Rabies vaccine


Human diploid cell rabies vaccine is an inactivated vaccine prepared from the rabies virus grown in human diploid cell cultures then dissolved in tributyl phosphate and inactivated a second time with b-propiolactone.
 
Incidence
108/100000-87/100000 type III reactions
 
9/100000 type I reactions
 
In some reports, type III reactions occurred in 6% of immunized individuals boosted with the current HDC rabies vaccine.
 
Risk factors
Booster doses for type III reactions.
 
Clinical manifestations
Type I: within minutes or hours after a dose of HDCV: bronchospasm, laryngeal edema, generalized pruritic rash, urticaria or angioedema.
 
Type III: occurring 2 to 21 days after a dose or doses of HDCV: generalized pruritic rash or urticaria, arthralgias, arthritis, angioedema, nausea, vomiting, fever and malaise.
 
Diagnostic methods
Cutaneous testing: positive tests to vaccine and mock vaccine.
 
Specific IgE (immunofluorescence): the specificity of this method has been confirmed by solid phase binding of the vaccine to antigens (19 out of 21 cases of urticaria).
 
Mechanisms
Type I hypersensitivity.
 
Type III hypersensitivity.
 
The principal antigen implicated in the IgE-mediated response is a modified protein component of the vaccine: a b-propiolactone - human serum albumin (BPL-HSA) complex formed during preparation of the vaccine.
 
Some individuals produce a dual reaction (IgG and IgE) against BPL-HSA and fetal calf serum.
 
Management
The new HDC rabies vaccine, Lyssavac-HDC Berna is safer (no type III hypersensitivity reactions).
 
The vaccine should be prepared without b-propiolactone (inactivation with formalin or tributylphosphate only).
Boosters should only be administered to risk-group patients
 
The use of the intradermal route for both primary and booster injections may result in lower rates of reactions.

References

  1. Briggs DJ, Dreesen DW, Morgan P, Chin JE, Seedle CD, Cryz L, Glück R, Cryz SJ, "Safety and immunogenicity of Lyssavac Berna human diploid cell rabies vaccine in healthy adults", Vaccine. 1996;14 (14): 1361-5
  2. Fishbein DB, Yenne KN, Dreesen DW, Teplis CF, Mehta N, Briggs DJ, "Risk factors for systemic hypersensitivity reactions after booster vaccinations with human diploid cell rabies vaccine: a nationwide prospective study", Vaccine. 1993;11 (14): 1390-4
  3. Swanson MC, Rosanoff E, Gurwith M, Deitch M, Schnurrenberger P, Reed CE, "IgE and IgG antibodies to beta propiolactone and human serum albumin associated with urticarial reactions to rabies vaccine", J. Infect. Dis., 1987, 155, 5, 909–913.
  4. Warrington RJ, Martens CJ, Rubin M, Rutherford WJ, Aoki FY, "Immunologic studies in subjects with a serum sickness-like illness after immunization with human diploid cell rabies vaccine", J. Allergy. Clin. Immunol. 1987;79:
    605-10
  5. Anonymous "Systemic allergic reactions following immunization with human diploid cell rabies vaccine" MMWR Morb. Mortal. Wkly. Rep. 1984;33 (14): 185-7

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.