The contents of the ampoule with the vaccine should be dissolved in 1.0 ml of water for injection. The dissolution time should not exceed 5 minutes. Dissolved vaccine is a clear or slightly opalescent liquid from colorless to light yellow color. Storage of dissolved vaccine for more than 5 minutes is not allowed.
Dissolved vaccine is administered slowly intramuscularly in the deltoid muscle of the shoulder, children under 5 years old - in the upper part of the anterolateral surface of the thigh.
The introduction of the vaccine into the gluteal region is not allowed.
Rendering anti-rabic help
Anti-rabies care consists of local treatment of wounds, scratches, abrasions and the subsequent administration of a vaccine to prevent rabies COCAV or, in the presence of indications, combined administration of immunoglobulin anti-rabies (AIG) and a vaccine for the prevention of rabies COCAV. The interval between the introduction of AIG and COCAV is not more than 30 minutes.
Local wound treatment
Local treatment of wounds (bites, scratches, abrasions) and places of mourning should begin immediately or as soon as possible after a bite or injury. It consists in extensive washing for a few minutes (up to 15 minutes) of the wound surface with water with soap or other detergent (detergent) or, in the absence of soap or detergent, the place of damage is washed with a jet of water. After this, the edges of the wound should be treated with 70% ethyl alcohol or 5 % alcohol solution of iodine.
If possible, sutures should be avoided.
Sealing is shown only in the following cases:
with extensive wounds - several leading skin seams after pre-treatment of the wound;
- for cosmetic indications (application of skin seams to facial wounds);
stitching of bleeding vessels to stop external bleeding.
In the presence of indications for the use of anti-rabies immunoglobulin, it is used immediately before suturing (see section The dose of anti-rabies immunoglobulin (AID)
After local treatment of wounds (injuries), immediately begin treatment preventive immunization.
Treatment and prophylactic immunization
Detailed Scheme of treatment and prophylactic immunization and notes on the scheme are presented below in the "Prophylactic Vaccine Vaccine for the Prevention of Rabies COCAV and Immunoglobulin Anti-Rabies (AIG) Vaccine."
Treatment of all people exposed to the risk of infection with rabies is subject to treatment and prophylaxis. If there are indications for the combined treatment, then first AIG is introduced and, no more than 30 minutes after it is injected COCAB.
Immunoglobulin anti-rabies (AIG) appoint as soon as possible after contact with a rabid animal or animal with suspected rabies, wild or unknown animals.
Before the introduction heterologous (horse) immunoglobulin anti-rabies it is necessary to check the individual sensitivity of the patient to the horse's proteins (see "Instructions for the use of anti-rabies immunoglobulin from horse blood serum"). Heterologous anti-rabies immunoglobulin Enter not later than 3 days after the bite.
Before the introduction homologous (human) immunoglobulin anti-rabies individual sensitivity is not checked. Homologous anti-rabies immunoglobulin Enter not later than 7 days after the bite.
The dose of immunoglobulin anti-rabies (AIG). Heterologous (horse) anti-rabies immunoglobulin is prescribed in a dose of 40 ME per 1 kg of body weight. The volume of heterologous immunoglobulin administered antirabies should not exceed 20 ml. Homologous (human) anti-rabies immunoglobulin is prescribed in a dose of 20 ME per 1 kg of body weight.
Introduction of AIG. As much of the recommended dose of AIG can be infiltrated into the tissue around the wound and deep inside the wound. An unused portion of the dose of the drug is administered intramuscularly to a site other than the administration of an antirabies vaccine.
