical treatment for the management of a possible anaphylactic reaction immediately after injection of the vaccine, especially in cases of post-exposure in patients with known hypersensitivity to polymyxin B, streptomycin , or néomycine.Ne not inject intravascularly. Make sure the needle does not penetrate a blood vessel before injecting the vaccin.VACCIN RABIES PASTEUR should not be administered subcutaneously. RABIES VACCINE PASTEUR should not be injected into the gluteal region, because of lower titers of neutralizing antibodies were observed by this voie.Des regular serological testing are needed.These serological tests are carried out by checking the complete neutralization of a virus test by RFFIT (Rapid Fluorescent Focus Inhibition Test). This test should be performed every 6 months in people exposed to a constant risk, and every 2 to 3 years after each recall in subjects subjected to intermittent exposure. If the antibody level is below the title considered protective, 0.5 IU / ml (RFFIT), a booster injection must be administrée.Lorsque the vaccine is administered to subjects with known immunodeficiency due to disease or immunosuppressive to concomitant immunosuppressive therapy (including corticosteroids), serological testing their antibody levels should be measured 2 to 4 weeks after vaccination. If the antibody level is below the title considered protective, 0.5 IU / ml (RFFIT), an additional injection should be administered.The potential risk of apnea and the need for respiratory monitoring for 48-72 h must be carefully taken into account when administering the primary immunization series to very premature infants (born at 28 weeks of gestation) and particularly for those with history of respiratory immaturity. Due to the high profit of vaccination in these infants, the administration should not be suspended or postponed.
Corticosteroids and other immunosuppressive therapies may interfere with antibody production and defeat the vaccination, see 4.4.Les immunoglobulin should be administered at a site different from the vaccine (the contralateral side), see section 6.2
There are no reliable data on teratogenic in animals. Clinically, the use of the vaccine in a limited number of pregnancies has apparently revealed no toxic or fetotoxic particular date. However, further studies are needed to assess the consequences of exposure during pregnancy.Due to the severity of the disease, the conduct of the vaccination should not be altered by pregnancy.
Local reactions and mild pain, erythema and edema, pruritus, and induration at the injection site. Reactions: fever, chills, malaise, asthenia, headache, dizziness, arthralgia, myalgia, gastrointestinal disturbances (nausea, abdominal pain) . Exceptionally: anaphylactoid reactions, urticaria, rash.Apnée in very premature infants (born at 28 weeks of gestation) (see section 4.4).
Prevention and Treatment
Rabies Prevention
French as a global level, it is the eradication of rabies. In France, sylvatic rabies has been eradicated, it goes through the vaccination of pets and people potentially exposed to rabies (bat, veterinary ,…), and a monitoring plan for this disease national level.
Treatment of rabies
Rabies is a disease almost always fatal in humans so when it’s first signs.Cases of survival are quite exceptional, however, rabies vaccination performed between infection and the onset of signs is very effective. The vaccine was tested in 1885 by Louis Pasteur on Joseph Meister, a boy bitten by a rabid dog on the way to school Meissengott in Alsace. The dog’s owner, Theodore Vonne, had then shot the beast and then led the child to the doctor Weber Villé.
However in late 2004, in Wauwatosa, Wis., an experimental treatment has saved a young girl without vaccination American named Jeanna Giese, contaminated by a bat. Treatment, since known as the Milwaukee protocol, is to immerse the patient in a medically induced coma to slow the progression of the disease and to administer intensive medical treatment. Two other patients were able to be treated.In an article published in 2009, it was identified 25 attempts to apply this treatment (known as the Milwaukee Protocol) in its first version with a survival rate of 8% (2 out of 25), and 10 in its second version with 2 survivors, 20%. However, there is no animal model demonstrating the effectiveness of this method.
In areas where vampire bats are carriers of rabies is endemic (South America), it is recommended to protect against bites from bats during the night. Thus, travelers in the forest sleeping under a mosquito net even in the absence of mosquitoes. The screen should be positioned sufficiently large to make it impossible for a bat to bite the person through the net.
It is recommended not to handle bats found injured or approaching abnormally homes. Anyone bitten or scratched should immediately notify her doctor. The wound should be washed with soap and water.
Preventive treatment
A preventive vaccine against rabies exists.It is inoculated persons whose activity is a risk factor for infection. Veterinarians or people traveling to countries like India are examples. It preventive vaccine does not provide a curative vaccine.
Curative vaccination
It can prevent the disease if done before the first signs appear, that is to say during the incubation period, applying a curative vaccination. This idea due to Galtier was applied for the first time by Louis Pasteur in 1885.
