Clinical Safety and Side Effects of Intra Dermal regimen of Tissue culture Anti-rabies Vaccine
Abstract
Rabies is 100% fatal but preventable disease. WHO recommends Tissue culture Anti-rabies Vaccines for post exposure treatment but this prophylaxis becomes expensive. So for reducing the 1/6th cost of this prophylaxis intradermal ARV regime was also recommended. But again there is a question mark for balance between cost effectiveness and safty so this cross sectional study was carried out in year 2013 on 654 recipients of Purified Chick Embriyo Cell Vaccine (PCECV) anti-rabis vaccine (ARV) at Anti Rabies Clinic (ARC) of a tertiary-care teaching hospital (SMS) at Jaipur, Rajasthan. Side effects were observed during the follow up visits on days 3, 7 and 28. Though all the recipients complained of local side effects at site of inoculation but these symptoms were relieved by simple administration of paracetamol and ceterizine orally. The side effects (local symptoms) noted on First dose were local itch (4%), local pain (3.8%), low grade fever (2.1%) and the local signs noted are local induration (22.3%), local erythema (1.2%). Same pattern of sign and symptoms were observed in D3 and D7 dose of injection but in decreased frequency. None of the cases had anaphylaxis or regional lymphadenopathy. Thus, this cost effective way of treating the animal bite cases using PCECV in Intra Dermal Rabies Vaccination (IDRV) is recommended to deal with the burden of animal bite cases for the prevention of Rabies in India.
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Introduction
Rabies is a zoonotic disease with100% fatality.1Nearly 95% of all human infections are due to exposure to rabid dogs. The disease is preventable, provided complete post exposure prophylaxis is implemented promptly with potent rabies vaccines as per WHO guideline. Globally, rabies is the tenth leading cause of death due to infection in humans. The WHO (1994) had recommended withdrawing NTV for rabies prophylaxis and it is to be replaced by TCV.2 Production and use of this NTV vaccine have been stopped since December 2004 in our country. In 1992, WHO recommended the multisite intra-dermal method for post-exposure treatment i.e. Intra Dermal Rabies Vaccination (IDRV). 3
In developing countries, rabies is an endemic disease and the use of intra-dermal rabies vaccination (IDRV) is cost effective. Many countries in Asia including India are now using IDRV for rabies prophylaxis. In this regime, antigen is directly presented to the antigen presenting cells (without circulation/ dilution in blood) at multiple sites triggering a stronger immune response.2 Studies have showed a good antibody production on using intradermal doses of PCECV.4,5
Conclusion
The study revealed that IDRV is quiet safe as it is associated with minor side effects which can be can be taken care by symptomatic therapy and counseling if given with vaccination. These IDRV regime is also cost effective than intra-muscular regime, it’s a well known fact. So this IDRV regime may be recommended.