Scheme of curative and prophylactic vaccinations vaccine for prophylaxis
| rabies COCAV and immunoglobulin anti-rabies (AIG)
| Category: ria damaged the | Nature of contact | Data on the animal | Treatment | | 1 | There are no damages to the skin, there are no discomforts of the skin, there are no mucus membranes. | A patient with rabies | Not assigned | | 2 | Inflammation of intact skin, abrasions, scratches, superficial bites of the trunk, upper and lower extremities (except for the head, face, neck, hand, fingers and toes) caused by domestic and farm animals. | If within 10 days of monitoring the animal it remains zdooovym. then treatment ppekoashat (ie after the 3rd injection). If the absence of rabies in an animal has been laboratory proved. then the treatment is translated from the moment of establishment of absence of rabies. In all other cases, when it is impossible to observe the animal for 10 days (killed, killed, run away, etc.), continue treatment according to the indicated scheme. | Prescribe immediate treatment: COCAV 1.0 mL at 0, 3, 7.14, 30, 90 day | | 3 | Any mucus membranes, any bites of the head, face, neck, hand, fingers and toes, genitals; single or multiple deep ragged wounds inflicted by domestic or farm animals. Any damnation and damage caused by wild carnivorous animals, bats and rodents. | If it is possible to observe the animal and it remains for 10 days zdooovym. then the treatment poekoashayut (ie after the third injection). If the absence of rabies in an animal has been laboratory proved. then the treatment is translated from the moment of establishment of absence of rabies. In all other cases, when it is impossible to observe the animal, continue treatment according to the indicated scheme. | Initiate immediate combination therapy with immunoglobulin anti-rabies: AIG on day 0 (see Immunoglobulin anttoabic dose (AIH)) and vaccine for rabies prevention: COCAB 1.0 mL at 0, 3, 7, 14, 30 and 90 day | |
Notes to the Scheme of curative and prophylactic vaccinations vaccine for the prevention of rabies COCAV and immunoglobulin anti-rabies (AIG):
1. Doses and regimens of treatment-and-prophylactic immunization are the same for children and adults.
2. The course of treatment-and-prophylactic immunization is prescribed irrespective of the period of treatment of the victim for anti-rabies help, even several months after contact with rabies sick animals suspicious of rabies disease by animals, wild or unknown animals.
3. For individuals who received a previous full course of preventive or preventive vaccinations, from the end of which no more than 1 year has passed, three injections of the vaccine for the prophylaxis of COCAV rabies are prescribed for 1.0 ml at 0, 3, 7 days; if a year or more has passed or an incomplete immunization course has been carried out, vaccinations are carried out in accordance with the above-mentioned "Vaccine preventive vaccination regimen for the prophylaxis of rabies COCAV and anti-rabies immunoglobulin (AIG)",
4. After the course of preventive or preventive immunization, the vaccine is given a certificate (certificate of preventive vaccination), indicating the type and series of drugs, the course of vaccinations and the presence of postvaccinal reactions.
5. The vaccinated must know: it is forbidden to drink any alcohol during the course of vaccination and 6 months after it ends. It should also avoid fatigue, hypothermia, overheating throughout the course of vaccinations.
6. Glucocorticosteroids and immunosuppressants can lead to ineffective vaccine therapy. Therefore, in cases of vaccination against the background of taking corticosteroids and immunosuppressants, the determination of the titer of virus neutralizing antibodies is mandatory.In the absence of virus neutralizing antibodies, an additional course of administration of the vaccine is carried out according to the scheme of 0, 7 and 30 days.
Preventive immunization
The vaccine is injected intramuscularly into the deltoid muscle of the shoulder by 1.0 ml at 0, 7 and 30 days. Revaccination is carried out once, at a dose of 1.0 ml every other year and every three years thereafter.
| The scheme of preventive immunization |
| Primary immunization | Three injections on days 0, 7 and 30 for 1.0 ml |
| First revaccination in 1 year | One injection, 1.0 ml |
| Subsequent revaccinations every 3 years | One injection, 1.0 ml |
Preventive immunization of contingents of increased risk of infection with rabies is carried out in vaccination rooms of medical and prophylactic institutions, where they fill out and issue a "Certificate of preventive vaccinations", where they bring all the necessary information (names, series, doses, multiplicities and dates of receipt of drugs).
Precautions for use.
The drug is not suitable for use in ampoules with broken integrity, marking, as well as when the color and transparency change, if the expiration date, improper storage.
Opening of ampoules and the vaccination procedure are carried out with strict compliance with aseptic rules.
Vaccinated should be under medical supervision for at least 30 minutes.
Places for vaccination should be equipped with anti-shock therapy.