Survival of 21 Dogs after Post-exposure Prophylaxis using Intra-dermal Rabies Vaccine in the Pre-scapular Region and Emergency Use of Expired Equine Rabies Immunoglobulin for Local Wound Infiltration in Victims of a Rabid Dog Bite using One Health Approach

Abstract

Rabies is a 100% fatal zoonotic disease and is preventable through timely and adequate Post-Exposure Prophylaxis (PEP). World Organization for Animal Health (WOAH) haven’t issued any guidelines for PEP for rabies in animals, still in certain Indian states like Himachal Pradesh (HP) PEP regimen with active immunization on 0,3,7,14 and 28 days mostly by Intramuscular Rabies Vaccine (IMRV) is being followed. Recently in Rampur Bushahar, a suspected rabid dog later laboratory confirmed had bitten 21 dogs, 2 cows, and 2 men. We employed PEP in animals using Raksharab vaccine intra-dermally (IDRV) (0.2 ml, pre-scapular region) on days 0, 3,7,14, and 28 along with only local wound infiltration of eRIG in 8 out of 11 bitten dogs with Category III exposure. Furthermore, 3 noncooperative dogs with Category III exposure were given IMRV (1ml) on day 0,3,7,14,28 with only wound infiltration of eRIG. 2 Cows were administered 0.2 ml IDRV in the skin at the middle of the neck with only wound infiltration of eRIG. Human bite victims also received 0.1 ml IDRV at 2 sites in the deltoid region on days 0,3, and 7 along with wound infiltration of eRIG at the nearby health center. Serum samples were collected for Rapid Fluorescent Focus Inhibition Test (RFFIT) for estimation of Rabies Vaccine Neutralizing Antibody (RVNA) titer after day 14 for 8 dogs, 2 cows, and human bite victims, and all had RVNA titer >0.5 IU/ml on day 14 except one in IMRV group. None of the bitten victims had clinical manifestations of rabies even after 1 year of follow-up. This indicates wound infiltration with eRIG along with the vaccine could be a life-saving protocol. Also using expired eRIG in emergencies was safe and life saving in animals. Expired eRIG used was later tested and was found to be potent.