Rabies is a fatal disease in humans, and, to date, the only survivors of the disease have received rabies vaccine before the onset of illness. The approach to management of the rabies normally should be palliative. In unusual circumstances, a decision may be made to use an aggressive approach to therapy for patients who present at an early stage of clinical disease. No single therapeutic agent is likely to be effective, but a combination of specific therapies could be considered, including rabies vaccine, rabies immunoglobulin, monoclonal antibodies, ribavirin, interferon-alpha, and ketamine. Corticosteroids should not be used. As research advances, new agents may become available in the future for the treatment of human rabies. (+info)
Prophylactic immunization of humans against rabies by intradermal inoculation of human diploid cell culture vaccine.
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The antirabies human diploid cell vaccine produced by 1'Institute Merieux, Lyon, France, was administered intradermally to 35 high-risk volunteers using 0.2-ml amounts and various immunization schedules. Three groups never before vaccinated against rabies developed virus-neutralizing antibodies, the titer of which was dose dependent. A single injection stimulated the formation of antibodies. Four inoculations induced the highest antibody levels and the longest persistence of antibody. The administration of a single intradermal booster inoculation was sufficient, even in the case of low-persisting antibody, to elicit a rapid increase of antibodies to high levels. A primary inoculation course of two injections induced a sufficient antibody level which, in case of exposure, could apparently be rapidly elevated by a 0.2-ml intradermal booster inoculation. Adverse side reactions were observed in 7 of 14 individuals after a 1- or 1.5-year intradermal booster inoculation. We therefore suggest that the intramuscular and subcutaneous routes continue to be used for primary vaccinations and that the highly effective intradermal route be restricted to booster inoculations. This is the first long term study of this vaccine and should be a guideline for the pre-exposure treatment of high-risk personnel. (+info)
T helper cell-independent antibody responses to the transgene product of an e1-deleted adenoviral vaccine require NK1.1 T cells.
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Mice lacking CD4(+) T cells due to a knock-out mutation respond to vaccination with a replication-defective adenoviral recombinant expressing the glycoprotein of rabies virus with a long-lasting virus-neutralizing antibody response. The vaccine-induced B cells secrete antibodies that are mainly of IgG isotypes. The response can be enhanced upon booster immunization, indicating the induction of B cell memory in the absence of CD4(+) T cells. The antibody response is independent of CD8(+) T cells but requires the presence of CD3(+) cells carrying the NK1.1 markers. (+info)
Compendium of animal rabies prevention and control, 2003.
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Rabies is a fatal viral zoonosis and a serious public health problem. The purpose of this compendium is to provide information to veterinarians, public health officials, and others concerned with rabies prevention and control. These recommendations serve as the basis for animal rabies-control programs throughout the United States and facilitate standardization of procedures among jurisdictions, thereby contributing to an effective national rabies-control program. This document is reviewed annually and revised as necessary. Parenteral vaccination procedure recommendations are contained in Part I; Part II details the principles of rabies control; all animal rabies vaccines licensed by the United States Department of Agriculture (USDA) and marketed in the United States are listed in Part III. (+info)
Rabies update for travel medicine advisors.
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Rabies is a neglected disease in many developing countries. It is preventable, and the tools to prevent it are known. There is urgent need for more funding, for study of innovative dog population-control measures, and for sustainable canine immunization. Safe and effective tissue-culture rabies vaccines and human and equine rabies immunoglobulins (HRIG and ERIG) are not readily available in many regions where rabies is endemic. This and the continuing presence and spread of rabies have increased the risk for travelers, who cannot rely on being able to receive optimal postexposure treatment in many parts of the world. Alternatives to HRIG or ERIG are not available. Travelers who leave the safe environments of tourist hotels and buses in regions of Asia, Russia, Africa, and Latin America where canine rabies is endemic may be at risk of life-threatening exposure to rabies. (+info)
Elimination of human rabies in a canine endemic province in Thailand: five-year programme.
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A five-year project to prevent human deaths from rabies in Phetchabun Province, Thailand involved increasing accessibility of post-exposure treatment with the Thai Red Cross intradermal (2-2-2-0-1-1) regimen for humans exposed to potentially and confirmed rabid animals; intensifying documentation of post-exposure treatment; increasing educational awareness through advocacy in provincial schools, television programmes, and newspapers; reducing canine rabies by monitoring the dog population and implementing vaccination and sterilization programmes; increasing the cooperation between the Ministries of Public Health, Agriculture, and Education on a provincial level; and assessing the impact of the programme through intensified follow-up of patients exposed to suspected and laboratory-confirmed rabid animals. Between 1996 and 2001, 10350 patients received post-exposure treatment; 7227 of these received the Thai Red Cross intradermal regimen. Fewer than 3% of exposed patients received rabies immunoglobulin. Seventy-three percent of all patients presented with WHO category III exposures. In a retrospective study, 188 patients exposed to laboratory-confirmed rabid animals were followed to determine their health status. Of these patients, 20 received the intramuscular Essen regimen and 168 the Thai Red Cross intradermal regimen (148 received 0.1 ml purified chick embryo cell rabies vaccine, 10 received 0.1 ml purified vero cell rabies vaccine, and 10 received 0.2 ml purified duck embryo cell rabies vaccine). All patients were alive one year after exposure. Two human deaths occurred in the first two years of the programme - neither patient had received vaccine or rabies immunoglobulin after exposure. No deaths occurred during the last three years of the programme, which indicated that the programme was successful. (+info)
Evaluation of lumpy skin disease virus, a capripoxvirus, as a replication-deficient vaccine vector.
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Lumpy skin disease virus (LSDV), a capripoxvirus with a host range limited to ruminants, was evaluated as a replication-deficient vaccine vector for use in non-ruminant hosts. By using the rabies virus glycoprotein (RG) as a model antigen, it was demonstrated that recombinant LSDV encoding the rabies glycoprotein (rLSDV-RG) was able to express RG in both permissive (ruminant) and non-permissive (non-ruminant) cells. The recombinant LSDV, however, replicated to maturity only in permissive but not in non-permissive cells. Recombinant LSDV-RG was assessed for its ability to generate immunity against RG in non-ruminant hosts (rabbits and mice). Rabbits inoculated with rLSDV-RG produced rabies virus (RV) neutralizing antibodies at levels twofold higher than those reported by the WHO to be protective. BALB/c mice immunized with rLSDV-RG elicited levels of RV-specific cellular immunity (T-cell proliferation) comparable with those of mice immunized with a commercial inactivated rabies vaccine (Verorab; Pasteur Merieux). Most importantly, mice immunized with rLSDV-RG were protected from an aggressive intracranial rabies virus challenge. (+info)
Human illness associated with use of veterinary vaccines.
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Veterinary vaccines are being used with increasing frequency in the United States to protect the health of animals. However, humans may be inadvertently exposed to these products by means of unintentional inoculation or other routes of exposure. The potential for both exposure and for adverse consequences secondary to exposure to veterinary vaccines may be growing. With the exception of brucellosis vaccines, there have been few reports of suspected or confirmed adverse events in humans associated with the use of animal vaccines, but it is unclear whether that is because few adverse events occur or because adverse events are not recognized and/or reported. Results of a search for relevant literature and of communications with health officials at governmental and private institutions suggest that enhanced efforts are needed to recognize and to prevent human illness associated with use of veterinary vaccines. (+info)