Between when the virus enters the body (most commonly through bites, but sometimes also by licking a wound or scratch) and when the disease occurs, it usually takes between two and eight weeks leaving a reaction time. In fact, the incubation period depends on the dose of virus inoculated, the location of the bite (the closer it is an area rich in nerve endings, the sooner the disease is present) and the severity of the wound .
It has long been prepared vaccines against rabies from nervous tissue, but in 1991, the Treaty of GM Baer reserved the place of choice, first vaccines obtained by culture on embryos of ducks (PDEV ‘Purified duck embryo vaccine ‘) and the other three types of vaccines prepared on cell culture:
Action to be taken in respect of the dog biting
It is very important to know that a dog ‘biter’ infected with rabies can spread the virus before the onset of symptoms. It is therefore necessary to keep him under observation for at least fifteen days. Impounded, the dog must be fed and watered. If the dog is rabid, it will die within ten days after the first symptoms. Any dog which bites a person, even if no signs of rabies, should be placed under observation (three veterinary examinations within fifteen days after the bite). During this observation period, if the signs of the disease appear, the rapid evolution of the fatal character of evil can establish the diagnosis.
Do not sacrifice a dog ‘biting’ as it is often tempted to do so. This could prohibit whether it was rabid. If the biting dog is dead, you should contact the departmental (in France) veterinary services which will decide whether to perform laboratory analysis on the brain of the dog.
Indeed, the testing for the virus can not distinguish between antibodies from the virus, and antibodies due to the vaccine. In France, two tests are used in research of rabies virus: immunofluorescence and inoculation of cell cultures. Both techniques are used to see if the virus reaches the brain, but usually do not deny or confirm the contamination of the subject, the animal is generally sacrificed too early.
Since 1998, 9 cases were positive, but not the virus has been confirmed in animals euthanized contacts as a precaution, nor among those suites euthanized animal health measures applied in the case of suspected rabies cases.
Action to be taken in respect of the person bitten
When symptoms of rabies occur in humans it is too late to intervene: death is a near certainty, the only way out. Therefore it should follow the following recommendations:
When a person is bitten or very deeply, or in many parts of the body or face or head or neck, or fingers, it must undergo rabies treatment as soon as possible even if dog biting does not show signs of rabies and even though it has not been in contact with a rabid dog. The bitten person should wash the wound with soap and water then disinfect the wound with antiseptic and immediately consult a health center to be administered the serum anti-tetanus and rabies vaccine.
Accidents vaccine
Neurological accidents caused by rabies vaccine have been reported even in the time of Pasteur by Mr. Lutaud particular and later by Paul Remlinger, who spoke of ‘laboratory rabies’.Long remained unexplained, these accidents have been attributed to the presence of active virus in inactivated rabies vaccine imperfectly (and in Fortaleza, Brazil). Until the 1960s, the myelin is still present in the vaccine could also cause allergic encephalitis.
Notifiable
Belgium, France and Switzerland, this disease is on the list of notifiable infectious diseases.
Description of virus
Rabies is caused by a virus of the family Rhabdoviridae and the genus Lyssavirus, which was identified in 1903 by Paul Remlinger. They are enveloped viruses, their genome is an RNA molecule of negative polarity of helical shape. As such, they are highly sensitive to physical and chemical agents for disinfection and therefore lower resistance in the external environment.
The rabies virus infects all mammals. He has a tropism nervous, especially the central nervous system, which explains the observed disorders.
RABIES VACCINATION
The vaccination should be performed in the tourists’ adventurous ‘who travel to endemic countries (countries where rabies occurs), particularly in Africa, South America and Asia.
The new vaccine, well tolerated and very effective, justifies its use in these cases.
The vaccination schedule:
– An injection on D0,
– A second injection at D28
– Recall a year later
– Then booster every 3 years.
The injection is done by intramuscular in the deltoid (shoulder).
Of course, this vaccination is recommended for game wardens, veterinarians, foresters, laboratory workers, especially in areas where rabies is rampant.
This vaccination is a definite step forward for rabies kills 25,000 people a year worldwide.
Remember that even vaccinated, anyone bitten by a suspect animal, especially in tropical areas, will suffer the earliest possible date a booster.
If confirmation of rage biting animal is made, is that multiple booster doses will be administered.
In conclusion, to travel in tropical countries, in addition to vaccination against yellow Fieve, tetanus, typhoid, hepatitis B, polio, rabies vaccination is becoming increasingly necessary, especially for the ‘adventurers’.