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Infectious Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Susanna J. Dunachie, Hanif Esmail, Ruth Corrigan, Maria Dudareva
The killed rabies vaccine is effective and safe. It can be given before exposure to those at particular risk or as PEP after a possibly infected bite. Additionally, immunoglobulin may also be given following high-risk exposure. Present regimens prevent the onset of rabies in the great majority of cases. However, it is essential that prophylaxis is started as soon as possible after any skin abrasion caused by any mammal in an endemic area.
Immunization
Published in Julius P. Kreier, Infection, Resistance, and Immunity, 2022
Michael F. Para, Susan L. Koletar, Carter L. Diggs
Allergic responses to vaccine components, independent of any protective responses, may result in immunologic disease in the vaccine recipient. Hypersensitivity reactions occurred following immunization with the original rabies vaccine prepared by Pasteur. This vaccine was composed of rabbit nervous tissue infected with rabies virus. After treatment to inactivate the virus, the entire preparation of nervous tissue was inoculated. The neural tissue in the vaccine produced an immune response which cross-reacted with host neural tissue and damaged the recipient′s nervous system. Damage to vaccine recipients as a result of hypersensitivity to immunizing agents has also occurred following administration of killed measles vaccine. Occasionally this vaccine induced incomplete humoral immunity, and, following infection by the measles virus, a cell-mediated hypersensitivity sometimes developed which caused a severe atypical measles syndrome.
Animal Bites
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Rabies PEP consists of rabies vaccine +/− human rabies immune globulin. A patient with a previous history of rabies vaccination should only receive the rabies vaccine. If the animal is available for 10 days of confinement and observation and exhibits normal behaviour during that time, prophylaxis can be withheld. Prophylaxis should be instituted immediately if the animal develops clinical signs of rabies. At this point, the animal should be euthanized, and the brain should be forwarded to a laboratory for definitive diagnosis.
Clinical features and management of animal bites in an emergency department: a single-center experience
Published in Postgraduate Medicine, 2023
Orkun Aydin, Elif Tugce Aydin Goker, Zeynep Aybuke Arslan, Halil Mustafa Sert, Ozlem Teksam
Fourteen patients (3.3%) received IV antibiotic therapy due to infectious complications. Twenty-two patients were sutured as widely as possible due to their extensive injuries. Five patientsrequired an operation. Twelve patients (2.8%) required hospitalization and a follow-up. Thirty-three patients (7.8%) required consultation from at least one surgical department. The most common specialty consultation was plastic surgery (n = 25) (Table 2). Prophylactic measures after suspected rabies exposure are shown in Table 2. The number of patients who received oral antibiotic therapy was 34.3% (n = 144). 43.1% of the patients (n = 181) received tetanus prophylaxis. The rabies vaccine was administered to most patients (97.1%). Based on the location and the characteristics of the wound, 38.4% of the cases (n = 161) received rabies immunoglobulin. No patients reported adverse reactions after the rabies vaccine or immunoglobulin. A classification of injuries using Lackmann’s criteria is summarized in Table 3.
Current status of human rabies prevention: remaining barriers to global biologics accessibility and disease elimination
Published in Expert Review of Vaccines, 2019
Charles E. Rupprecht, Naseem Salahuddin
The basic approach to the bite victim is fairly standard [18–20]. The core principle of animal bite management is to rapidly and thoroughly flush out saliva, containing virus or bacteria, and lavage with soap and water. This action denatures the surface glycoprotein of virions and inactivates rabies virus. Such a simple, mechanical process reduces the risk of developing rabies by over 30%, and also flushes out soil and other debris from the wound. Topical antiseptic application can destroy accompanying bacteria, that are usually present in animal saliva. Subsequently, rabies vaccine should be administered in all suspect cases post-bite, with RIG infiltrated thoroughly into deep or multiple wounds (Figure 1). After a bite, prophylaxis for tetanus is also warranted, in tetanus-prone wounds. Antibiotics should be prescribed in cases of deep wounds, to provide coverage against the oral flora of the biting animal.
Maternal immunization: where are we now and how to move forward?
Published in Annals of Medicine, 2018
Ivo Vojtek, Ilse Dieussaert, T. Mark Doherty, Valentine Franck, Linda Hanssens, Jacqueline Miller, Rafik Bekkat-Berkani, Walid Kandeil, David Prado-Cohrs, Andrew Vyse
Pregnant women may also be vaccinated against meningococcal disease, cholera, Japanese encephalitis or tick-borne encephalitis during outbreaks, in endemic regions or if the risk of infection is high [83–85]. Although live-attenuated vaccines are not recommended for pregnant women, women who live in or must travel to areas where the risk of yellow fever is high should be vaccinated since the risk of yellow fever infection during pregnancy substantially outweighs the limited theoretical risk from vaccination [86]. However, some cases of yellow fever infection in infants acquired through breast milk have been reported with the live-attenuated vaccine strain, hence nursing mothers should be counselled regarding the benefits and potential risks of vaccination [87]. The rabies vaccine is recommended as post-exposure prophylaxis or even as pre-exposure prophylaxis if the risk of exposure to rabies is substantial [88]. Similarly, the adsorbed anthrax vaccine is recommended as a component of post-exposure prophylaxis in pregnant women exposed to aerosolized Bacillus anthracis spores [89]. Finally, results from pneumococcal maternal immunization studies are encouraging so far but insufficient to determine whether infections are reduced in infants born to vaccinated women [90].