Source: http://healthycanadians.gc.ca/publications/healthy-living-vie-saine/4-canadian-immunization-guide-canadien-immunisation/index-eng.php?page=18
Timestamp: 2016-12-11 07:57:15
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Vaccine and Immune Globulin Safety and Adverse Events
If indicated, initiate post-exposure prophylaxis as soon as possible but administer regardless of the time interval since exposure. Post-exposure prophylaxis of immunocompetent persons who have not been previously immunized with rabies vaccine consists of: local wound treatment; rabies immune globulin (20 IU/kg body weight) given on day 0 with as much as possible infiltrated into and around the wound; and four 1.0 mL IM doses of rabies vaccine given on days 0, 3, 7 and 14. In those who have not previously been immunized, and either are immunocompromised or are taking antimalarial drugs, a fifth dose of vaccine should be given on day 28.
Post-exposure prophylaxis of persons previously appropriately immunized with rabies vaccine consists of: local wound treatment and two 1.0 mL IM doses of rabies vaccine given on days 0 and 3. Rabies immune globulin should not be given to persons who have previously received appropriate rabies vaccinations.
Significant revisions since the last chapter update are highlighted in the Canadian Immunization Guide Table of Updates available on the Public Health Agemcy of Canada website.
For additional information, refer to previously published National Advisory Committee on Immunization (NACI) Statements and Statement Updates. For additional information regarding rabies vaccine and travellers, refer to previously published Committee to Advise on Tropical Medicine and Travel (CATMAT) Statements and Statement Updates.
Rabies immune globulins (RabIg)
IMOGAM® Rabies Pasteurized (rabies immune globulin [human]), sanofi pasteur Ltd.
HYPERRAB®S/D (rabies immune globulin [human]), Grifols Therapeutics Inc.
Dog, cat or ferret
Healthy and available for a 10-day observation period
Skunk, bat, fox, coyote, raccoon and other carnivores.
Regard as rabidTable 2 - Footnote * unless geographic area is known to be rabies-free
The recommended dose of RabIg is 20 IU/kg body weight for all age groups, including children, given on the first day of initiation of therapy (day 0). Because of possible interference of RabIg with the immune response to the rabies vaccine, the dose of RabIg should not be exceeded. If possible, the full dose of RabIg should be thoroughly infiltrated into the wound and surrounding area. Any remaining volume of RabIg should be injected intramuscularly, using a separate needle, at a site distant from the site of vaccine administration. When more than one wound exists, each wound should be locally infiltrated with a portion of the RabIg using a separate needle. In such instances, the RabIg can be diluted twofold to threefold in a solution of 0.9% sodium chloride to provide RabIg in sufficient volume for thorough infiltration of all wounds. If the site of the wound is unknown, the entire dose should be administered intramuscularly at a separate site from the administration of rabies vaccine. Rabies vaccine and RabIg should never be mixed in the same syringe. If RabIg is not administered as recommended at the initiation of the rabies vaccine series, it should be administered up to and including day 7 after vaccine is initiated but should not be administered after that time.
Refer to Vaccine Administration Practices in Part 1 and Passive Immunizing Agents Part 5 for additional general information.
Refer to Storage and Handling of Immunizing Agents in Part 1 for additional general information. Refer to Passive Immunizing Agents in Part 5 for information regarding RabIg storage requirements.
If rabies immunoglobulin is administered, this may interfere with the response to live vaccines. Refer to Blood Products, Human Immune Globulin and Timing of Immunizations, and Timing of Vaccine Administration chapters in Part 1.
Persons with a proven history of hypersensitivity to the vaccine or any component of the vaccine or its container should not be given the vaccine for pre-exposure immunization if possible. For specific advice, consult an allergy specialist. Refer to Table 1 and Table 2 in Contents of Immunizing Agents Available for use in Canada in Part 1 for lists of all vaccines and passive immunizing agents available for use in Canada and their contents. For rabies vaccines and rabies immune globulin, potential allergens include:
Persons with specific IgA deficiency have increased potential for developing antibodies to IgA after receipt of blood products, including rabies immune globulin, and may be at risk for anaphylactic reactions to subsequent administration of blood products containing IgA, such as RabIg.
Refer to Contraindications, Precautions and Concerns in Part 2 and Passive Immunizing Agents in Part 5 for additional general information.
Talecris Biotherapeutics, Inc. Product Monograph - HYPERRAB®S/D, June 2006.