Dog bite on hand
Alisa McQueen, S. Margaret Paik in Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
Depending on geographic location, rabid dogs may be rare or common (Centers for Disease Control and Prevention, 2014). Therefore, assessing the risk of rabies is important for all dog bite injuries. If the dog appears rabid or is unable to be located and quarantined for a period of 10 days, the patient should begin rabies post-exposure prophylaxis. In addition, if during the 10-day quarantine period, the dog shows signs of rabies, then the patient should initiate rabies prophylaxis. When indicated, active and passive immunization is recommended. For previously unimmunized patients, rabies vaccine is given on the first day of post-exposure prophylaxis, and then again on days 3, 7, and 14 (American Academy of Pediatrics, 2009). In addition, rabies immune globulin (RIG) should be used concomitantly with the first dose of rabies vaccine. Half of the RIG should be infiltrated directly into the dog bite wound with the rest administered intramuscularly in a site (or multiple sites, if necessary) distant from where the rabies vaccine was administered (American Academy of Pediatrics, 2009).
Neurological events following immunizations
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
Among the vaccines more commonly associated with ADEM the only epidemiologic and pathologically strongly substantiated association has been with the Semple rabies vaccine. Earlier strains of the vaccinia (smallpox) vaccine have also had a strong association with ADEM, albeit not a proven association. Elevated levels of anti-myelin basic protein (MBP) antibody titers have been observed and lymphocytic proliferation in the presence of myelin has been demonstrated in patients following rabies vaccination, suggesting that MBP is a possible encephalitic antigen in post-rabies vaccine ADEM [40]. The reporting rates of ADEM following Semple rabies vaccine have been estimated to be between 1/300 and 1/7000 doses [98]. It is presumed that this was on the basis of the use of the neurally derived vaccine made from inoculation of rabies virus into sheep or goat brain and inactivated with phenol. Embryo-based and cell-culture based formulations of rabies vaccine have been associated with far fewer cases of ADEM. The most widely used and available vaccine to Japanese encephalitis virus (JEV) is also derived from neural tissue (suckling mouse brain). Reporting rates of ADEM following JEV vaccine have been estimated to be 0.2/100,000 [44]; new, cell-culture-based formulations of JEV vaccine are becoming more widely available and utilized [99–101].
Immunization
Julius P. Kreier in Infection, Resistance, and Immunity, 2022
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.
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.
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.
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].